Decentralization of Health Systems
Health System Financing
Innovative Training Programs
Human Resources for Health
Politics and Governance
Building Capacity through Social Capital
Sustainability and Implementation Science
Strengthening Health Systems Support for Reproductive Health and HIV/AIDS
The Harvard T. H. Chan School of Public Health brings together a rich tradition of scholarship, research, and service in the field of international health. Among the school’s faculty and senior staff are many esteemed individuals with outstanding international reputations in health-related disciplines and equally outstanding records of international service. The school has on-going working relationships with, and access to, the most senior health officials—many of whom were trained at Harvard—in countries and international organizations around the world.
The International Health Systems Program (IHSP), in the Department of Global Health and Population 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 bringing this knowledge to bear on appropriate applications to achieve better health status, reduction in poverty, and gains in human well-being for the poorer populations in both low and middle-income countries.
IHSP and associated members have applied several areas of its health systems expertise to HIV/AIDS. From a politics and governance perspective, several analyses have been conducted on governmental HIV/AIDS policies in Brazil. IHSP capacity-building in HIV/AIDS programs has been undertaken through such through activities as management of a governmental ART program in South Africa and overseeing the development of an ART Global Fund proposal in Guatemala. Examples of IHSP members strengthening health system support for HIV/AIDS include helping to organize China’s health surveillance system on HIV/AIDS and other major infectious diseases – as well as national and regional China HIV/AIDS Public Policy Workshops, directing programs and advocacy efforts of a major U.S. AIDS foundation, and serving on the UN Millennium Development Taskforce on HIV/AIDS, Malaria, TB, and Access to Basic Medicines. IHSP can also draw upon the complementary expertise of the HSPH AIDS Initiative which focuses on developing HIV/AIDS education and training programs.
The International Health Systems Program’s experience includes:
Albertina Sisulu Executive Leadership Program in Health (ASELPH): IHSP faculty collaborated with health policy leaders from the South African Department of Health, South Africa Partners, Harvard T.H. Chan School of Public Health, University of Pretoria, and University of Fort Hare to develop ASELPH. This leadership program honors the life-long contributions of Albertina Sisulu, an educator, nurse, wife, mother, and highly respected leader in the anti-Apartheid struggle who dedicated her life to building the health and well-being of all South Africans. The Chan School is supporting and training South African faculty in the Harvard adult learning and case method teaching by offering several modules that have combined Harvard and South African faculty, including modules on policy transformation, leadership and management, strategic organizational planning, and financial management. In addition, the Harvard faculty and doctoral students are collaborating with teams from both South African universities to develop applied research on key issues related to the anticipated National Health Insurance reform. Harvard faculty have also participated in distance learning seminars on various innovative work that Harvard faculty has done as well as participating in round tables and policy seminars in South Africa on health insurance and decentralization that have contributed to the policy debates within South Africa.
ASELPH was officially launched in May 2013 with funding from The Atlantic Philanthropies, the Elma South Africa Foundation and USAID. The vision of ASELPH is to strengthen the efforts of the South African Department of Health by building the capacity of health leaders who serve as “drivers” of transformative change.
Decentralization of Health Systems: IHSP faculty developed and have applied widely the innovative “Decision Space” approach to comparatively analyze health sector decentralization. Based on principal-agent theory, the Decision Space framework focuses on the range of choices accorded to decentralized authorities over a number of different functions. IHSP faculty found that the Decision Space framework was able to comparatively describe decentralization across four countries: Zambia, Ghana, Uganda and Philippines. In Chile and Colombia the decision space methodology has been used to analyze relationships between decentralization and health sector performance. An innovative assessment of decentralization of logistics system for vaccines, essential drugs and contraceptives in Guatemala and Ghana indicated the nuanced relationship between decentralization and health sector performance. These studies were used by the USAID project Deliver to advise the governments of Guatemala and Ghana. Studies using the decision space approach in Pakistan and India for the World Bank have contributed to the understanding that decision space, local capacity and accountability are synergistically related. Specific recommendations for training were made based on this research. These technical assistance projects have also been published in peer reviewed journal articles in Social Science and Medicine, Health Policy and Planning, and Health Systems and Reform. Recent technical assistance on decentralization using the decision space approach has been provided to the governments of El Salvador, Guatemala and Mongolia for USAID and World Bank projects.
