Course on Health Systems Assessment and Diagnosis

Courses begin on August 27, 2024.

About the Course

Systematic, evidence-based health system assessments and diagnosis are essential for driving impactful health reforms. A health system’s performance is measured by its ability to achieve both end goals and intermediate outcomes. Unlike traditional evaluations of specific interventions and programs, these diagnostic strategies and assessments require a holistic approach that encompasses all facets of the health system, extending beyond basic indicators like mortality and morbidity.

This free course on Health System Assessments and Diagnosis adopts Harvard’s Getting Health Reform Right Framework, a pioneering approach to analyzing health systems. Participants will learn the methodologies and data necessary for conducting comprehensive assessments and diagnosis, enriched with case studies from India and other nations. This course is designed to equip participants with the tools to evaluate and enhance health system performance effectively, and is available to selected participants at no cost.

Highlights


Learn from leading experts from Harvard T.H. Chan School of Public Health.	Gain practical knowledge to assess and diagnose health system performance.	Explore comprehensive approaches to health system reform.	Participate in interactive and participatory webinar sessions.

Objectives

This course aims to equip participants with a robust conceptual framework and systematic processes for conducting health system assessments and diagnosis, with a focus on India’s unique contextual realities.
Participants will learn the critical importance of examining health system design, identifying key aspects to measure, and understanding how to evaluate a health system’s performance comprehensively.
Our goal is to support researchers and practitioners in the practical task of conducting health system assessments and diagnostics. This includes identifying the underlying causes of both successful and poor performance and leveraging evidence to inform and design effective health system reforms.

Organizers

Public Health Foundation of India (PHFI)

PHFI is a public private initiative that has collaboratively evolved through consultations with multiple constituencies including Indian and international academia, state and central governments, multi- and bi-lateral agencies and civil society groups. PHFI is a response to redress the limited institutional capacity in India for strengthening training, research and policy development in the area of Public Health.

Harvard T.H. Chan School of Public Health (HSPH)

At the forefront of global public health education, the Harvard T.H. Chan School of Public Health leverages decades of experience in researching health systems worldwide. Our faculty and researchers have been instrumental in shaping policy and designing health systems in India, as well as in comparable countries.

Course Modules

The Course will consist of 10 modules, each with interactive and participatory webinar sessions. Although each session will be conducted as a standalone webinar, the topics are interlinked. Participants interested in learning about comprehensive health system assessments will benefit the most by participating in the entire course. Participants would have the choice to select the modules they want to attend and benefit from. However, only those participants who attend the entire course will be awarded completion certificates.

August 27 | Session 1: Introduction to the Health Systems Assessment Framework

Instructors: Michael Reich & Winnie Yip

Date & Time: August 27, 2024

6:00 – 8:00 PM IST (India)
8:30 – 10:30 AM ET (Boston)

Overview of the Getting Health Reform Right Framework: This session provides an overview of the and its relevance to universal health coverage (UHC). The Getting Health Reform Right (GHRR) Framework helps policymakers diagnose health system issues, design reforms, and manage the reform process. Key features include a rigorous method for problem definition and policy development tailored to each country’s context, focusing on technical, ethical, and political analysis. The session aims to introduce the main elements of the GHRR framework, linking it to the challenges of UHC in India, particularly Ayushman Bharat. Topics covered include the health reform cycle, key elements of the approach, causal analysis, health systems analysis, and applying the GHRR framework to UHC. Key messages highlight the importance of considering politics and ethics in health reform, the need for health system strengthening to advance UHC, and the necessity of understanding why health systems underperform to improve them. Discussion questions will explore the goals and policy levers within the GHRR framework, definitions of health systems, and the interaction of technical, political, and ethical analyses.

August 28 | Session 2: Introduction to Health System Assessment and Diagnosis

Instructors: Michael Reich & Winnie Yip

Date & Time: August 28, 2024

6:00 – 8:00 PM IST (India)
8:30 – 10:30 AM ET (Boston)

(2a) Assessment of Ultimate and Intermediate Outcomes: This session focuses on assessing ultimate and intermediate outcomes of health systems. It aims to help participants understand the three primary objectives of health systems: improving health status, reducing financial risks, and increasing citizen satisfaction. Measurement issues related to these ultimate objectives will be discussed. Additionally, the session will cover the intermediate outcomes of access, efficiency, and quality, exploring their roles in determining health system performance and the associated measurement challenges. Participants will consider examples from the assessment of health system performance in Odisha, India, to differentiate between ultimate and intermediate objectives. They will also discuss the measurement challenges and the role of equity and distributional aspects in these performance objectives.

