Global Health Sector Reform, HS 333F

01-03-14

Global Health Sector Reform, HS 333f

Module I, Spring 2014

Sarita Bhalotra

Office: Heller-Room 109

Telephone 781-736-3960; email

Fridays, 9 to 11:50 a.m., Rm. G53

University notices

1. If you are a student with a documented disability on record at BrandeisUniversity and wish to have a reasonable accommodation made for you in this class, please see me immediately.

2. Academic integrity is central to the mission of educational excellence at BrandeisUniversity. Each student is expected to turn in work completed independently, except when assignments specifically authorize collaborative effort. It is not acceptable to use the words or ideas of another person – be it a world-class philosopher or your roommate – without proper acknowledgement of that source. This means that you must use footnotes and quotation marks to indicate the source of any phrases, sentences, paragraphs or ideas found in published volumes, on the internet, or created by another student. If you are in doubt about the instructions for any assignment in this course, you must ask for clarification. You are expected to be honest in all of your academic work. The University policy on academic honesty is distributed annually as section 5 of the Rights and Responsibilities handbook. Instances of alleged dishonesty are subject to possible judicial action. Potential sanctions include failure in the course and suspension from the University. If you have any questions about expectations, please ask.

This syllabus is subject to minor changes during the module. The latest version will be posted to LATTE with changes highlighted. When in doubt, please consult the Instructor.

Description

This two-credit, seven sessionseminar is about global efforts by all nations of the globe to reform their health sectors. At an ideological level, few would argue that a health system should be:

structured to achieve healthier outcomes
equitable in its methods of raising and distributing resources
efficientin allocating funds.

However, in reality,wide variations in health outcomes, immense disparity in the distribution of health goods and services, and duplication, fragmentation and corruption in the delivery of services, continue to occur.

Improved health status at a population level is recognized as an economic, political, and social good for countries at all income levels. This seminar will provide an opportunity to learn about the history and evolving rationale behind health sector reform. It will identify methods and tools that are used to assess and evaluate health systems, including determining the causes of problems. It will provide students with the conceptual and technical tools to develop innovative solutions that can be implemented with an aim to improving health system performance and equity, given specific contexts.Since global health sector reform entails an interdisciplinary approach from experts, this module will also provide information about this process. This module is a useful adjunct for implementation, monitoring, and evaluation.

Approach

The seminaris practical, usingreadings, interactive class as well as web-based discussions and class presentations by students. Students will learn about the health reform policy cycle, and the challenges faced by health sector reformersas they enter into the different phases of the cycle.They will look atethical theory and political values, explicit but mostly implicit,that guide reform.

Core health system performance goals and measures will be identified, and students will learn how they can be used to improve and evaluate performance and equity of the health system. Building on thetheoretical and technical knowledge of health sector reform provided in this module, they will then delve into effecting change in practice.

In addition to the core topics of health systems analysis from a theoretical viewpoint, tools from management science such as control options, other topics introduced very briefly includehuman resource needsin the health field,the very basics of health promotion theory and practice, corruption in the health sector, the political economy of global health and development, and the role of health in facilitating peace.If a student is interested, the Instructor can guide and point the way to further readings for the student to explore on his/her own.

Prerequisite This is a graduate level course. Undergraduate students who have taken Global Perspectives on Health (HSSP102a) may join this course. Doctoral students will have additional requirements. These are listed at the end.

Office Hours These are by appointment. Please send an e-mail request which will be accommodated promptly.

Evaluation

Students will be evaluated based on:

Attendance and contribution to class
Five memos (dates to be chosen by the student) summarizing key points from the day’s readings (2 to 3 pages) and posing two questions for class discussion.
Group project: Based on class size, students will form team(s) and present a proposal for Health Sector Reformcomparing and contrasting approaches in two selected countries of interest, e.g. Cuba and the United States; Israel and Jordan, etc. (Group size and presentationdates TBD) Attendance and contribution to class: The success of this course depends on the cohesiveness of the class, and the knowledge and expertise that each student brings to the class. Attendance is expected at every class. Occasionally, absences will be excused exceptional circumstances. If an absence is anticipated, please request it in writing by submitting an e-memo to the Professor. If it is a sensitive topic, you may convey it orally, and share only as much as is necessary to explain the absence. If an unanticipated need to be absent arises, please submit an e-mail memo explaining the circumstances as soon as possible before the next class or meet with the Instructor.

With regard to contribution and participation, we recognize, understand, and appreciate that there are different ways of doing so. Being prepared with readings, reflecting on them with regard to your own experience, and briefly sharing it with your classmates provides an invaluable learning opportunity for all.

