Activities by Country:
Bolivia
Chile
Colombia
Costa Rica
Egypt
Estonia
Ghana
Guatemala
Hungary
India
Kenya
Malaysia
Mexico
Morocco
Nicaragua
Nigeria
Poland
Thailand
Turkey
Zambia
Bolivia
Date of Project: 1998-2000
Key Contact: Thomas Bossert
Sponsor: USAID/LAC Health Sector Reform Initiative and USAID/La Paz
Collaborators: Ministry of Health and Abt Associates (in PHR Project)
Main Activities: Decentralization Applied Research Study Applied Research on decentralization of health system. Bolivia has an innovative recent decentralization of investment and supply budgets to municipalities. The study is an analysis of the degree of decentralization and its impact on system performance using the “Decision Space” Methodology developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia, Colombia, Nicaragua.
Key Results: Decentralization has been limited to funding supplies and equipment and over time even this range of choice has been restricted by earmarking a percentage that had to be assigned to Maternal and Child Health services. Decentralization has had no demonstrable impact on changing indicators of equity, efficiency and quality of services. It has however, increased local innovations and a sense of local control. Evaluation of Maternal and Child Insurance System Evaluation of quality and utilization issues in an evaluation of the new Insurance system. The evaluation found an increase in utilization by the target population and a likely increase in quality since the insurance funds supplies that are often not available. The evaluation also included financing and costing evaluation as well as administrative requirements.
Key Results: The evaluation found significant revisions of financing and administrative processes would improve the insurance system.
Related Publications:
Applied Research on Decentralization of Health Care Systems in Latin America: Bolivia Case
Thomas J. Bossert, Fernando Ruiz Mier, Scarlet Escalante, Marina Cardenas, Bruno Guisani, Katherina Capra, Joel Beauvais, and Diana Bowser, June 2000
Decentralization of Health Systems in Latin America: A Comparative Study of Chile, Colombia, and Bolivia
Thomas Bossert, June 2000
La Descentralización de los Servicios de Salud en Bolivia
Thomas J. Bossert, Fernando Ruiz Mier, Scarlet Escalante, Marina Cardenas, Bruno Guisani, Katherina Capra, Joel Beauvais, and Diana Bowser, junio 2000
Workshop Report — Cost and Cost-Effectiveness of Health Services, La Paz, Bolivia
Julia Walsh and David Anderso, May 9-11, 1995
Resource Mobilization for the Health Sector in Bolivia
Marina Cárdenas Robles, Jorge A. Muñoz and Mukesh Chawla, July 1996
Popular Participation in Bolivia
Oleh Wolowyna
Chile
Date of Project: 1997-2000
Key Contact: Thomas Bossert
Sponsors: USAID/LAC Health Sector Reform Initiative
Collaborators: Graduate Faculty of Economics and Public Administration, University of Chile and Ministry of Health
Main Activities: Decentralization Applied Research Study Applied Research on decentralization of health system. Chile has experienced the longest period of recent decentralization in Latin America. This study is an analysis of the degree of decentralization and its impact on system performance using the “Decision Space” Methodology developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia, Colombia and Nicaragua.
Key Results: Decentralization appears to increase inequality of primary health expenditures per capita with richer municipalities spending three times the others. Despite Chile’s reputation of having a significant decentralization, the actual range of choice (“decision space”) in Chile at the municipal level was quite limited and was reduced over time. Health Reform Policy Process Applied Research Study Applied Research on policy process of health reform in financing and insurance focusing on ISAPREs. This research evaluates stakeholders, institutions and role of “change team” in producing the health reforms that began in 1979. This study is part of a regional study of three countries: Chile, Colombia, Mexico.
Key Results: Policy processes of developing a coalition of key actors in favor of reforms through an formal and informal legislative process occurred even under the Pinochet dictatorship. Key to success was a carefully recruited “change team” of like-minded technocrats with significant political skills and located in the Ministry of Finance, Planning Office, and other key ministries and supported by horizontal and vertical linkages to other important actors.