(2b) Diagnosis – Identifying Causes of Performance Problems: This segment on diagnosing performance problems in health systems introduces the Getting Health Reform Right (GHRR) Framework’s approach to identifying and addressing these issues. Reformers are urged to pinpoint areas where the health system is underperforming and work backwards to uncover the root causes, proposing changes in control knobs as solutions. This method is aligned with modern process and quality improvement practices. The session highlights the diagnostic tree tool, which helps identify causes of performance problems, and demonstrates its application through relevant examples. Participants will learn about the diagnostic tree approach, its use in the GHRR Framework, and its role in linking causes with control knobs. The session will include working through examples of diagnostic analysis specific to the Indian context and preparing participants for group diagnostic work. The session will cover where diagnostic analysis fits in the Flagship Framework, the key features of the diagnostic tree, examples of diagnosing performance problems, and guidance for conducting personal diagnoses. Key messages emphasize that health system performance issues are often interlinked, with multiple interconnected causes contributing to poor performance. Improving outcomes typically requires addressing several control knobs simultaneously. Participants will also consider recent reform proposals in their state or country, discussing whether a causal diagnosis was undertaken and the roles of government or external units in conducting such diagnoses.

August 29 | Session 3: Ethics and Setting Priorities for Health System Reform

Instructor: Michael Reich

Date & Time: August 29, 2024

6:00 – 8:00 PM IST (India)
8:30 – 10:30 AM ET (Boston)

Ethics and Setting Priorities for Health System Reform: This session will begin by discussing the basic principles of ethics related to health system reform choices and the major ethical challenges in priority setting for health reform and universal health coverage, including financial risk protection. A case about setting priorities for Ayushman Bharat will follow, focusing on deciding the next steps towards universal health coverage (UHC) at the state level. Participants will prepare arguments for and against five options in small groups, which will then be discussed by the entire class.

The objectives are to explore the choices necessary for moving towards universal coverage with limited resources, consider how different ethical perspectives influence these choices and their consequences, and apply these concepts to the case of Ayushman Bharat in India.

During the session, participants will be divided into small groups, each assigned one of the five reform options described in the case. Groups will prepare arguments for and against their assigned option, report back to the class, and engage in a general discussion on the pros and cons of the various choices. The presenter will summarize the discussion, linking it to priority-setting and ethics. Key messages include the necessity of making difficult choices in resource-limited settings to expand coverage towards UHC, the various ways of considering equity and fairness in these decisions, and the often implicit or unexamined ethical implications of different coverage expansion decisions. Participants will discuss and reflect on ethical theories, their application in health policies and reforms, and the specifics of the Ayushman Bharat case. They will consider arguments for universal versus targeted coverage expansions, the importance of feasibility, cost-effectiveness, budget impact, and political consequences in decision-making. Finally, they will contemplate which option they would advise the Secretary of Health to prioritize in their state.

September 9 | Session 4: Assessment and Diagnosis of Financial Risk Protection

Instructor: Annie Haakenstad

Date & Time: September 9, 2024

6:30 – 8:30 PM IST (India)
9:00 – 11:00 AM ET (Boston)

Protection from the financial risks of healthcare costs is a key aim of health systems. When financial risk protection is poor, high healthcare costs may result in families foregoing basic needs like education, food and housing, or otherwise be pushed into poverty. Health insurance and government subsidies for healthcare are some of the key strategies used to ensure financial risk protection, but their effectiveness can vary depending on the health system and policy design. This session will provide an introduction to measuring and assessing financial risk protection. It will cover in depth the standard metrics used for financial risk protection and the data and methods used to assess this measure of health system performance. We will compare performance across countries and interpret the strengths and weaknesses of different indicators and data used to measure and understand financial risk protection. The session will have a special focus on the large datasets capturing financial risk protection available in the Indian context and how they do and do not lend themselves to effective measurement. Gaps in existing datasets and the kind of data that could be useful to address these gaps will also be covered.

This session is designed for participants with research experience in public health, health systems, health policy, and health services. Familiarity with national datasets and experience with statistics and quantitative analysis is preferred.

September 11 | Session 5: Assessment and Diagnosis of Public Satisfaction

Instructor: Anuska Kalita

Date & Time: September 11, 2024

6:30 – 8:30 PM IST (India)
9:00 – 11:00 AM ET (Boston)

One of the key goals of a health system, citizen satisfaction is the degree to which citizens or the public are satisfied with the health system. Measuring citizen satisfaction is important because members of the public are beneficiaries and actors in a health system, capable of providing feedback on the quality and responsiveness of services. Their opinions can be important in shaping health policies and bringing legitimacy and accountability to the policymaking process.

