Other Affiliations

Director of International Health Systems Program

International Health Systems Program – An interdisciplinary program which supports research, training and technical assistance on economics, politics, organizational and financing issues of health systems and health reform, including decentralization of health systems, public/private mix, political and policy analysis of reform processes, and institutional and governance reforms.  Projects for USAID, World Bank and other donors are developed and implemented through this program.  Until recently it was responsible for Harvard School of Public Health activities in Albertina Sisula Executive Leadership Program in Health which helped develop a sustainable capacity for executive training, policy analysis and research at the University of Fort Hare, University of Pretoria and the Department of Health in South Africa.


Thomas J. Bossert, PhD. is a Senior Lecturer and the Director of the International Health Systems Program of the Harvard T. H. Chan School of Public Health.  He has many years of experience in international health in Latin America and the Caribbean, Africa, Asia and Central and Eastern Europe. His specialties include health reform, decentralization, sustainability and transition, implementation science, social capital, human resources strategic planning and political feasibility analysis. His publications have appeared in Social Science and Medicine, Health Policy and Planning, WHO Bulletin, The Lancet among other journals and monographs. His innovative “decision space” approach to decentralization has appeared in many peer-reviewed journals and recently in an edited book on decentralization: Federalism and Decentralization in Health Care: A Decision Space Approach. Toronto: University of Toronto Press, 2018.  He has developed a guide to strategic planning for human resources for WHO. His pioneering work on sustainability of donor-funded projects was published in Social Science and Medicine in 1990, and he has recently studied sustainability and transition for projects funded by CDC and the Gates Foundation.  He has provided technical assistance, conducted research and project management for contracts with various donors including USAID, DfID, World Bank, WHO and the Inter-American Development Bank.  At Harvard, he teaches courses on health system reform and political economy of health systems and was the recipient of a Teaching Citation Award based on student evaluations for the academic year 2013-14. He also teaches in the Harvard/World Bank Flagship Course on Health System Strengthening in Washington and in various countries around the world. He also teaches executive training courses on decentralization and on human resources for the International Health Systems Program at Harvard and for country courses around the world.


Ph.D., 1976, University of Wisconsin, Political Science
A.B., 1968, Princeton University, Woodrow Wilson School for International Affairs


Bossert, TJ. “Federalism and Decentralization in Health Care: An Overview of Eight Cases” concluding chapter in Marchildon, GP and Bossert, TJ, editors. Federalism and Decentralization in Health Care: A Decision Space Approach. Toronto: University of Toronto Press, 2018

Marchildon, GP and Bossert, TJ, editors. Federalism and Decentralization in Health Care: A Decision Space Approach. Toronto: University of Toronto Press, 2018

Bossert, TJ. “Decision Space and Capacities in Decentralization in Fiji: Comment”  International Journal of Health Policy and Management  2016, 5(7), 443-4

Bossert T.J. and Leisewitz T. “Innovation and Change in the Chilean Health System”  The New England Journal of Medicine 374;1 January 7, 2016

Bossert T.J. “Empirical Studies of an Approach to Decentralization: “Decision Space” in Decentralized Health Systems” in Jean-Paul Faguet and Caroline Pöschl, eds. Is Decentralization Good for Development: Perspectives from Academics and Policy Makers. (London: Oxford University Press, 2015) pp. 277-298.

Bossert T., Mitchell A., Janjua M. “Improving Health System Performance in a Decentralized Health System: Capacity Building in Pakistan,”  Health Systems and Reform. at Taylor & Francis On Line, July 16, 2015.

Brenner S, Muula S A, Robyn J P, Bärnighausen T, Sarker M, Mathanga P D, Bossert T, De Allegri M. “Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi”, BMC Health Services Research, 2015.

Bowser D., Sparkes SP, Mitchell A, Bossert TJ, Bärnighausen T, Gedik G, Atun R. “Global Fund Investments in Human Resources for Health: Innovation and Missed Opportunities for Health Systems Strengthening”, Health Policy and Planning 29:8 (December 2014) 986-997.

Bossert T. “Decentralization of Health Systems: Challenges and Global Issues of the Twenty-First Century” Chapter 12 in Krishna Regmi, ed. Decentralizing Health Services (Springer, 2014)

Mitchell, A.; Bossert, T.J. “Politics and Governance for Human Resources for Health” Chapter 7 in Soucat, Agnes; Scheffler, Richard; and Adhanom Ghebreyesus,Tedros eds, The Labor Market for Health Workers in Africa: A New Look at the Crisis, Washington DC: World Bank 2013; pp. 109-127.

Brinkerhoff D. and Bossert T. “Health Governance: Principal Agent Linkages and Health System Strengthening” an introductory article for a symposium of three case studies in Health Policy and Planning 2013; 1-9

Farshad Farzadfar, Christopher J L Murray, Emmanuela Gakidou, Thomas Bossert, Hengameh Namdaritabar, Siamak Alikhani, Ghobad Moradi,,Alireza Delavari, Hamidreza Jamshidi, Majid Ezzati. “Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study.” Lancet 2011; 378:

Bossert T. “Commentary: Health Systems” Health Policy and Planning 2011: 1-3 doi: 10.1093/heapol/czr008

Mitchell, A, Mahal, A., Bossert,T. “Health care utilization in Rural Andhra Pradesh’, Economic and Political Weekly, India January 29, 2011 vol xlvi no 5

Bossert T., Mitchell A. “Health sector decentralization and local decision-making:
Decision space, institutional capacities and accountability in Pakistan” Social Science and Medicine 72 (2011) 39-48

Bossert T., Ono T. “Finding Affordable Health Workforce Targets in Low Income Countries”  Health Affairs (2010) 29/7: 1379-85.