Related Publications:
Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile
Thomas Bossert, Osvaldo Larranaga, Ursula Giedion, Jose Jesus Arbelaez, Diana Bowser, January 2003
Decentralization of Health Systems in Latin America: A Comparative Study of Chile, Colombia, and Bolivia
Thomas Bossert, June 2000
Applied Research on Decentralization of Health Systems in Latin America: Chile Case Study
Thomas J. Bossert, Osvaldo Larrañaga, Antonio Infante, Joel Beauvais, Consuelo Espinosa, and Diana Bowser, June 2000
Enhancing the Political Feasibility of Health Reform: The Chile Case
Alejandra González-Rossetti, Tomas Chuaqui and Consuelo Espinosa June 2000
Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia, and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish
Privatization and Payments : Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000
Colombia
Date of Project: 1998
Key Contact: Thomas Bossert
Sponsors: DDM: USAID/LAC Health Sector Reform Initiative
Collaborators: Ministry of Health
Main Activities:
Decentralization Applied Research Study
Applied Research on decentralization of health system. Colombia may have one of the most decentralized health system in Latin America. The study is an analysis of the degree of decentralization and its impact on system performance using the “Decision Space” Methodology developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia, Colombia, and Nicaragua.
Health Reform Policy Process Applied Research Study
Applied Research on policy process of health reform of the Law 100 in 1993. This research evaluates stakeholders, institutions and role of “change team” in producing the health reforms. This study is part of a regional study of three countries: Chile, Colombia, Mexico.
Key Results:Key to the success of the Colombian health reform (Law 100) was a carefully recruited “change team” of like-minded technocrats with significant political skills and located in the Ministry of Finance, National Planning Department, and other key ministries and supported by horizontal and vertical linkages to other important actors.
Related Publications:
Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile
Thomas Bossert, Osvaldo Larranaga, Ursula Giedion, Jose Jesus Arbelaez, Diana Bowser, January 2003
Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia, and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish
Applied Research on Decentralization of Health Care Systems in Latin America: Colombia Case Study
Thomas J. Bossert, Mukesh Chawla, Diana Bowser, Joel Beauvais, Ursula Giedion, Jose Jesus Arbelaez,and Alvaro Lopez Villan, June 2000
Enhancing the Political Feasibility of Health Reform: The Colombia Case
Alejandra González-Rossetti and Patricia Ramírez, June 2000
Decentralization of Health Systems in Latin America: A Comparative Study of Chile, Colombia, and Bolivia
Thomas Bossert, June 2000
Privatization and Payments : Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000
Costa Rica
Date of Project: 1998
Key Contact: Thomas Bossert
Sponsors: World Bank and Caja de Seguro Social Costarricense
Collaborators: Caja de Seguro Social Costarricense
Main Activities:Political feasibility of three options for reform of the Social Security System in Costa Rica using the Policy Maker Software developed by Michael Reich at Harvard School of Public Health.
Key Results:The Social Security System can consider the introduction of competition with private providers but this option will require special additional strategies to gain sufficient support for adoption and implementation. Options to continue and expand existing modernization programs have sufficient support without major new strategies.
Egypt
Date of Project: September 1993
Key Contact: Peter Berman
Sponsors:
DDM: 1994-1997
PHR: 1997-1998
Policy Project: 1999-2000
Collaborators: Ministry of Health and Population, Arab Republic of Egypt, and American University of Cairo
Main Activities: IHSP has been engaged in a wide range of activities in Egypt since 1994. Initially, under the DDM project, we developed a three-year program with the Department of Planning, Ministry of Health and Population to put in place a comprehensive information base for analysis of Egypt’s health and health care system problems and for the design of appropriate reform strategies. This program included:
- Estimation of National Health Accounts for 1991 and 1995
- Review of national health problems
- Cost-effectiveness analysis of 30 important intervention programs
- The Egypt Household Health Care Utilization and Expenditure Survey (EHHUES)
- The Egypt National Health Care Provider Survey
- “Political mapping” of strategies for policy change in Egypt
- Equity analysis of health care expenditures in Egypt
- Development of a Budget Tracking System for analyzing the uses of government expenditure in a decentralized fiscal structure
- Training and staff development in the Department of Planning, MOHP
Based on this work, we facilitated several workshops with senior staff of the MOHP to discuss and analyse health and health care system problems and strategies for Egypt. Our 1995 report “Egypt: Strategies for Health Sector Change” was widely discussed and used by Egyptian and international authorities.