Citizen satisfaction research remains undertheorized, and there are very few data sets that include variables needed to assess it, especially in low- and middle-income countries like India. Understanding the determinants of citizens’ satisfaction with a country’s or state’s health system has merit beyond its political and strategic value to reformers. More broadly, high public satisfaction with specific services such as health care is linked with higher trust in public institutions, which is an important element in the effective functioning of democratic governments.

This session will introduce the concept of citizen satisfaction and its importance in India. The session will cover the different data sets and survey items that have been used to measure citizen satisfaction worldwide. Drawing on primary research from India and other countries, the session will discuss the key correlates of citizen satisfaction, as well as some pitfalls of common measurement indices.

The session is designed for participants interested in health, health systems, and health policy. Some familiarity with the Indian health system, health policies, and programs is desired.

September 18 | Session 6: Assessment and Diagnosis of Quality (Clinical Effectiveness)

Instructor: Anuska Kalita

Date & Time: September 18, 2024

6:30 – 8:30 PM IST (India)
9:00 – 11:00 AM ET (Boston)

Quality of care is one of the most important intermediate outcomes of a health system. However, quality has unfortunately, been long neglected by most health reformers in low- and middle- income countries like India. Quality has three distinct aspects: clinical effectiveness, patient centeredness, and patient safety. This session will focus on the first aspect – clinical effectiveness.

Clinical effectiveness is the provision of health services based on scientific knowledge and avoiding both overuse of inappropriate care and underuse of effective care. Clinical processes, such as providing the correct clinical assessment, diagnosis, or treatment, are the cornerstones of effective care. The most important consideration for clinical effectiveness is the extent to which a diagnosis or treatment advice is based on evidence or standard guidelines and are shown to impact health outcomes. Without clinically effective care, i.e., correct treatment and diagnosis, access to and utilization of healthcare are often meaningless. This session will introduce the concept of clinical effectiveness and the different ways in which it can be measured. Drawing on primary research in India and examples from the COVID-19 pandemic, this session will discuss the importance of focusing on clinical effectiveness in health reforms and raise some key challenges in achieving this in India.

The session is designed for clinicians, practitioners, and researchers who are interested in understanding quality assessments and brainstorming about ways to improve quality of healthcare in India. Some familiarity with symptoms and basic primary level treatment advice for common illness conditions like tuberculosis, pre-eclampsia, and heart attack is desired.

September 19 | Session 7: Assessment and Diagnosis of Quality (Patient Centeredness)

Instructor: Anuska Kalita

Date & Time: September 19, 2024

6:30 – 8:30 PM IST (India)
9:00 – 11:00 AM ET (Boston)

Details forthcoming.

October 7 | Session 8: Assessment and Diagnosis of Efficiency

Instructor: Terence Cheng

Date & Time: October 7, 2024

4:30 – 6:30 PM IST (India)
7:00 – 9:00 AM ET (Boston)

Conducting a data-driven analysis of a health system is critical for supporting health reform designs. This idea stems from the Getting Health Systems Right Framework, where a health system is defined as “a set of relationships where the structural components (means) and their interactions are associated and connected to the goals the system desires to achieve (ends)”. Any successful reform, therefore, must be based on a systematic means-ends analysis. The first step in such an analysis is to evaluate health system performances, including three final goals (health status, citizen satisfaction, and financial risk protection) and three intermediate goals (access, efficiency, and quality of care). The intermediate goals are characteristic of the system that “are critical links in the chains that connect root causes to ultimate performance goals.” The objective of this session is to provide a practical guide on how to assess the efficiency of a health system.

This session is intended for analysts interested in conducting a diagnosis of a healthcare delivery system, and thus, will focus on the issues of measurement and analysis of efficiency. Despite the recent emphasis on the need for efficiency in individual health organizations and the health system as a whole, there is a surprising absence of a standardized approach to measuring efficiency or of a comprehensive list of widespread efficiency measures. This session will fill this gap by introducing analysts to commonly used metrics that can capture the significant forms of inefficiency rampant in the delivery of healthcare around the world.

The session will start with a brief overview of the concept of efficiency and its importance. It will then introduce the most commonly used efficiency indicators, followed by a discussion of the limitations of these existing methods. The main focus of the session will be exploring how analysts can construct simple yet meaningful efficiency indicators in the context of the Indian healthcare delivery system.

Participants will gain practical experience in the entire process of assessing efficiency, starting from obtaining data to analyzing the data. In addition, to learning how to construct efficiency indicators, the participants will be introduced to a list of the efficiency indicators that are frequently cited in peer- reviewed and gray literature. This webinar is intended to guide analysts through the process of measuring and analyzing efficiency while acknowledging the complexities of health systems and the data-related challenges that exist in most countries.

