Global Perspectives on Decentralized Health Systems

Many countries are currently developing policies to encourage decentralization of health care decision making.  However, if decentralization is not done in a thoughtful manner it may lead to more problems and failures than a centralized system.

This course will provide ways to think about how to decentralize in an effective way and if necessary, how to recentralize some aspects of health system decision making.  What are the functions that achieve better outcomes if they are decentralized?  What capacities are needed both at the subnational and the national levels to make decentralization more effective?  How should local officials be held accountable for making better choices?

The course will also provide some tools for better management within a decentralized system and how to improve the quality of services in that kind of setting.

This course introduces foundational ways to think about decentralization and its design so that it improves the performance of a health system. Using an innovative and now well-established “decision space” approach to decentralization, the course addresses policy and management issues related to designing, implementing, and managing a decentralization transition to more (or less) decentralization. It uses research that has been published in peer reviewed journals as well as observations from consultancies in many countries. Experienced Harvard faculty members have developed a comprehensive workshop to better equip policy makers and managers to meet the challenges of decentralization.

• Learn how to effectively assess the decentralization situation in your country/area using our innovative and practical “decision space” approach;
• Examine the financing, education and labor market for effective decentralization strategies;
• Learn tools to develop policies related to pay for performance, strategic planning, priority setting;
• Apply strategies to other system topics (quality, politics, human resources);
• Create your own draft strategic plan to address decentralization challenges.

The curriculum of the course includes the following: 

• Health System Decentralization: Approaches and Policy Options
• Financing Options for Decentralized Systems
• Human Resources in Decentralized Health Systems
• Political Feasibility and Political Strategies Using “Policy Maker” software
• Strategic Management and Quality Management
• Application in cases of Canada, Philippines, Chile among other countries.

This interactive, course offers a blend of theory and practice, geared to an audience focused on policy design and implementation.  Included throughout the course are lectures, group work, case studies, problem sets, and preparation of group and individual case presentations. Facilitated discussion among participants is expected throughout the course. Participants are encouraged to have on hand their own country material and resources on health systems related to the process of decentralization and management.

This workshop has been designed for management and policymakers especially in low- and middle-income and transitional economies, but is appropriate even for developed countries.  Officials who are concerned about implementing greater managerial autonomy in previously rigid government bureaucracies will find the experience very useful as will those who identify problems that would be improved by recentralization.

Additionally, we encourage participation by teams of participants who can work together in the course to develop draft strategic plans for their organizations or countries. 

Dr. Thomas J. Bossert the former director of the International Health Systems Program at the Harvard T. H. Chan School of Public Health as well as a Senior Lecturer, Emeritus on Health Policy in the Department of Global Health and Population.  His innovative “decision space” approach to decentralization has appeared in many peer reviewed journals and recently in two edited books on decentralization. His responsibilities have included providing training programs, technical assistance, conducting research and project management for contracts with various donors including USAID, DfID, World Bank, WHO and the Inter-American Development Bank in 80 countries all around the world.

Dr. Diana Bowser serves as course director for all training programs within the International Health Systems Program of the Harvard T. H. Chan School of Public Health. She is also is the Associate Dean for Research and Integrated Science at the Connell School of Nursing. Bowser has 20 years of experience in health system analysis related to health economics, health policy, and using econometric methods and costing techniques to evaluate health system changes in Latin America, Africa, and the United States. She is especially interested in health system issues and research related to health financing, cost impacts on efficiency and effectiveness, catastrophic health payments, evaluation, income inequality, quality improvement, workforce, decentralization, and resource allocation in the health sector, and health and economic growth. She has worked at both the global and federal level on several research projects focusing on specific populations such as women and children and migrants and topics related to behavioral health and substance use. She has provided technical assistance and conducted research with grants and funding from USAID, DFID, WHO, the Global Fund, Save the Children, Bill and Melinda Gates Foundation, IADB and the World Bank. She has worked closely with the following governments on these policy issues: Nigeria, Rwanda, Ethiopia, Ghana, Namibia, Swaziland, El Salvador, Nicaragua, Honduras, Colombia, Chile, Belize, Saint Lucia, Dominica, Ukraine, Kosovo, Bangladesh, Malaysia, Haiti, Egypt, Oman and Kuwait. Dr. Bowser earned her BA from Harvard College, her MPH from Yale School of Public Health and her Doctor of Science (Sc.D.) in health economics from the Harvard School of Public Health. She is fluent in Spanish and has lived and worked in Latin America.