In 1997, we collaborated with the new Minister of Health, Prof. Ismail Sallam, in applying the data and analysis to the design of a reform strategy for primary care in Egypt. The process of collaboration included intensive meetings with the Minister to review options, in-depth reviews and discussions with a high-level working group in Egypt, and production of new policy strategy: “A Reform Strategy for Primary Care in Egypt”. This strategy was adopted as official government policy and became the basis for a major multi-donor program in Egypt.
At present, IHSP continues to work with the MOHP through the PHR project to develop the pilot implementation of the new strategy in Alexandria. One of our staff is posted to the resident team in Cairo and we continue to contribute to policy analysis as well as new work on quality assurance.
In 1999, we initiated a new study in Egypt to estimate the total national expenditure on population and reproductive health care services, based on the national health accounts methodology. This study will be done in collaboration with American University of Cairo.
Related Publications:
The Relative Importance of Price and Quality in Consumer Choice of Provider: The Case of Egypt
Winnie Yip and Aniceto Orbeta, September 1999
The Distribution of Health Care Resources in Egypt: Implications for Equity An Analysis Using A National Health Accounts Framework
Ravindra Rannan-Eliya, September 1999
Understanding the Supply Side: A Conceptual Framework for Describing and Analyzing the Provision of Health Care Services With an Application to Egypt
Peter Berman, September 1999
Perception of Health Status and Limitations in Activities of Daily Living among the Egyptian Elderly
A.K. Nandakumar, Maha El-Adawy, Marc A. Cohen, December 1998
Health Budget Tracking System — Egypt Phase II: Final Report
Gordon Cressman, July 2, 1998
25.1 Egypt National Health Accounts 1994/95
Department of Planning/Ministry of Health, Egypt and Data for Decision Making Project, October 15, 1997
Cost Analysis and Efficiency Indicators for Health Care: Report Number 1 Summary Output for Bani Suef General Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997
Cost Analysis and Efficiency Indicators for Health Care: Report Number 2 Summary Output for Suez General Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997
Cost Analysis and Efficiency Indicators for Health Care: Report Number 3 Summary Output for El Gamhuria General Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997
Cost Analysis and Efficiency Indicators for Health Care: Report Number 4 Summary Output for 19 Primary Health Care Facilities in Alexandria, Bani Suef and Suez, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision Making, Harvard School of Public Health, University of California, Berkeley, School of Public Health, January 1997
Health Budget Tracking System — Egypt Phase I: Software Guide
Gordon Cressman, October 1996
Health Budget Tracking System — Egypt Phase I: Final Report
Gordon Cressman and Mahmoud Abdel Latif, September 1996
National Health Accounts of Egypt
Department of Planning/Ministry of Health, Egypt and Data for Decision Making Project, October 20, 1995
Cuentas Nacionales de Salud: El Caso de Egipto
El Departamento de Planification/Ministerio de Salud, Egipto y el Proyecto Data Decision Making, 20 de Octubre de 1995
Egypt: Strategies for Health Sector Change
Peter Berman, Michael Reich, Julia Walsh, A.K. Nandakumar, Nancy Pollock, Hassan Salah, Winnie Yip, Nihal Hafez and Ali Swelam, August 1995
Workshop Proceedings: First Health Budget Tracking System Workshop, Cairo, Egypt, June 18-20, 1995
Gordon Cressman, Oleh Wolowyna (RTI) and Mahmoud Abdel Latif
Health Care Utilization and Expenditures in the Arab Republic of Egypt
Department of Planning, Ministry of Health, Data for Decision Making, Harvard School of Public Health, 1994-1995
Egypt Provider Survey Report
Department of Planning, Ministry of Health, Data for Decision Making, Harvard School of Public Health, 1994-1995
Health Budget Tracking System — Phase I Pilot Study Results: Bani Suef 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995
Health Budget Tracking System — Phase I Pilot Study Results: Suez 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995
School Health Insurance — The Experience in Egypt: A Case Study
A.K. Nandakumar and Ali Swelam, 1995
Health Budget Tracking System — Phase I Pilot Study Results: Alexandria 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995