October 17 | Session 9: Monitoring and Evaluation of Health System Goals

Instructor: Rockli Kim

Date & Time: October 17, 2024

5:30 – 7:30 PM IST (India)
8:00 – 10:00 AM ET (Boston)

Course Instructors and Coordinators

Winnie Yip

Dr. Winnie Yip is Professor of Global Health Policy and Economics in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health, and serves as the Faculty Director of the school-wide Harvard China Health Partnership. Her research focuses on rigorous and policy-relevant health system evaluations and the design and testing of innovative health system interventions to improve equitable access to efficient and good quality health care. Dr. Yip often employs large-scale social experiments to test health system interventions, integrating economics, organization theory, management, and political economy. She applies this approach to developing viable and effective models of population health based integrated delivery systems in China and India. In addition, Dr. Yip has studied and advised health care reforms in the wider Asia region, including Hong Kong, Taiwan, Thailand, Malaysia and Vietnam. She has extensive experience in directing and teaching executive training courses for senior health policymakers.

Michael R. Reich

Dr. Michael R. Reich is the Taro Takemi Professor Emeritus in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. Dr. Reich is a political scientist whose research addresses the political dimensions of public health policy, including health system strengthening and reform, access to medicines and pharmaceutical policy, and the political economy of the policy-making process. He has worked on the analysis of health systems with colleagues at Harvard for over three decades and is co-author of the landmark book on health systems, Getting Health Reform Right: A Guide to Improving Performance and Equity (by M.J. Roberts, W. Hsiao, P. Berman, and M.R. Reich, Oxford, 2004). He is founding Editor-in-Chief of the journal Health Systems & Reform. He helped to establish the Takemi Program in International Health at Harvard in 1983, and has served as the Director of the Takemi Program since 1988.

Anuska Kalita

Anuska Kalita has worked in healthcare for almost two decades in different capacities, ranging from research and policy design to grant-making and strategy. Her work is focused on undertaking practice-relevant research and translating research into policy and practice through collaborations with diverse regional and global stakeholders. Her work has spanned 12 countries across Asia, Africa, Latin America, and Europe. Anuska is currently a Health Systems Specialist at Harvard and Director of the India Health Systems Project, an initiative leading a first-of-its-kind comprehensive health system assessment for reform design in India. She co-leads a new research and capacity-strengthening effort with the WHO (Geneva) on primary healthcare reforms. Prior to joining Harvard, she worked with the Bill and Melinda Gates Foundation, The World Bank, and was a founding member of the ICICI Foundation for Inclusive Growth.

Annie Haakenstad

Dr. Annie Haakenstad is an Assistant Professor in Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Dr. Haakenstad’s research focuses on financial risk protection, resource allocation, and health financing in low- and middle-income countries. Previously, she worked at the Institute for Health Metrics and Evaluation and consulted for the World Bank, UNICEF, the UN Environment Programme, and the UN Offices at Geneva. She was also a Postdoctoral Research Associate at the Harvard T.H. Chan School of Public Health.

Terence C. Cheng

Dr. Terence Cheng is a health economist and a Research Scientist at the Harvard T.H. Chan School of Public Health. His research focuses on the economics of health care systems, with a particular emphasis on how public and private health care systems interact. He has studied private health insurance markets, medical labor markets, and well-being. His research at Harvard focuses on the evaluation of innovative health care financing and delivery models and the integration of multi-site cohort epidemiological data with policy and system research, with an emphasis on emerging economies. Prior to joining Harvard, Dr. Cheng held academic and research appointments at universities in Australia and Singapore. He was an Australian Endeavour Fellow in 2018.

Himanshu Negandhi

Prof. Himanshu Negandhi is a distinguished medical doctor with a Doctorate in Public Health, specializing in Health System Strengthening with a focus on Human Resources for Health (HRH). Dr. Negandhi leads a dedicated team that collaborates with health departments across multiple states to implement District Hospital Strengthening initiatives. With profound expertise in evaluating the supply side of HRH, he excels in conducting capacity assessments and formulating strategic interventions to address HRH shortages. His work extends to the Monitoring and Evaluation of large-scale national public health programs, ensuring their effectiveness and sustainability. Currently, Dr. Negandhi serves as a Director of Academics, playing a pivotal role in supporting and enhancing the rollout of public health educational programs across a network of public health institutions.