Health System Financing: IHSP has collaborated with numerous countries in order to assess, improve and expand their systems for financing health care, including social health insurance, community financing, and national health accounts. In Nicaragua, for example, IHSP has collaborated with the Nicaragua government in devising a needs base formula for health care allocations. In India, an IHSP team in Andhra Pradesh, developed a Medium Term Strategy and Expenditure Framework that proposed significant increases in health financing levels and allocation shifts. In China, we have collaborated with 9 major Universities and the China Health Economics Institute on a 7-year survey and intervention study on financing and organization of healthcare in China’s poor rural areas. The results of this study helped inform China’s policies on establishing the New Rural Cooperative Medical System, a reformed version of community financing scheme that will soon cover 100% of China’s rural counties. IHSP is a leader in the development and implementation of National Health Accounts in countries around the world.
Innovative Training Programs: IHSP has been a major participant in the design and implementation of the renowned Harvard T.H. Chan School of Public Health and World Bank Institute Flagship Course on Health System Reform and Sustainable Financing which has been given annually in Washington and also in regional and country programs. IHSP was also closely involved in organizing the China Senior Health Leaders Training Program, a five-year program (2006-2010) as part of the School’s China Initiative. In addition, IHSP has been offering for a number of years 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. (Click Here for Details)
Human Resources for Health: IHSP has worked with several countries in order to analyze the importance of effective human resources policies for improving the performance of health systems. IHSP worked with the World Health Organization and the Government of Ethiopia to develop a tool for assessing the financing, education, management and policy context for health workforce development. This tool was field tested in Ethiopia and Turkey and has been used in Ukraine, Azerbaijan, Kazakhstan, and Turkmenistan among other countries
Politics and Governance: IHSP team has expertise in analyzing political strategies and advocacy related to specific policy changes as well as what works in fragile states. Using a computer software developed by Michael Reich, called Policy Maker, IHSP faculty have trained many health professionals in executive courses to assess the political feasibility of their proposed reform packages. In addition, IHSP faculty have been developing political economy approaches to providing technical assistance, based on an intensive doctoral seminar given at the Harvard T.H. Chan School of Public Health.
Public/Private Partnerships: IHSP has assessed how different combinations of public and private sector providers can be best used to achieve public health objectives in India, China, Vietnam, Cambodia, and Uganda.
Building Capacity through Social Capital Improvements: IHSP has implemented a series of studies of social capital in poor communities in Morocco and Nicaragua in order to improve social capital, health behaviors and governance. This technical assistance resulted in an innovative article on social capital published in Social Science and Medicine.
Strengthening Health Systems Support for Reproductive Health and HIV/AIDS: Recently, IHSP has evaluated the health systems support for Global Fund investments in health systems and published the findings and recommendations in Health Policy and Planning. The IHSP has helped the Philippines develop a Contraceptive Self Reliance Strategies to promote modern contraceptive methods and has worked in Ukraine on supporting advocacy efforts to increase support for reproductive health and human rights. Other examples include helping to organize China’s health surveillance system on HIV/AIDS and other major infectious diseases – as well as national and regional China HIV/AIDS Public Policy Workshops, directing programs and advocacy efforts of a major U.S. AIDS foundation, support for Africa Centre for Health and Population Studies in Mtubatuba, KwaZulu-Natal, and serving on the UN Millennium Development.
Sustainabilty and Implementation Science: Pioneers in the study of sustainability of donor funded projects 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. A recent study of the sustainability of PEPFAR funded CDC projects in Africa will result in a peer reviewed publication in 2016.
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