Workshop Report: Using Cost-Effectiveness Analysis to Identify a Package of Priority Health Interventions, Port Said, Egypt, January 8-13, 1995
Julia Walsh and Hassan Salah
Case Studies of Mosque and Church Clinics in Cairo, Egypt
Priti Dave Sen, December 1994
Workshop Report: Using Cost-Effectiveness Analysis to Identify a Package of Priority Health Interventions, Ismailia, Egypt, July 3-7, 1994
Julia Walsh and Hassan Salah
Egypt: Health Sector Brief
Dayl Donaldson, November 12, 1993
Health Budget Tracking System: Classification of Health Expenditures by Function
Gordon Cressman and Mahmoud Abdel Latif
Estonia
Date of Project: 1998
Key Contact: Peter Berman
Sponsors: Government of Estonia
Main Activities: Providing technical assistance in the launching of Estonia’s national health accounts study
Ghana
Decentralization and the Health Logistics System Ghana
Thomas Bossert, Ph.D., Diana Bowser, M.P.H., Johnnie Amenyah, B.Pharm., MBA, Rebecca Copeland, M.S.P.H., July 30, 2004
Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space
Thomas Bossert and Joel Beauvais, March 2002
Hospital Autonomy in Ghana: The Experience of Korle Bu and Komfo Anokye Teaching Hospitals
Ramesh Govindaraj, A.A.D. Obuobi, N.K.A. Enyimayew, P. Antwi and S. Ofosu-Amaah, August 1996
Guatemala
Guatemala: Decentralization and Integration in Health Logistics Systems
Thomas Bossert, Ph.D., Diana Bowser, M.P.H., Johnnie Amenyah, Rebecca Copeland, Management and Technology in Health and Development Guatemala (GETSA)
Hungary
Date of Project: 1998
Key Contact: Thomas Bossert
Sponsors: World Bank and Ministry of Health and Welfare, Hungary
Collaborators: Falso Pannon Region of Hungary
Main Activities: Assist the Falso Pannon Regional Consoritum prepare a proposal for the World Bank Health Service and Management Project, Health Service Delivery Modernization Subcomponent.
Key Results: The report recommended that Hungary adopt an incentive program to reward municipalities which consolidated hospitals by closing excess hospitals, experiment with optional payment mechanisms, develop uniform information systems in accounting and medical records for a more effective DRG system, strengthen the regulatory capacity at the county office, and develop strategic planning skills in regional hospitals.
India
Health System Reform Strategy for Andhra Pradesh State, India
Kenya
Date of Project: 1998-
Key Contact: Peter Berman
Sponsors: USAID/Kenya, Danish International Development Agency (DANIDA)
Collaborators: Department of Planning, Ministry of Health
Main Activities: The purpose of this activity was to provide technical support to USAID/Kenya and the Government of Kenya (GOK) to develop a set of national health accounts (NHA). Specifically, this NHA initiative conducted the following activities:
1. Produced a set of NHA accounts and final report for Kenya, describing the sources and uses of health care expenditures, which is a basic requirement for managing the allocation of health sector resources, developing policies, and assessing the impact of policy interventions. Information was disaggregated to illustrate the flow of funds from sources to financing agents. Additional information was presented on the uses of expenditures according to provider type, function and region.
2. Ensured that the NHA process is useful and sustainable in Kenya by:supporting a local NHA technical team composed of a cross-ministerial team in the GOK to conduct the work; and,
training the technical team and other collaborating partners in the methodology (data collection, processing, and analysis), use of software, construction of national health accounts matrices, and in the application of NHA results (e.g. secondary analyses, policy implications, health sector reform strategies);
3. Disseminated NHA findings to Kenyan policy makers to promote national-level discussions of the policy implications from the results of the NHA data and any associated analyses that have been done and the conclusions drawn. 4. Provided technical advice on institutionalization of the NHA activity. 5. Coordinated the activities undertaken by the Kenya technical team with those of the larger East and Southern Africa regional NHA initiative. The Kenyan technical team contributed their country experiences to the content of the workshops and benefitted from the technical assistance provided through its participation.
