Goals and Approach
Many low and middle-income countries are committed to improving the performance of their health care systems. They face daunting challenges: the historical burden of infectious disease and malnutrition, the increasing toll of non-infectious disease and aging populations, rising expectations, and scarce resources. To contribute knowledge and solutions to these problems, the International Health Systems Program (IHSP) in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health, has gathered a highly experienced, multidisciplinary team of scholars and experts to apply innovative approaches to improving health care through research, training, and technical assistance. IHSP is committed both to advancing the state of relevant knowledge and to improve health system performance by bringing this knowledge to bear to achieve better health status, patient and citizen satisfaction, and financial risk protection that can contribute to reduction in poverty, and gains in human well-being for the poorer populations in both low and middle-income countries.
To achieve these goals, IHSP works with many partners around the world. We seek both to meet the specific needs of our collaborators, but also to create learning that can contribute to solving the problems of others. We also strive to enhance the skills and capacities of our partners for further leadership. As a university-based group, IHSP is committed to intellectual excellence and exchange based on mutual learning. As an active participant in development projects, we are also dedicated to timely and effective implementation of effective health system change.
Major Areas of Focus
IHSP’s research contributes to health system improvements worldwide by emphasizing six interrelated areas of focus. The combination of operations and academically-oriented research allow the findings and methodologies of Program members’ research to reach a wide audience and inform policymaking. A listing of peer-reviewed journal articles, project-related technical analyses and reports, and other material emanating from IHSP member research activities can be found on the publications page.
The seven areas of IHSP research include the most relevant issues for low- and middle-income countries. These areas include:
- Institutional reforms and capacity building: Many challenges faced by governments around the world center around the management, organization and effectiveness of their health systems. IHSP’s research in this area emphasizes decentralization, organizational reform of ministries of health, human resource strategic planning, and case method management training.
- Politics and governance: Technical solutions to health systems deficiencies must take the political and governmental contexts into account to be effective and sustainable. IHSP’s research in this area emphasizes political strategies, advocacy and approaches to working in fragile states.
- Health system financing: Strengthening the financial resources and reducing the financial risks of illness that drive many into poverty requires innovative approaches in different country contexts. IHSP’s research in this area emphasizes social health insurance, community financing and national health accounts.
- Public/Private partnerships: Involving and working with the private sector is crucial to long-term improvements in health systems quality and efficiency. IHSP’s research in this area emphasizes assessments of private markets and public/private partnerships.
- Building community capacities: Community involvement in delivery of health services is a key to promoting healthy behaviors and utilization of the health system. IHSP’s research in this area emphasizes the role of social capital in improving health systems delivery and innovative ways to make community health workers more effective.
- Reproductive health and HIV/AIDS projects: The Sustainable Development Goals and worldwide efforts to control the spread of HIV/AIDS have put a continuing concern on improving reproductive health services. IHSP’s research in this area emphasizes strengthening health system support for maternal and neonatal health, shifting family planning preferences from abortion to contraception and addressing economic and political aspects of HIV/AIDS programs.
- Sustainability and Scale up of donor funded initiatives: Pioneers in the study of sustainability and leaders in the new field of implementation science, IHSP faculty are involved in several projects to assess the sustainability of projects funded by donors and to provide effective recommendations to strengthen sustainability as well as develop useful evaluation research on the implementation of scale up and replication of innovations.
IHSP faculty and researchers have worked all over the globe in a variety of country situations. We have been involved in projects and training activities in South Africa, Guatemala, India, China, Pakistan, Bangladesh, Philippines, El Salvador, Nicaragua, Ukraine, Mongolia, Kosovo, Chile, Pacific Islands, Uganda, Turkey, Oman and Egypt. In the past, we have also had long term projects in Zambia, Colombia and Poland.
- Decision-Space mapping for decentralization assessment. Based on an innovative approach to decentralization, this instrument assesses the degree of choice over different key health system functions that local officials are able to exercise. Survey instruments have been developed in Nicaragua, Morocco, Pakistan, India, El Salvador and Guatemala to assess the actual, as opposed to the theoretical, “decision space” that local officials exercise.
- PolicyMaker software for policy analysis and feasibility forecasting. This software is a useful tool for assessing the political map of support and opposition to health system reforms both large and small and for developing political strategies to gain support and reduce opposition.
- Private Healthcare Market Mapping
This tool provides a comprehensive framework for assessing the extent and major players of private market provision of services and provides models for maximizing private sector contribution as well as enhancing the Public-Private Partnership towards achieving social goals.
Innovative Training Programs
IHSP has been a major participant in the design and implementation of the renowned Flagship Course on Health System Reform and Sustainable Financing, which has been given annually with the World Bank Institute and also in regional courses in the Caribbean, Asia, Middle East and Pacific Islands and country programs in Turkey, Egypt, and South Africa.
IHSP is closely involved in organizing the China Senior Health Leaders Training Program, as part of the School’s China Initiative.
IHSP also has a series of well-attended, two-week executive training programs in Boston on policy and management of decentralization, human resources strategic planning, quality improvement, strategic planning, and public/private partnerships. (see separate section on Training for details)
Through international collaborations, IHSP is strengthening the research and training capacity of institutions and gaining valuable long-term partners for the continuing generation of high quality knowledge on health reform issues. IHSP has had long-term collaborative relationships with the University of Fort Hare and University of Pretoria in South Africa; the University of Chile; the Catholic University; and the University of Andrés Bello in Santiago, Chile; the Institute of Public Health at the Jagiellonian University in Krakow, Poland; National Health Accounts Networks in Latin America, Africa, and the Middle East; the Central and Eastern European Health Reform Network; and the China Network in Training and Research in Health Economics and Financing. We also have strong working relationships with Catalyst Management Services in Bangalore, India; Contech in Lahore, Pakistan; Center for Economic Policy Research (CEPR) in Manila, Philippines; ALVA, S.A. in Managua, Nicaragua; and Fundacion Plenitude in Santo Domingo, Dominican Republic.
IHSP has received significant funding from a series of global and bilateral USAID projects, including the Albertina Sisulu Executive Leadership Program in Health (ASELPH) project in South Africa (with Elma Foundation and Atlantic Philanthropies); ASSIST and TRAction projects with the University Research Corporation; Deliver Project with John Snow Incorporated; and in the past Data for Decision Making Project, Partnerships for Health Reform Project, Poland Health Reform Project, Management and Leadership Project (Nicaragua), LEAD Project (Philippines) and Together for Health Project (Ukraine). The British aid agency, DFID has provided global support for health reform research and support for the Medium Term Strategy and Expenditure Framework for Andhra Pradesh, India. The World Bank has collaborated with IHSP on the Flagship Course on Health Reform and Sustainable Financing. Sweden’s SIDA has supported public private partners.
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