Publication: Lessons from 20 Years of Capacity Building for Health Systems Thinking
Loading...
Files in English
335 downloads
Published
2016-08-24
ISSN
2328-8604
Date
2016-11-03
Author(s)
Reich, Michael R.
Berman, Peter
Bitran, Ricardo
Bossert, Thomas
Escobar, Maria-Luisa
Hsiao, William C.
Johansen, Anne S.
Samaha, Hadia
Shaw, Paul
Editor(s)
Abstract
In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.
Link to Data Set
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Citations
- Cited 15 times in Scopus (view citations)
Collections
Related items
Showing items related by metadata.
Publication Review of World Bank's Experience with Country-Level Health System Analysis(World Bank, Washington, DC, 2010-12)The World Bank often carries out in-depth analysis of the conditions and challenges facing different sectors in our client countries as a contribution to developing the analytical and information base for lending, policy dialogue, and more in-depth analytical work. In the health sector, we have identified a substantial body of this type of work focusing on analyzing the performance of health systems, its causes, and potential strategies for performance improvement. The Bank's 2007 Health, Nutrition and Population (HNP) strategy emphasizes the importance of our work on health system strengthening. HSA is often the analytical foundation of this work in countries. This paper reviews a sample of HSAs, 12 major studies carried out since 2000 across all Bank regions. Using the health systems framework of the flagship program on health sector reform and sustainable financing, a comparable synopsis of each study has been prepared in a simple two page chart which traces the analysis from measures of health system performance to its causes and then from policy 'control knobs' to proposals for reform which are intended to improve that performance. Several key questions about the conceptual basis, content, process, and results of the Bank's work on HSA are investigated. The review finds that most of our HSAs make use of sound analytical frameworks that link performance to a causal analysis and derive policy recommendations and reform strategies from that analysis.Publication Health Policy Research in South Asia : Building Capacity for Reform(Washington, DC: World Bank, 2003-08)The richness of the research papers in this volume makes it difficult to quickly capture the main themes and implications of their research. But three repeated themes can be highlighted: equality of public spending, the role of the private sector, and the role of consumers. On the theme of equality in public expenditures, research in Bangladesh, India, Nepal, and Sri Lanka shows that in some parts of South Asia-such as south India and Sri Lanka-governments do a much better job of distributing subsidies in the health sector than other regions. The research overwhelmingly documents the dominance of the private sector in Bangladesh and India and finds a very strong private sector in Sri Lanka. The research also highlights different policy instruments available to the government for working with the private sector to achieve health sector outcomes. A third general theme is the role of consumers and the mechanisms available to them to influence health services delivery. The authors in this volume have supported the belief that individuals and households can make a difference in how health services are delivered. While the three themes summarized above cut across several of the chapters in this volume, a more basic theme underlies all the chapters and is the main motivation for conducting health policy research. That theme is that empirical research can and should challenge basic assumptions about the health sector and will provide policymakers some of the tools needed to improve and monitor the performance of the sector.Publication Health Systems Analysis for Better Health System Strengthening(2011-05)Health system strengthening and reform are often necessary actions to achieve better outcomes. The World Bank's 2007 strategy for health, nutrition, and population emphasizes the importance of health system strengthening for results. This paper proposes 'health systems analysis' as a distinct methodology that should be developed and practiced in the design of policies and programs for health system strengthening. It identifies key elements of health systems analysis and situates them in a logical framework supported by a wide range of data and methods and a sizable global literature. Health systems analysis includes evidence on health system inputs, processes, and outputs and the analysis of how these combine to produce the outcomes. It considers politics, history, and institutional arrangements. Health systems analysis proposes causes of poor health system performance and suggests how reform policies and strengthening strategies can improve performance. It contributes to implementation and evaluation. Examples from Mexico, Ethiopia, and Turkey illustrate the positive contributions health systems analysis has made to development of successful health system strengthening policies. Health systems analysis should be an integral part of good practice in health system strengthening efforts, including planning, policy development, monitoring, and evaluation. Health systems analysis can be conceived in a coherent and logical fashion and can be practiced and improved.Publication Social Health Insurance for Developing Nations(Washington, DC: World Bank, 2007)Good health is necessary for well-being but also has another critical impact: it causes poverty, in that large health expenditures can bankrupt families. Many nations are now hoping