Related Publications:
Hospital Autonomy in Kenya: The Experience of Kenyatta National Hospital
David H. Collins, Grace Njeru and Julius Meme, June 1996
Kenya: Non-Governmental Health Care Provision
Peter Berman, Kasirim Nwuke, Kara Hanson, Muthoni Kariuki, Karanja Mbugua, Sam Ongayo and Tom Omurwa, April 1995
Conference Report — Private and Non-Governmental Providers: Partners for Public Health in Nairobi, Kenya, November 28, 1994 – December 1, 1994
Gerald Hursh-Cesar, Peter Berman, Kara Hanson, Ravi Rannan-Eliya and Joseph Rittmann
Conference Report Summaries: Private Providers Contributions to Public Health in Four African Countries, Nairobi, Kenya, November 28, 1994 – December 1, 1994
Gerald Hursh-Cesar, Peter Berman, Kara Hanson, Ravi Rannan-Eliya, Joseph Rittmann and Kristen Purdy
Malaysia
Date of Project: 2001-present
Key Contact: Peter Berman
Sponsors: UNDP/Govt. of Malaysia
Collaborators: Ministry of Health
Main Activities: Technical assistance in the development of National Health Accounts in Malaysia
Key Results: Project ongoing
Mexico
Date of Project: 1998-2000
Key Contact: Thomas Bossert
Sponsors: USAID/LAC Health Sector Reform Initiative
Collaborators: Ministry of Health
Main Activities:
Health Reform Policy Process Applied Research Study
Applied Research on policy process of health reform of the Social Security System. This research evaluates stakeholders, institutions and role of “change team” in producing the health reforms. This study is part of a regional study of three countries: Chile, Colombia, Mexico.
Key Results:The failure to develop a full multi-institutional like-minded “change team” with horizontal and vertical linkages to other key actors has resulted in frustrated attempts at reform in Mexico.
Related Publications:
Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia, and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish
Enhancing the Political Feasibility of Health Reform: The Mexico Case
Alejandra González-Rossetti and Olivia Mogollon, June 2000
Morocco
Exploratory Study of Social Capital and Social Programs in Morocco
Thomas Bossert, Diana Bowser, Volkan Cakir, Andrew Mitchell, Final DRAFT May 2003
Proposal for Decentralization of Health System in Morocco
Thomas Bossert, March 2001
Nicaragua
Building Social Capital through Human Capital Development Programs in Rural Nicaragua: An Evaluation of MSH Management and Leadership Programs in Waslala and Pantasma
Nancy Brune, Thomas Bossert, Diana Bowser, Freddy Solis, Agosto 2005
English
Spanish
Social Capital and Health in Nicaraguan Communities
Thomas Bossert, Nancy Brune, Diana Bowser, Freddy Solis, December 2003
English
Spanish
Studies of Decentralization of the Health System in Nicaragua: Final Report
Thomas Bossert, Diana Bowser, Leonor Corea, September 2001
English
Spanish
Nigeria
HIV/AIDS and Health Expenditures in Nigeria
Poland
Date of Project: 1995-2000
Key Contact: Paul Campbell
Sponsors: DDM/USAID Mission
Collaborators: Jagiellonian University Foundation for Public Health
Main Activities: The Consortium’s activities have centered on policy and management issues in the areas which the Polish Ministry of Health has structured health sector reform. These areas focus on the decentralization of the central government controlling the entire scope of health care and the creation of sixteen regional insurance funds, having these new regional funds contract with both public and private providers, and providing market-like incentives for improving health care. The Consortium is facilitating their implementation by:
- Being involved with the policy-making process. Working with local governments to develop and test models of health delivery
- Increasing managerial capacity
Key Results The projects, workshops, trainings and other activities conducted by the Consortium since it’s inception in late 1995, have produced the following results:
- Completion of Poland’s first application of market research methods (focus groups and patient surveys)
at the health facility level. - Facilitated the rapid spread of the practice of provider contracts across the country through conferences and training programs
- Developed and implemented new approaches for quality monitoring of
gmina-managed outpatient services - Assisted with the establishment of the nation’s first truly private non-profit hospital of the post-communist period
- Completed a successful city-wide experiment with public relations related to health sector reform
- Assisted Krakow city officials with the design and implementation of significant reforms leading to a documented increase in consumer satisfaction levels
Related Publications
Unpredictable Politics: Policy Process of Health Reform in Poland
Thomas Bossert and Cesary Wlodarczyk, January 2000
Public Relations and Health Sector Reform: The Experience in Poland
Paul Campbell, Andrzej Rys, and Witoslaw Stepien, June 2000
Privatization and Payments : Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000
The Impact of Economic and Demographic Factors on Government Health Expenditure in Poland
Mukesh Chawla, Dorota Kawiorska, and G. Chellaraj
Provision of Ambulatory Health Services in Poland: A Case Study from Krakow
Mukesh Chawla, Peter Berman, Adam Windak, and Marzena Kulis
Quality of Outpatient Services, Krakow Gmina
Ann G. Lawthers and Bogdan S. Rózanski, May 1998
Health Care Options for Polish Municipalities: The Implications of International Experience
Marc Roberts and Thomas Bossert
Notes on Health Sector Reform in Poland
Peter Berman, Andrzej Rys, Thomas Bossert, and Paul Campbell
Innovations in Provider Payment Systems in Transitional Economies: Experience in Suwalki, Poland
Mukesh Chawla, Peter Berman, and Dariusz Dudarewicz, May 1998
National Health Insurance in Poland: A Coach without Horses?