Memos:Students will bring their own observations and analyses to bear on the readings and discussions in class. Product: When the memos are put together, the student will have a short report that is relevant to their own context, and will deepen their understanding of health sector reform.Choose a particular week’s readings. As you read, think about how that might apply to a specific health sector situation that you are familiar with. You might for example, comment on ethical theories(Chapter 2) and how you think a particular health policy that you know of is influenced by an influential policy-maker who holds a particular value system. Or, the readings may remind you of a situation where diagnostic techniques as outlined in Chapter 7 (for example), were used, or would have been useful had they been used. The language can be informal, your own opinions can be voiced. We are interested in YOUR responses to what you are learning from the readings. In summary, writing down your responses to the readings can help you: remember salient points, fix them in memory better because you have linked it to previous knowledge and experience, and facilitate your learning, using the new readings in an applied setting. The memos should be submitted the evening before the class. .

Here is one way to do it (everyone has their own way of learning, so use whichever method works best for you). As you read, either highlight, or jot down something that strikes you particularly. When you review what you have highlighted, you will see a pattern emerge for yourself, about what you find helpful and interesting (or not!) about understanding health sector reform, from these readings. Put this together in a memo. Another way is to bullet salient points in a Word document from that week’s readings and review those. As the module goes on, you will find some themes emerging for you that can help guide you in actual situations in health sector reform.

Group Project:Your group has been hired as an interdisciplinary team by a country to design a reform for its health sector. Present the major health problems facing the country, and very briefly highlight its current health sector structure (delivery system and financing). (You may draw on your final research papers from HS276f,World Health,or HSSP 102a Global Health if you have taken it). Next, please use the tools and concepts contained in the text-book to develop a design for health sector reform. We realize this is an idealized narrative. But if you could, how would you re-design the health care sector: i.e., where are they in the health reform cycle? What is (are)the dominant ethical theory/value system(s) of the country? How will you diagnose, develop policy, incorporate political, economic and social considerations? What does the political analysis tell you about which strategies might be successful? Incorporate considerations of sustainability andcorruption. If you have taken “cost-effectiveness”, or are taking it, incorporate those perspectives as well. Product: Students will have a template for developing health sector reform. This project will be presented to the class in atimed, professional presentation no longer than 25 minutes, with ten minutes for questions and discussion. Subsequently,the project should be put into an 18-20 page report. Unlike the memos, the report is scholarly in presentation. Students may use any citation style referenced by the links on LTS’s list . The selected citation style must be used consistently throughout the paper (including punctuation, capitalization, etc.). Because you are writing professional/academic reports, be sure to use sources that assure accuracy. In addition to the substance of the paper, proper organization and formatting is essential, e.g., the use of headings and sub-headings. Use the suggestions from the white paper on consulting (in the readings) to frame your report.

Classroom Protocol:

Classes will start promptly. Please refrain from using any kind of electronic noise-emitting devices. Laptop use is encouraged for saving paper, and for accessing information on-line during class for issues that need clarification. Any use other than for class-related activity is not allowed. All assignments are to be posted to LATTE in WORD. Please feel free to bring a (quiet) meal, snack, drink to class as needed.

Grading:

Participation:42% (this includes attendance)

Memos:30% (6% each)

Class Project:28% (all students in a group will receive the same grade for creating a report on Global Health Sector Reform

Doctoral students are not given a letter grade, so the quantitative schema does not apply to them, however, they will still be evaluated according to their participation, attendance, memos, and class project

Course Readings:

Required Textbook:

Getting Health Reform Right: A Guide to Improving Performance and Equity: Marc Roberts, William Hsiao, Peter Berman, and Michael Reich, (2008)OTHER READING MATERIALS:

These will be available on LATTE. Please check the syllabus weekly for updates.

SUUGESTED WEB RESOURCES:

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Partial Recommended Bibliography:(These will be scanned and posted on LATTE)

Students may find the following resources useful. In addition, please feel free to suggest your own.

Basics of Public Health Core Competencies Larry Holmes Jr., (2009)
The Nation’s Health Lee and Estes, eds (2003)
The Practice of International Health Perlman and Roy (2009)
Theory in Health Promotion and Practice Goodson, (2010)
Peace through Health, Arya and Santa Barbara, (2008)
Anticorruption in the Health Sector, Vian, Savedoff and Mathisen, 2010
Textbook of International Health, Ann-Emanuelle Birn, Yogan Pillay, and Timothy H. Holtz, Oxford University Press, 2009
Foreign Remedies, David A Rochefort, Kevon P. Donnelly Routledge, 2012
Global recommendations and guidelines (WHO)
Case Studies: from Africa, Malaysia, Mexico, and India (available for reference from Instructor as needed; several of these are HBS studies that are not allowed to be posted on LATTE, but which have been paid for per copyright and can be shared on an individual basis)

Session 1,Jan. 23: Introduction to the Course

Health Systems Analysis

Roberts et al. Preface and Chapter 1
Roberts et al, Chapter 2: The health-reform cycle

Suggested reading:

Goodson: Chapter 1: Theory as Practice
Goodson, Chapter 4: Overview of Theory in Health Promotion

Optional reading:

BeauchampDE, “Public Health as Social Justice”, in Hofrichter ed, “Politics, Ideology and Inequity in Distribution of Health”
Bhutta ZA, “Ethics in International Health Research” Bulletin of the WHO, 2002, 80(2)

Session 4:Date TBD (make-up session for Jan. 16)

Health System Diagnosis and Prescription

Roberts et al, Chapter 6: Assessing health system performance

Roberts et al, chapter 7: From diagnosis to health-sector reform
Disease Control Priorities in Developing Countries

Choose any chapter to present orally and briefly to your classmates

OPTIONAL

Statistical Control Tools, “Total Quality Management”, Melum and Sinioris, AHA 1992

Video: Bataldan’s Quality Improvement in Health Care
Foreign Remedies: Rochefort, Chapter Four

Ghatak, Hazlewood and Lee: McKinsey Quarterly: How Private HealthCare Can help Africa; March 2008

Session 5:Feb. 14

Health System Reform Control Options

Roberts et al, chapter 10: Organization

HIGHLY RECOMMENDED

Decentralization and Governance in Health (USAID, Health Systems 20/20)
Pfeiffer et al, “Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations”, AJPH, Dec. 2008, 98(12) 2134 – 2140
Vian, “Review of Corruption in the Health Sector”, Health Policy and Planning, 2008, 23, 83-94
Vian, “Approaches to Teaching and Learning about Corruption in the Health Sector”, December 2009, U4 brief
Foreign Remedies, Rochefort: Chapter Six

Session 6:Feb. 28

Health system reform control options (contd).

Roberts et al, Behavior and conclusion (chap. 12 and 13)
International Health Care Consulting: Design for a Workshop for Hopefuls

RECOMMENDED:

Arya and Santa Barbara, Introduction
Arya and Santa Barbara, Chapter 15: Epidemiology as a Tool for Peace through Health

The class will be assigned to two teams, to read one of the following chapters to discuss in class:

Chu and Garcia-Cuellar: “Farmacias Similares: Private and Public Health Care for the Base of the Pyramid in Mexico: HBS 9-307-902 March 1, 2007
Rangan, “Aurolab: Bringing First World Technology to the Third-World Blind” HBS 9-507-061 Feb 20, 2008

OPTIONAL:

The White House and the World: A Global Health Development Agenda Executive Summary

Session 7:Human resources for health

Global recommendations and guidelines for human resources (WHO)
Retaining Health Workers in the Public Sector: Report-out
Birn et al, chapter 9: Globalization, Trade, Work, and Health

Two teams of students will be assigned to read one of the following chapters to discuss in class:

Holmes, Chapter 5:Social and Behavioral Sciences in Public Health
Holmes, Chapter 4: Health Policy and Management Sciences in Public Health

GROUP PRESENTATIONS

WRAP-UP AND CELEBRATION

Additional requirements for doctoral students: Seven memos will be required instead of five. The student will also submit a narrative (4 to 6 pages) about how the tools acquired in this course might advance how s/he informs her dissertation proposal and dissertation on a selected area, such as the problem statement, hypotheses, research plan, methodology, policy implications,and career goals. The Instructor will work closely with the student to process this thinking and writing. It will depend on where the student is in the dissertation process. It might take the form of a fledgling concept paper, more research into a particular aspect of global health sector reform as it pertains to the area that the student is interested in, delving into a particular methodology, how this course can inform policy implications of the dissertation,and so on. The student should be in close touch with her advisor about this process.
A SELECTION OF CASE STUDIES AVAILABLE FOR REFERENCE FROM THE INSTRUCTOR IF YOU WISH

Preparing for a Pandemic

Jeffrey Staples, Scott F. Dowell, Joseph S. Bresee, Nitin Nohria, Warren G. Bennis, Baruch Fischhoff, William MacGowan, Larry Brilliant, Peter Susser, Sherry Cooper, Wendy Dobson, Brian R. Golden

Product Type: Harvard Business Review Article

Product#: F0605A Pub. Date: May 01, 2006

Length: 17p

Instituto Clinico Humanitas (A)

Richard Bohmer, Gary P. Pisano, Ning Tang

Product Type: Case (Field)

Product#: 603063 Pub. Date: September 18, 2002

Length: 32p

Drug Testing in Nigeria (A)

Debora Spar, Adam Day

Product Type: Case (Library)

Product#: 706033 Pub. Date: January 09, 2006

Length: 19p

NarayanaHrudayalayaHeartHospital: Cardiac Care for the Poor

Tarun Khanna, V. Kasturi Rangan, Merlina Manocaran

Product Type: Case (Field)

Product#: 505078 Pub. Date: June 22, 2005

LEARNING GOALS:

CORE SKILLS:

Communication: The assignments in this module should assist the students to express themselves clearly, both orally and in writing, about the core theoretical frameworks, diagnostic techniques, and processes of health sector reform.