Mitchell, A., Bossert T. “Decentralization, Governance and Health System Performance: “Where you stand depends on where you sit”” Development Policy Review 28 (6) November 2010 pp. 669-691

Bossert T., “Institutional Capacities and Decentralization of Health Systems in Latin America: Need for More Evidence” Americas Quarterly  Summer 2010

Brune, N. and Bossert T. “Building Social Capital in Post-Conflict Communities: Evidence from Nicaragua” Social Science and Medicine, 68 (2009) 885-893.

Bossert T., Meekers D. Brief Guide to Publishing.Washington DC.: Global Health Fellows Program (USAID Project) 2009

Bossert. T., Mitchell A., Mazumdar S, Belli P. “Decentralization of Health in the Indian State ofWest Bengal: Analysis of Decision Space, Capacities and Accountability” Report to the World Bank and Government ofIndia.  September 2009

Bossert. T., Mitchell A., Blanchet N. “Governance and Decentralization of Health Systems in Vietnam: Analysis of Provincial Organization, Decision Space/Accountability and Capacity”  Report to World Bank and Government ofVietnam. September 2009

Bossert T. Mitchell A, Valladares Cardona R, Bowser D. “Resource Allocation Options for Financing in the Health Sector: International Experience and Lessons forGuatemala”  Report for Proyecto Dialogo para la Inversión Social enGuatemala(Dialogue for Social Investment inGuatemala) (USAID)Guatemala.  June 2009

Bossert T. Mitchell A “Background note on sectoral decentralization and local governance for an economic and sectorwork(ESW):Health Sector.” World Bank, March 2009

Bossert T, Blanchet N. “Social Capital and Community Participation and Health: A Review for Health Planners in Andhra Pradesh” Report for Andhra Pradesh Health Sector Reform Program (DFID) February 2009

Bossert T. “Decentralization and Governance in Health”,Bethesda: Health Systems 20/20 Project, June 2008.

Brinkerhoff, D. and Bossert T. “Governance: Concepts, Experience and Program Options”,Bethesda: Health Systems 20/20 Project, February 2008

Mitchell, A., Bossert, T. Yipp, W., Mollahaliloglu, S. “Do more health workers mean higher immunization coverage? Evidence from Turkey,” Human Resources in Health, 2008, 6:29. http://www.human-resources-health.com/content/6/1/29

Bossert T. and Baernighausen T, Mitchell A. and Bowser D. Assessing Financing, Education and Management for Strategic Planning for Human Resources in Health. Geneva: World Health Organization 2007

Bossert T. and Bowser D and Amenyah J. “Is decentralization good for logistics systems? Evidence on essential medicine logistics from Ghana and Guatemala,” Health Policy and Planning (2007) 22:73-82

Mitchell, A. and Bossert, T. “Measuring Dimensions of Social Capital: Evidence from Surveys in Poor Communities in Nicaragua” Social Science and Medicine  2006, (64), pp. 50-63 Mello, M, Powlowski M and Bossert, T. “The Role of Law in Public Health: The Case of Family Planning in the Philippines”, Social Science and Medicine 2006, 63 (2), pp. 384-396.

Bossert, T. and Larrañaga O, Giedion U, Arbelaez J, and Bowser D. “Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile.” Bulletin of World Health Organization, 2003, 81 (2) pp. 95-100

Bossert T. and Chitah, Mukosha Bona and Bowser, Diana. “Decentralization Of The Health System In Zambia: Resource Allocation And District Performance” Health Policy And Planning 2003 18(4): 357-369

Bossert T. and Joel Beauvais “Decentralization of Health Systems in Ghana, Zambia, Uganda and the Philippines: A Comparative Analysis of Decision Space” in Health Policy and Planning, December 2001

Bossert T. “La investigación sobre reformas del sector salud en América Latina desde la perspectiva de las ciencias políticas” in Celia Almeida, Roberto Bazzani and Patricia Pittman, eds. Investigació sobre Reformas del Sector Salud en América Latina y el Caribe: Reflexiones sobre sus Contribuciones al Desarrollo de Políticas Washington DC, Organizacíon Panamericana de la Salud, Abril 2001

Bossert T. , Larrañaga O., and Ruiz Meir F. “Decentralization of Health Systems in Latin America” Pan American Journal of Public Health July August 2000 Year 79, Vol 8, Nos ½, pp. 84-92.

Bossert T. “Analyzing the Decentralization of Health Systems in Developing Countries: Decision Space, Innovation and Performance,” Social Science and Medicine, November 1998.

Bossert T., et.al. “Transformations of Ministries of Health in the Era of Health Reform: the Case of Colombia,” Health Policy and Planning, March, 1998.

Bossert T., Wlodarczyk C. and Koprowska I. ” Unpredictable Politics: Policy Process of Health Reform in Poland.” Harvard & Jagiellonain Consortium for Health, Data for Decision Making Project Report 74, January 2000. (https://www.hsph.harvard.edu/ihsp/publications)

Bossert T. “Privatization and Payments: Lessons for Poland from Chile and Colombia,” Data for Decision Making Project Report 77, March 2000. (https://www.hsph.harvard.edu/ihsp/publications)

Bossert T. “Decentralization of Health Systems: Chile, Colombia and Bolivia.” Latin American and Caribbean Regional Health Sector Reform Initiative Report 29, June 2000. https://www.hsph.harvard.edu/ihsp/publications )

Bossert T. and González Rossetti A. “Enhancing the Political Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia and Mexico.” Latin American and Caribbean Regional Health Sector Reform Initiative Report 36, June 2000.