IHSP IMPLEMENTATION PROJECTS
D-Tree International
Global Fund Investments in Human Resource and Training
Global Health Fellows Program
LAC NHA Network
Hospital Autonomy Studies
Resource Mobilization Studies
Managed Care
CEE Network
The Role of Private Health Care Providers
D-Tree International
As part of the IHSP implementation team, Marc Mitchell was the leader and founder of D Tree, a hand held devise that provides easy to use protocols to guide the health worker step by step to the correct diagnosis and treatment for each patient. D Tree has been implemented in Tanzania the ground work is being developed for larger scale-up.
Global Fund Investments in Human Resource and Training
With support from the Global Fund (GF) to Fight AIDS, Tuberculosis and Malaria, IHSP is undertaking a detailed assessment of budgetary and expenditure allocations data for human resource and training line items extracted from the Global Fund’s Enhanced Financial Reporting (EFR) for 115 Global Fund (GF) countries covering Rounds 1-9. Linking these data to service delivery outcome data tracked by the GF (primarily training activities), as well as, to the ultimate objectives of health improvements, IHSP is analyzing the impact of GF investments in human resources and training by:
1) Disaggregating budgetary and expenditure data by: country, round, geographic region, income level, disease-specific activities (i.e., TB, Malaria, HIV/AIDS) vs. HSS activities, and private/public sector investments;
2) Analyzing expenditure and budgetary investments in relation to GF human resource and training activities by: country, round, geographic region, income level, disease-specific activities (i.e., TB, Malaria, HIV/AIDS) vs. HSS activities, private/public sector, type of health worker trained, pre-service versus in-service training, duration of training, and as a percent of total country training activities.
Case Studies: Based on the results from the initial analysis, case studies in up to ten countries will be conducted to provide a more in depth approach to measuring and evaluating the impact of GF HRH investments.
Publications: A report co-authored with the Global Fund will be finalized by November 2009. Please contact Diana Bowser at dbowser@hsph.harvard.edu for further information.
Global Health Fellows Program
The Global Health Fellows Program (GHFP) is a five-year cooperative agreement implemented and managed by the Public Health Institute (PHI) in partnership with the Harvard School of Public Health, Management Systems International, and Tulane University School of Public Health and Tropical Medicine. GHFP is supported by the US Agency for International Development (USAID).
The goal of GHFP is to improve the effectiveness of USAID Population, Health and Nutrition programs by developing and increasing capacity of health professionals in Washington, DC and overseas. This is accomplished through the recruitment, placement and support of a broad spectrum of health professionals; a diversity initiative focused on providing internship and mentoring opportunities in international public health to underrepresented communities; and professional and organizational development activities to bolster USAID’s ability to maximize results and strengthen its leadership role in international health.
Click Here to access the GHFP Short Guide to Peer-Reviewed Publishing
LAC NHA Network
Bolivia, Ecuador, and Guatemala were countries we worked with directly. Mexico was a regional resource center. Nicaragua, Dominican Republic, and El Salvador were directly supported by PAHO. Peru joined with their own resources.
Date of Project: 1997-
Key Contact: Peter Berman
Sponsors: USAID, Latin America and Caribbean Equitable Access Initiative through the Partnerships for Health Reform Project and the Pan American Health Organization Collaborators.
Main Activities:
Using the National Health Accounts methodology developed by IHSP through the Data for Decision Making Project, each country team participated in a regional network to develop their own national health accounts study and to allow comparative analysis and learning across countries in the region. The country team conducted data collection and analysis. The PHR project and PAHO organized three regional network meetings for training, exchange of preliminary and final results, and policy discussions. Technical assistance was provided to each country in addition to the workshops through country visits of experts and through participation in national workshops to review results
Hospital Autonomy Studies
Zimbabwe Kenya India Indonesia Ghana
Date of Project: 1995-
Key Contact: Peter Berman
Sponsors: USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through the Data for Decision Making Project Collaborators
Main Activities:
Based on a common methodology (Chawla et al report on Methodological Guidelines), a national research team carried out a study of the objectives, implementation, and results of efforts to make public hospitals more autonomous. The study assessed the degree of autonomy intended and achieved across several different dimensions. The effects of autonomy effort were also analysed in terms of the financial condition of the institition and changes in technical efficiency, quality of care, equity in use, and community perceptions.
Key Results: These case-studies suggest that success with autonomy in public sector hospitals in developing countries has been limited, and there have been few gains in terms of efficiency, quality of care, and public accountability. We have drawn on the lessons learned from these studies to advance several testable hypotheses regarding the conceptualization and implementation of hospital autonomy. In general, we have argued that it is as much the confused and erroneous ideas of autonomy, as the poor implementation of the autonomy measures, that have been responsible for the relative lack of success of the autonomy initiative. However, an important caveat is in order. Given the limited sample size of this study, and the fact that in many of the countries hospital autonomy is a relatively new concept, the findings of our research must be viewed as preliminary. In our opinion, therefore, further inquiry into the issue of autonomy in public sector hospitals is a research imperative. A report comparing the results of all five country case studies was produced,
(DDM No-32.2. Recent Experiences with Hospital Autonomy in Developing Countries — What Can We Learn?) and a set of implementation guidelines for future hospital autonomy efforts was developed.
Results were reviewed and discussed at two regional workshops: Zimbabwe and Senegal
Resource Mobilization Studies
Zimbabwe
Senegal
Bolivia
Sri Lanka
Cote D’Ivoire
Date of Project: 1995-
Key Contact: Peter Berman
Sponsors: USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through the Data for Decision Making Project Collaborators
Main Activities:
Based on a common methodology (Chawla et al report on Methodological Guidelines), a national research team studied the contributions of different sources of finance to total national health expenditures in the country and how this has changed over time and in response to new health finance policy initiatives such as user charges and health insurance.
Key Results:
These case-studies suggest that although governments often make decisions about individual resource mobilization methods, such as user fees or the level of general revenue financing, they rarely think in terms of a strategy of health financing that considers the overall mix of methods, their interaction with one another, and their linkages with other components of the health care system. Therefore, the success of even individual methods has been limited in terms of contributions to resources, efficiency, equity and quality of care, even if they have been well thought out and implemented. At the same time, a common weakness has been a tendency on the part of most governments to ignore the role of household spending at private providers in financing health services. On the more positive side, our studies show that where it has been possible, private and community initiatives have succeeded in raising funding in the health sector.
A comparative analysis of the five country studies was prepared, (DDM No. 31.2. Experiences with Resource Mobilization Strategies in Five Developing Countries: What Can We Learn?) Results were review and discussed at two regional workshops: Zimbabwe and Senegal
Managed Care
Zimbabwe
Date of Project: 1998-2000
Key Contact: Paul Campbell
Sponsors: U.S. Agency for International Development/ DDM
Collaborators: Cimas Medical Aid Society
Main Activities:
The managed care project in Zimbabwe has been in operation for just over a year. The team has consisted of Karen Quigley, Arlen Collins and Claudia Corra, as well as Paul Campbell.
We have worked with Cimas, one of the two largest medical aid societies operating in Zimbabwe, as well as the National Association of Medical Aid Societies (NAMAS). Cimas serves the private sector and covers 4-5 hundred thousand lives. (Less than a million of Zimbabwe’s 12 million total population is covered by private insurance).
Zimbabwe is under great economic stress. The medical aid societies are fighting for their economic lives as revenue is constricted and costs spiral out of control in large part due to foreign currency problems. Medical aid society failure will only intensify Zimbabwe’s current health care crisis.
Key Results:
Economic pressures are forcing the medical aid societies to re-engineer their relationships with providers. Our technical assistance focuses upon these relationships. Under our guidance Cimas hired the first ever (in Zimbabwe) medical director, and began to alter the way it interacts with doctors and consumers. Co-payments have been introduced. A new program to strengthen the role of primary care providers is about to be initiated.
We have provided a series of workshops in Zimbabwe on managed care for providers. Next October we will offer a seminar for small medical aid societies. We will also produce a Guidebook on managed care that can be used after our departure. No doubt we will have greatly facilitated the transition in Zimbabwe to managed care, but the rapid adoption of managed care concepts and tools will be primarily caused by the adverse economic conditions rather than our project.
CEE Network
Poland
Czech Republic
Hungary
Romania
Out of Pocket Payments and Informal Payments for Health in Middle Income European Countries
The Role of Private Health Care Providers
Kenya
Zambia
Date of Project: 1993-
Key Contact: Peter Berman
Sponsors: USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through the Data for Decision Making Project
Main Activities:
Based on a common methodology (DDM No. 9. Berman and Hanson methodology for private sector assessment), a national research team studied the numbers and composition of the private health care provider sector. The assessment included developing a typology of private health care providers, including hospitals, ambulatory care providers, and informal and traditional practicioners. Estimates were developed of the shares in national health expenditures accounted for by private providers and of the volume and types of services delivered and how they were distributed in the population according to urban and rural areas and socio-economic distribution.
Key Results:
The results of the country case studies were combined with related work in Tanzania and Senegal and disseminated at a regional conference in Nairobi.
(DDM No. 21.1. Conference Report Summaries: Private Providers Contributions to Public Health in Four African Countries, Nairobi, Kenya, November 28, 1994 – December 1, 1994.)