that formally mandated social health insurance (SHI), involving payroll taxes, will provide a solution. This report examines the principles, design, and practices of SHI for low and middle-income nations and the necessary conditions for its viability and sustainability, with a focus on design and implementation issues. This volume presents five country case studies to provide evidence and greater detail on key issues that arise at different stages of implementation in low-income countries. They have been selected to reflect on a continuum and timeline of operational stages, beginning with the initial design and legislation of SHI, the first phase of implementation, the expansion to cover larger segments of the population, and on up to completion, whereby SHI becomes the predominant form of health care financing in a country. Accordingly, Kenya has been selected for illustration of the design stage, Ghana for initiation, the Philippines for extension of population coverage, Colombia for SHI and reform of health care delivery, and Thailand for universal coverage and reform of health care delivery. This sequencing and implied timeline of case studies allows this report to reflect on two questions. First, where can a country expect to be in relation to designing and implementing SHI in, say, 10 years? Second, as countries gain experience with SHI, what can they expect to offer or achieve in terms of variations in benefit design, who administers SHI, and how providers are contracted and paid?Publication China's Health System and Its Reform : A Review of Recent Studies(2009)This paper provides a survey of the recent empirical research on China's old health system (i.e. prior to the spate of reforms beginning in 2003). It argues that this research has enhanced our understanding of the system prior to 2003, in some cases reinforcing conclusions (e.g., the demand-inducement associated with perverse incentives) while in other cases suggesting a slightly less clear storyline (e.g., the link between insurance and out-of-pocket spending). It also concludes that the research to date points to the importance of careful evaluation of the current reforms, and its potential to modify policies as the rollout proceeds. Finally, it argues that the research on the pre-2003 system suggests that while the recently announced further reforms are a step in the right direction, the hoped-for improvements in China's health system will far more likely occur if the reforms become less timid in certain key areas, namely provider payments and intergovernmental fiscal relations.
Users also downloaded
Showing related downloaded files
Publication The Container Port Performance Index 2023(Washington, DC: World Bank, 2024-07-18)The Container Port Performance Index (CPPI) measures the time container ships spend in port, making it an important point of reference for stakeholders in the global economy. These stakeholders include port authorities and operators, national governments, supranational organizations, development agencies, and other public and private players in trade and logistics. The index highlights where vessel time in container ports could be improved. Streamlining these processes would benefit all parties involved, including shipping lines, national governments, and consumers. This fourth edition of the CPPI relies on data from 405 container ports with at least 24 container ship port calls in the calendar year 2023. As in earlier editions of the CPPI, the ranking employs two different methodological approaches: an administrative (technical) approach and a statistical approach (using matrix factorization). Combining these two approaches ensures that the overall ranking of container ports reflects actual port performance as closely as possible while also being statistically robust. The CPPI methodology assesses the sequential steps of a container ship port call. ‘Total port hours’ refers to the total time elapsed from the moment a ship arrives at the port until the vessel leaves the berth after completing its cargo operations. The CPPI uses time as an indicator because time is very important to shipping lines, ports, and the entire logistics chain. However, time, as captured by the CPPI, is not the only way to measure port efficiency, so it does not tell the entire story of a port’s performance. Factors that can influence the time vessels spend in ports can be location-specific and under the port’s control (endogenous) or external and beyond the control of the port (exogenous). The CPPI measures time spent in container ports, strictly based on quantitative data only, which do not reveal the underlying factors or root causes of extended port times. A detailed port-specific diagnostic would be required to assess the contribution of underlying factors to the time a vessel spends in port. A very low ranking or a significant change in ranking may warrant special attention, for which the World Bank generally recommends a detailed diagnostic.Publication Digital Progress and Trends Report 2023(Washington, DC: World Bank, 2024-03-05)Digitalization is the transformational opportunity of our time. The digital sector has become a powerhouse of innovation, economic growth, and job creation. Value added in the IT services sector grew at 8 percent annually during 2000–22, nearly twice as fast as the global economy. Employment growth in IT services reached 7 percent annually, six times higher than total employment growth. The diffusion and adoption of digital technologies are just as critical as their invention. Digital uptake has accelerated since the COVID-19 pandemic, with 1.5 billion new internet users added from 2018 to 2022. The share of firms investing in digital solutions around the world has more than doubled from 2020 to 2022. Low-income countries, vulnerable populations, and small firms, however, have been falling behind, while transformative digital innovations such as artificial intelligence (AI) have been accelerating in higher-income countries. Although more than 90 percent of the population in high-income countries was online in 2022, only one in four people in low-income countries used the internet, and the speed of their connection was typically only a small fraction of that in wealthier countries. As businesses in technologically advanced countries integrate generative AI into their products and services, less than half of the businesses in many low- and middle-income countries have an internet connection. The growing digital divide is exacerbating the poverty and productivity gaps between richer and poorer economies. The Digital Progress and Trends Report series will track global digitalization progress and highlight policy trends, debates, and implications for low- and middle-income countries. The series adds to the global efforts to study the progress and trends of digitalization in two main ways: · By compiling, curating, and analyzing data from diverse sources to present a comprehensive picture of digitalization in low- and middle-income countries, including in-depth analyses on understudied topics. · By developing insights on policy opportunities, challenges, and debates and reflecting the perspectives of various stakeholders and the World Bank’s operational experiences. This report, the first in the series, aims to inform evidence-based policy making and motivate action among internal and external audiences and stakeholders. The report will bring global attention to high-performing countries that have valuable experience to share as well as to areas where efforts will need to be redoubled.Publication Global Economic Prospects, January 2025(Washington, DC: World Bank, 2025-01-16)Global growth is expected to hold steady at 2.7 percent in 2025-26. However, the global economy appears to be settling at a low growth rate that will be insufficient to foster sustained economic development—with the possibility of further headwinds from heightened policy uncertainty and adverse trade policy shifts, geopolitical tensions, persistent inflation, and climate-related natural disasters. Against this backdrop, emerging market and developing economies are set to enter the second quarter of the twenty-first century with per capita incomes on a trajectory that implies substantially slower catch-up toward advanced-economy living standards than they previously experienced. Without course corrections, most low-income countries are unlikely to graduate to middle-income status by the middle of the century. Policy action at both global and national levels is needed to foster a more favorable external environment, enhance macroeconomic stability, reduce structural constraints, address the effects of climate change, and thus accelerate long-term growth and development.Publication Business Ready 2024(Washington, DC: World Bank, 2024-10-03)Business Ready (B-READY) is a new World Bank Group corporate flagship report that evaluates the business and investment climate worldwide. It replaces and improves upon the Doing Business project. B-READY provides a comprehensive data set and description of the factors that strengthen the private sector, not only by advancing the interests of individual firms but also by elevating the interests of workers, consumers, potential new enterprises, and the natural environment. This 2024 report introduces a new analytical framework that benchmarks economies based on three pillars: Regulatory Framework, Public Services, and Operational Efficiency. The analysis centers on 10 topics essential for private sector development that correspond to various stages of the life cycle of a firm. The report also offers insights into three cross-cutting themes that are relevant for modern economies: digital adoption, environmental sustainability, and gender. B-READY draws on a robust data collection process that includes specially tailored expert questionnaires and firm-level surveys. The 2024 report, which covers 50 economies, serves as the first in a series that will expand in geographical coverage and refine its methodology over time, supporting reform advocacy, policy guidance, and further analysis and research.Publication Global Economic Prospects, June 2025(Washington, DC: World Bank, 2025-06-10)The global economy is facing another substantial headwind, emanating largely from an increase in trade tensions and heightened global policy uncertainty. For emerging market and developing economies (EMDEs), the ability to boost job creation and reduce extreme poverty has declined. Key downside risks include a further escalation of trade barriers and continued policy uncertainty. These challenges are exacerbated by subdued foreign direct investment into EMDEs. Global cooperation is needed to restore a more stable international trade environment and scale up support for vulnerable countries grappling with conflict, debt burdens, and climate change. Domestic policy action is also critical to contain inflation risks and strengthen fiscal resilience. To accelerate job creation and long-term growth, structural reforms must focus on raising institutional quality, attracting private investment, and strengthening human capital and labor markets. Countries in fragile and conflict situations face daunting development challenges that will require tailored domestic policy reforms and well-coordinated multilateral support.