Nanki Singh

Nanki Singh received her Master of Science from the Harvard T.H. Chan School of Public Health, from the Global Health and Population Department. Her research interests focus on long standing infectious disease challenges, health system strengthening, and health equity challenges in low- and middle-income countries. She has previously worked in the development sector in India with The Gates Foundation, Ministry of Health, and USAID.

Celline Wijaya

Celline Wijaya is a physician from Indonesia and received her Master’s in Global Health Delivery from Harvard Medical School. Her research interest is on health systems and financing, particularly on identifying sustainable health financing options in LMICs. Celline completed her thesis on assessing the implementation of emergency obstetrical and neonatal care in Indonesia and has also previously collaborated with Indonesia’s social health insurance administrator (JKN) and the World Bank’s Service Delivery Indicators (SDI) Health Team.

Twinkle Shokeen

Twinkle Shokeen is a dentist and public health professional based in Delhi, India. She earned her Master’s in Public Health from the Indian Institute of Public Health, Delhi, with a specialization in Health Economics and Healthcare Financing. Her research interests include health system strengthening, health economics, and health technology assessment (HTA), with a focus on developing sustainable health policies. Currently at PHFI, she focuses on project management and knowledge management for the Institutional Health Systems Strengthening project. Previously, she served as a Technical Specialist on a USAID initiative called “Learning4impact”. She applies her research, analytical, and program management skills to address complex health systems challenges. Her dedication to innovative policy solutions and strategic initiatives reflects her commitment to enhancing health outcomes and advancing the field of public health.

Wendy Zhou

Wendy Zhou works with the India Health Systems Reform Project at Harvard. She has previously worked with the Berkeley Human Rights Center and the United Nations to conduct open source investigations on human rights crises in Kashmir, Lebanon, Myanmar, Chile, and beyond. She is passionate about global development, human geography, and advancing human rights in the broader Asia region. Wendy received her B.A. in Political Economy from the University of California, Berkeley with a concentration in international development.

Course Registration

Applications are now closed.

For course-related queries, please contact:

Program Officer (eLearning)

Public Health Foundation of India

Phone No.

+91 1244722900

Address:

3rd Floor, KIIT College of Engineering, KIIT College Campus,

Sohna Road-Mumbai Expressway, Bhondsi (Near Maruti Kunj),

Gurgaon-122102, Haryana, India

Website:

PHFI Center for eLearning

Courses begin on August 27, 2024.

About the Course

Highlights

Objectives

Organizers

Course Modules

Instructors: Michael Reich & Winnie Yip

Date & Time: August 27, 2024

6:00 – 8:00 PM IST (India)

8:30 – 10:30 AM ET (Boston)

Instructors: Michael Reich & Winnie Yip

Date & Time: August 28, 2024

6:00 – 8:00 PM IST (India)

8:30 – 10:30 AM ET (Boston)

Instructor: Michael Reich

Date & Time: August 29, 2024

6:00 – 8:00 PM IST (India)

8:30 – 10:30 AM ET (Boston)

Instructor: Annie Haakenstad

Date & Time: September 9, 2024

6:30 – 8:30 PM IST (India)

9:00 – 11:00 AM ET (Boston)

Instructor: Anuska Kalita

Date & Time: September 11, 2024

6:30 – 8:30 PM IST (India)

9:00 – 11:00 AM ET (Boston)

Instructor: Anuska Kalita

Date & Time: September 18, 2024

6:30 – 8:30 PM IST (India)

9:00 – 11:00 AM ET (Boston)

Instructor: Anuska Kalita

Date & Time: September 19, 2024

6:30 – 8:30 PM IST (India)

9:00 – 11:00 AM ET (Boston)

Details forthcoming.

Instructor: Terence Cheng

Date & Time: October 7, 2024

4:30 – 6:30 PM IST (India)

7:00 – 9:00 AM ET (Boston)

Instructor: Rockli Kim

Date & Time: October 17, 2024

5:30 – 7:30 PM IST (India)

8:00 – 10:00 AM ET (Boston)

Course Instructors and Coordinators

Winnie Yip

Michael R. Reich

Anuska Kalita

Annie Haakenstad

Terence C. Cheng

Himanshu Negandhi

Nanki Singh

Celline Wijaya

Twinkle Shokeen

Wendy Zhou

Course Registration

Applications are now closed.

For course-related queries, please contact:

Program Officer (eLearning)

Public Health Foundation of India

Phone No.

+91 1244722900

Address:

3rd Floor, KIIT College of Engineering, KIIT College Campus,

Sohna Road-Mumbai Expressway, Bhondsi (Near Maruti Kunj),

Gurgaon-122102, Haryana, India

Website: