Around the world, governments are trying to assess and improve the quality of health services. In low- and middle-income countries, it is increasingly clear that low quality health systems are a binding constraint to improving health outcomes. But what is health system quality and how do we measure and improve it?
The course will review the conceptual frameworks of health systems and quality of care and discuss how these can be used to organize measurement and performance assessment. It will review measures of health system quality, suggest where to focus measurement and provide examples of innovative tools for measuring quality, including in settings without extensive data. The course will critically review past and current approaches to quality improvement and suggest structural levers for improving health systems at scale, including for settings with substantial decentralization and large private sectors.
Upon completion of the course, participants will be able to identify the key concepts underpinning health system quality, including care and system competence, user experience, and user confidence. They will be able to discuss best practices and innovations in the measurement of health system quality and identify data sources for quality measures. They will be able to identify and critique more and less successful approaches to improvement using the lens of complex adaptive systems, taking into consideration broader system issues including financing, payment, management and leadership. Finally, participants will apply these concepts to and challenges to their country setting in their presentation applying the topics of the course to their own quality challenges. The course is informed by concepts and recommendations from the Lancet Global Health Commission on High Quality Health Systems and the QuEST Network.
- Explain main conceptual frameworks for the design of an overall health improvement system and health care quality
- Describe and compare legacy and novel approaches to measure quality
- Using multiple measures, synthesize the state of quality of a given country’s health system
- Critically assess effectiveness of past and current strategies for quality improvement
- Describe a taxonomy of strategies that can be used to improve health systems at the macro, meso, and micro levels, taking into consideration other system issues.
- Identify strategies to evaluate large-scale health system improvement and discuss how these can be applied in the local context
The curriculum of the course includes the following:
- Overview of high quality health systems
- Measurement of quality impacts, processes, and equity
- Understanding the customer
- Strategic management and planning for quality
- Structural quality improvement opportunities: governance, new training models involving the user, service delivery redesign, financing & payment, management, and leadership
- Politics of health system improvement
- Testing and evaluating reforms
- Negotiation and conflict resolution to promote structural change
This interactive, in person course offers a blend of theory and practice, geared to an audience focused on implementation. Included throughout the course are lectures, Q&A time, 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 quality performance and management.
Who Should Participate
This eight-day (over two weeks) course is designed for individuals working in either the public or private sectors who are committed to improving the quality of health services in resource-constrained environments, including both policy makers and senior health care managers. This course will be useful for country or regional leaders engaged in health sector reforms, especially those contracting for health services with private or quasi-governmental institutions. Managers with strategic authority at health care institutions are appropriate. Researchers and global multilateral partners working in the area of health system quality will benefit. Additionally, we encourage participation by teams of participants who can work together in the course to develop draft strategic plans for their own organizations or countries.
About the Course Directors
Dr. Margaret E. Kruk is Professor of Health Systems at the Harvard T.H. Chan School of Public Health. Dr. Kruk’s research generates evidence on how health systems can improve health for people living in low-income countries. Working with colleagues in Ethiopia, Kenya, South Africa, India, and countries in Latin America among others, she develops novel measures of health system quality and studies the links between quality and population demand for health care, health outcomes, and confidence in the system. Dr. Kruk and her team use implementation science and econometric methods to evaluate large-scale health system reforms.
Dr. Kruk is Director of the QuEST Centers and Network: a multi-country collaboration to produce a global evidence base for improving health systems. The QuEST Network responds to the findings of the Lancet Global Health Commission on High Quality Health Systems in the SDG Era (HQSS Commission). QuEST will develop new instruments to assess health system quality, test structural and policy solutions to systemic quality deficits, and support expansion of high-impact health systems research in partner countries.
Dr. Diana Bowser is the Director of Global Executive Training Programs within the Department of Global Health and Populaiton. She is also Associate Professor and Director of the PhD Program in Social Policy at the Heller School for Social Policy and Management. She has 20 years of experience in health system analysis related to health economics, health policy, and using econometric methods to evaluate health system changes in Latin America, Africa, and the United States. She has provided technical assistance and conducted research with funding from USAID, DFID, WHO, the Global Fund, Save the Children, Bill and Melinda Gates Foundation, IADB, NIH, 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, Belize, Saint Lucia, Dominica, Ukraine, Kosovo, Bangladesh, and Malaysia.