Peter Berman, April 1998
Enrollment Procedures and Self-selection By Patients: Evidence From A Family Practice in Krakow, Poland
Mukesh Chawla, Tomasz Tomasik, Marzena Kulis, Adam Windak, and Deirdre A. Rogers, April 1998
Poland Health Policy: Democracy and Governance At Local Levels In International Perspective
Thomas Bossert
Financing Health Services in Poland: New Evidence on Private Expenditures
Mukesh Chawla, Peter Berman, and Dorota Kawiorska
Economics of A Family Practice in Krakow
Mukesh Chawla, Tomaz Tomasik, Marzena Kulis, and Adam Windak, July 1997
Physician Contracting in Suwalki
Dariusz Dudarewicz and Mukesh Chawla, February 1997
Thailand
Date of Project: 1998
Key Contact: Winnie Yip
Sponsors: USAID
Collaborators: Chulongkorn University in Thailand
Main Activities:
The objective of the MAR/Provider Payment Project in Thailand is to examine the impact of capitation payment on system performance. In particular, the study aims to answer the following three questions:
- What is the impact of capitation payment on resource allocation between primary and secondary/tertiary services?
- What is the impact of capitation on organizational and/or internal management changes adopted to increase efficient provision of services (or risk selection)?
- What is the impact of capitation on networking building and contracting practices between primary and tertiary care providers, and between public and private providers, and their implications on market structure and market competition?
The study will empirically examine the experience of the Social Security Scheme, which is a social insurance scheme that covers employees of enterprises. The scheme pays contract hospitals by capitation and covers general and specialist outpatient care, hospitalization, drugs and prescriptions, ambulance and transportation services, and ancillary services. This study is one component of the provider payment study which includes 3 countries, the other two are Argentina and Nicaragua.
Key Results:Findings from the study are expected to generate useful lessons for the host country, such as reforming provider payment of other insurance schemes, e.g. the Civil Servant Scheme and the health card scheme; building a more primary care-based health system; and understanding the market process of public/private competition.
Turkey
Developing National Health Accounts in Turkey
Zambia
Date of Project: 1999-2001
Key Contact: Thomas Bossert
Sponsors: PHR Major Applied Research Project and USAID/Lusaka
Collaborators: Ministry of Health and Abt Associates (in ZIHP Project)
Main Activities:Applied Research on decentralization of health system. Zambia has an innovative recent decentralization to district levels of the Ministry of Health. The study is an analysis of the degree of decentralization and its impact on system performance using the “Decision Space” Methodology developed by DDM Project and modified by the PHR Applied Research team. It will be compared to the LAC regional study of four countries: Chile, Bolivia, Colombia, and Nicaragua.
Key Results:It is too soon to have any significant results from the study.
Related Publications:
Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space
Thomas Bossert and Joel Beauvais, March 2002
Decentralization of the Health System in Zambia
Thomas J. Bossert, Mukosha Bona Chitah, Maryse Simonet, Ladslous Mwansa, Maureen Daura, Musa Mabandhala, Diana Bowser, Joseph Sevilla, Joel Beauvais, Gloria Silondwa, and Munalinga Simatele, December 2000
Decentralization of Health Systems: Decision Space, Innovation and Performance
Tom Bossert, March 1997
Proceedings of Zambia National Conference on Public/Private Partnership for Health, Siavonga, Zambia, June 8-11, 1995
Kasirim Nwuke and Abraham Bekele
Zambia: Non-Governmental Health Care Provision
Peter Berman, Kasirim Nwuke, Ravindra Rannan-Eliya and Allast Mwanza, January 12, 1995
