Working Paper 8: A Guide to Health Reform: Eight Practical Steps

A Guide to Health Reform: Eight Practical Steps

By Michael R. Reich, Paola Abril Campos, Anuska Kalita, Anya Levy Guyer, and Winnie Yip
August 2023

A Guide to Health Reform: Eight Practical Steps instructs readers on how to navigate the complex challenges of doing health system reform. The Guide builds on the 2004 book Getting Health Reform Right: A Guide to Improving Performance and Equity (GHRR), which presents a framework for understanding and achieving successful health reform. The GHHR framework (also known as the “control knob” model) is the foundation of this Guide’s Eight Practical Steps. The step-by-step guidance is presented in easy-to-read language and general terms, so that government policy makers, analysts, advisors, advocates and other stakeholders in any country can use the Guide to plan and implement health reform.

The Eight Steps are: 1) Decide to start the health reform process; 2) Create a health reform team; 3) Assess the health system’s performance and define its performance problems; 4) Diagnose the causes of performance problems; 5) Decide on a reform package; 6) Conduct political analysis and design political strategies; 7) Manage the implementation of health reform to achieve results; and 8) Evaluate impacts and create sustainability for health reform.

The Guide describes each step in a short chapter, highlighting between four and six key actions and noting additional references for more details. The Eight Steps can be read (and applied) in a different order depending on the needs and circumstances of health reformers. The Guide includes 12 worksheets, 5 appendices and a glossary, to assist readers of the Guide to adapt and apply the Eight Steps to the real-world complexities of health reform.


The Guide and its accompanying resources can be accessed here.