Flagship Training Course on Health Sector Reform and Sustainable Financing

The Background for Better Health Sector Development

Developing countries everywhere are struggling with the dual objective of achieving widespread and equitable coverage of health services while providing health care more efficiently under tight budget constraints. The World Bank is playing an increasing important role in assisting the reform process not only in the form of loans, but also by providing policy guidance, technical advisory services, and national capacity building as complements to its lending programme.

To assist in this process, the Economic Development Institute (EDI) of the World Bank has developed an intensive course on Health Sector Reform and Sustainable Financing, which is offered (in English) in Washington, DC, as well as at regionally based partner institutes throughout the world, in multiple languages.

In Thailand, the Centre for Health Economics (CHE), WHO collaboration, Faculty of Economics, Chulalongkorn University has been chosen as the regional partner institute. As such, the CHE will carry out training in Thailand, using and adapting to the Asian situation the learning materials developed for the Washington course.

Objectives

The course aims at providing an integrated and coherent learning programme covering health sector reform and financing options, presented through a sequence of interconnected modules. At the end of training, the successful participants should be able to:

• speak a common language about dimensions of health sector reform and sustainable financing options,
• assess how well the participants’ national health systems rate on performance criteria; such as, equity, efficiency and sustainability,
• determine alternate paths their national health systems could take, and why it would be desirable to pursue some paths over others,
• understand how to do and what to do in moving their national health systems to critical defined health reform dimensions, and
• understand how to select and apply tools and procedures to make desired changes including justify its effects.

Course Contents

For May 1999, the course consists of two week-long, 3 modules; 1, 2 and 3 as described in the accompanying.

Module 1, a pre-course distance learning module, will be provided to all participants prior to the convening of the course. In Washington, all participants complete Modules 2 and 11 as well as two other modules chosen from among the rest. In Thailand, the training course will typically be of shorter duration (2-3 weeks) with participants completing correspondingly 3 modules. Participants may return to complete additional modules at a later stage.
Module 2, Diagnostic Approaches to Assessing Strengths, Weaknesses, and Change of Health Systems
Module 3, Revenue Sources and Collection Modalities

For September 1999, the course consists of three week-long, 4 modules; 1, 2, 3 and 7:
Module 7, Provider Payment Mechanism

Learning Style

Three principles guide the Flagship learning style. It will emphasise implications of different options in terms of efficiency, equity, and sustainability. It will be evidence based, seeking to distill lessons learned and best practices from country experience. It will complement understanding of "What to do" with advice on "How to do it."

A typical day of training in each Module can be expected to be organised into three sections. The first part will introduce the policy relevance of the subject or sub-issue, theory, analytical framework, expectation, and hypotheses. The second part will review evidence from country case studies what was tried, what was learned. The third part will involve participants in the case-method of learning, whereby students will grapple with the context and facts of a real-life management or implementation issue, and work out ways of resolving it.

Collaborating Institutions

Developmental work on the Flagship programme has concentrated on the preparation of high quality learning materials, in collaboration with several external centres of excellence. These centres include the Centre for Health Economics and Policy, McMaster University (Canada), the School of Public Health, Harvard university (USA), the Institute for Health Sector Development (UK), Basys (Germany), Britran and Associates (Chile), Health Economics Unit of the University of Cape Town and the Centre for Health Policy of the University of Witwatersrand (South Africa), and the Essential Drug Programme, WHO (Switzerland).

Organiser and funders

The Flagship Learning Programme was developed at EDI in collaboration with the World Bank Human Development Network, which also partially supports this training programme. The EDI managing division for the programme is the Human Resources and Poverty Division (EDIHR).

In Thailand, Dr. Siripen Supakankunti, the Executive Director of the Centre for Health Economics, Faculty of Economics, Chulalongkorn University, serves as the Flagship programme coordinator. The Flagship learning materials have been adapted to the Asian situation by teams of CHE. EDI staff, and others.

Brief Description of the Flagship Modules

Module 1: Introduction to the Concepts and Analytical Tools of Health Sector Reform and Sustainable Financing. (A pre-course distance-learning module.)
Reviews core concepts of efficiency and equity in health markets, and how market imperfections necessitate government intervention to correct distortions. Features the design of national health accounts, and different approaches to sustainable financing, funding and remuneration practices.

Module 2: Diagnostic Approaches to Assessing Strengths, Weaknesses, and Change of Health Systems
Diagnostic approaches to assessing goals of health care resources allocation and how the structure of national health systems are affected by history and ethics, politics, institutions, management and incentive structures. Show how different structures of health care system affect performance.

Module 3: Revenue Sources and Collection Modalities
Principles and practice of designing and implementing different financing schemes including general revenue financing, mandated social insurance, user fee, drug revolving funds, community financing, and medical saving accounts.

Module 4/5: Targeting and Cost-Effective Benefit Pages in the Privatization and Allocation of Public resources for Health
Assesses the rationale, methods and experience behind the targeting health subsidies under different government health financing policies. Shows how cost-effectiveness analysis may influence decisions about the use of scarce public fund for health, towards obtaining greatest “value for money” and improving the welfare of the poor.

Module 6: Separating Public Financing from Provision
Explains why increasing numbers of governments are separating public finance from provision of services, what involved in doing so (contracting autonomous hospitals), and lesson learned in major on-going reforms. Illustrates functions of providers and purchasers under such arrangements, as well as implication for other shareholders in health.

Module 7: Provider Payment mechanisms
Shows how different payment or reimbursement mechanism have a major impact on provider incentives, cost-containment, and quality of services. Distinguishes strengths and weaknesses of line-item budgeting, fee-for service, payment per episode of illness, diagnostic related groups, capitation, and salaries within different modes of health care delivery.

Module 8: Regulating Private Markets and Insurance
Examines the role and importance of regulatory reform and functions in private health care delivery markets and public and private insurance. Assesses the importance of contextual factors on the efficacy of regulatory functions, including legal provisions, government capacities, information system, and grievance procedures.

Module 9: Decentralisation
Explains the core functions served by decentralisation, the importance of fiscal decentralisation, and factors affecting the successes and failures of different decentralisation initiatives. Shows how to determine the administrative and financial management capacity needed for successful decentralisation reforms.

Module 10: Towards Efficiency and Equity in the Pharmaceutical Sector
Explores how to improve the functioning of the pharmaceutical sector. In particular, analyses policies to ensure accessibility and affordability of pharmaceuticals, the rational use of drugs, as well as appropriate production and procurement policies.

Module 11: The New Public Sector Management in Health
Examines why administrative, managerial, and institutional changes in health systems are being motivated by the doctrine of “business-like” practices and how principles of the new public sector management are being used to foster continuous improvements in performance. Identifies how operational and management practices are being improved across several, predominant institutional forms that range; for example, from “government department/entities” or “autonomous managed public facilities, to “corporatised enterprises.”

The Regional Flagship Training Course In FY 1999-2000

Participant Selection Process

Participants will be recruited from the entire WHO South East Asian Region and some part of Western Pacific Region (except China, as there is already the regional institute).

Participants of the 1999 course will tend to be mid-career and senior programme manager, who are actively involved in planning or managing:

1. government-initiated health sector reforms,

2. new compulsory social health insurance programmes,

3. private-voluntary and private sector initiatives, and

4. developing country training programmes in health sector reform and sustainable financing.

All participants will be selected and nominated in close consultation with EDI/WB and suggestions by Donor agencies.

Asia Regional Flagship Programme

Mailing address for further details:

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