December 16, 2009—Suppose you are responsible for helping to meet the health needs of 1.1 million people in a vastly, mostly rural region of Ghana. All told, there are just five physicians in all the region’s villages. How do you deliver even minimal health care when you face that intimidating demand-supply ratio?
That’s the challenge facing Dr. John Koku Awoonor-Williams, a public health specialist with the Health Service in Ghana’s fast-growing Northeast region.
The principal goal of this WBI Flagship Course is to provide intensive, state-of-the-art knowledge on options for health sector development, including lessons learned and best practices from country experience.
To help him do a better job closing the health-care gap in the region, Awoonor-Williams enrolled in the World Bank Institute’s
(WBI's) Flagship Course on Health Sector Reform and Sustainable Financing.
How to Make It Happen
- It’s not an end, but a process.
- Don’t react to symptoms – look for causes, and causes of causes.
- Identify goals.
- Ask “why” questions.
- Engage all the stakeholders.
- Weigh all the options.
- Politics is the key to implementation.
- You might have to compromise to make things happen.
- Monitor measurable results.
- Don’t pretend to have all the answers – learn together.
Health Development Aid Reaches US$21.8 Billion
The World Bank Group
has focused attention on strengthening health systems in low-income developing countries. Indeed, the Bank Group, other donors, as well as implementing developing countries, see this capacity-building as essential to ensure that $21.8 billion in development assistance for health—an increase of more than 50 percent over five years ago—delivers results.
The World Bank Institute, the Bank’s learning arm, has recently adopted a new strategy based on connecting global sources of knowledge and working with partners, including regional institutions, to develop and replicate its learning programs across several regions and countries.
Through its Flagship Course on Health Sector Reform and Sustainable Financing, WBI’s Health Systems Strengthening
practice develops learning materials with partner institutions worldwide, adapting learning to regional and local needs.
The principal goal of this Flagship Course is to provide intensive, state-of-the-art knowledge on options for health sector development, including lessons learned and best practices from country experience.
The three-week course, delivered in Washington in October 2009 in partnership with Harvard University’s School of Public Health
, drew 50 public and private officials from 15 countries in Sub-Saharan Africa, South Asia, as well as East Asia and the Pacific.
"This course has really driven home to me the importance of financial access to health care delivery," Awoonor-Williams said during its third and last week.
Another Ghanaian participant, Sylvester Mensah, CEO of Ghana’s National Health Insurance Authority, said taking the course convinced him to change the payment system for health providers to provide more incentives to control costs. This would involve shifting the current flat-payment system, he said, to one based on a patient’s individual needs.
Evidence-Based Decisions … with Some Improvisation
Roman Tesfay Mebrahtu, of Ethiopia’s Federal Ministry of Health, the course has prompted him to focus on making evidence-based decisions. "My new knowledge and skills will also help me, when I have to improvise this way and that way to bring reform," he said.
"What I take from the course is the value of systematic thinking," said Erkhembulgan Purevdorj, Deputy Director Strategic Policy and Planning Department in Mongolia’s Ministry of Health. "That means you look at all the points on the control knob to help you arrive at the right solution. Without systematic thinking, there’s a high chance to fail."
Each of the 15 countries whose nationals took part in the course faces specific health-care challenges, affected by geography, culture, economics and, often, politics. "Whatever the specifics of these problems, the course gives participants a common framework to think systematically about health systems strengthening," said course manager Hadia Samaha. This approach, she added, allows participants to identify their own system’s problems and review them with a diagnostic methodology that uses "five control knobs" to identify root causes: Financing, Payment, Organization, Regulation and Persuasion. Once identified, relevant policy interventions for each one are reviewed to assess their viability as potential solutions.
Samaha is co-author of Building Capacity for Health Systems Strengthening: A Strategy that Works
(PDF 2.25MB), which reviews how the 12-year-old global course has shifted its emphasis to implementation of reform. “Our course used to be more on ‘what to do,’ but now focuses more on ‘how to do’" she said. Toward that end, the entire third week was devoted to implementation.
A typical day of training is organized into three sections:
- Policy relevance of the subject, theory, analytical framework, expectations, and hypotheses
- Real-life implementation issues
- Group exercise to apply course concepts to a national setting
After three weeks of learning, including country case studies of what worked and didn’t, Dr. Awoonor-Williams was ready to return to Northeastern Ghana, informed by a wide range of experiences. "I was immensely touched by the issue of actual financial access to health care delivery," he said. "That’s the gap we have to close."
Team Sessions Emphasize Implementation
To reinforce the focus on implementation, participants break into teams to present their strategies for solving the problems of their countries’ health system, said WBI Health Practice Manager Maria-Luisa Escobar. “They might select one specific problem, or one specific goal. This provides an opportunity for them to structure their thoughts in the systematic way the course proposes.”
The program also promotes knowledge exchange among countries and international experts by connecting existing knowledge and training networks of partner institutions in Africa and Asia and by creating new ones in other regions. The program’s focus on design and implementation of health systems strengthening activities helps build communities of practice around topics of special interest and areas of substantial expertise in client countries.
Since its inception in the mid-1990s, this program has reached more than 19,000 participants from 65 countries. More than 80 percent of the training is delivered by WBI’s regional partner institutes in developing countries.