Title: Analysing Disrupted Health Systems (ADHS)
Keywords: Management
International/Global Health
Health systems
Health information
Health in emergencies
Country: Netherlands
Institution: The Netherlands - Royal Tropical Institute (KIT), Amsterdam
Course coordinator: Fernando Maldonado
Date start: 2022-08-15
Date end: 2022-08-28
About duration and dates: 2 weeks (10 days) with 1 day preparation reading ahead of the course Application deadline: 2022/07/01
Classification: advanced optional
Mode of delivery: Face to face
Course location:
Amsterdam (spring) – Addis Ababa, Ethiopia (winter)
ECTS credit points: 3 ECTS credits
SIT: SIT: 82 hours
Contact hours: 48 hours plenary sessions; 6 hours group work; 6 hours group presentation
Self-study: 22 hours
Language: English
Description: At the end of the module the participants should be able to:
1. Analyse the structure and features of disrupted health systems;
2. Distinguish key health sector actors’ agendas and propose a plan of action to influence decision making;
3. Use adequate tools for health system analysis in countries in crises and adapt them to the local context;
4. Identify the type of adaptation process that health systems undergo during crises and formulate measures to develop effective strategies and plans for rebuilding;
5. Present findings of health systems analysis using a case study
Assessment Procedures: 30% of mark will come from the presentation of the country case study (group mark).

70% of mark will come from an individual 3-hour written open-book exam. Students take the exam via the online platform (KIT Virtual Grounds). Questions are essay-type. Marking is done contrasting student responses against a set of suggested answers and marking grid.

Feedback is provided within 3 weeks. Students who fail the open book exam are given 1 possibility to re-sit the open-book exam within one month after finalising the course.

See annex for description of country case study and assessment grid.
Content: Protracted crises, mainly those labelled complex emergencies, have a severe impact on health systems, in all their sub-components such as policy development, planning, human resource development, financing, management, infrastructure, and support systems. Unreliable and incomplete information hampers sound decision making, while fast evolving conditions increase uncertainty. Health professionals often have limited experience analysing the major features and distortions of disrupted health systems. Learning from successes and failures in health sectors of countries in crises is particularly difficult because lessons that could be relevant to different contexts are not always well documented.

The following subjects are covered during the course:
● Analysing disrupted health systems
● Complex emergencies: trends, challenges and impact to health systems
● Humanitarian aid and its politics
● Data and information challenges in crises
● Health policies, strategies and plans (such as Universal Health Coverage; Essential Packages of Health Services)
● Health system’s building blocks
● Recovery process of the health sector
Methods: Lectures, interactive group discussions, group work, role plays, case studies and self-study:

Contact hours: 48 hours plenary sessions; 6 hours group work; 6 hours group presentation; 3 hours open-book exam
Self-study: 22 hours

48 hours: Contact hours including lectures, exercises, group work, interactive group discussions, and role plays building on participants’ experiences

6 hours: Group work will consist of a country case study and health systems analysis (country case study) based on the evidence found during a desk review.

6 hours: Participant groups will present their analysis to the class and to 2 panellists (facilitators playing the role of examiners) that are familiar with the country of the case study. Participants will comment on each other’s work. The discussion will be moderated by the members of the panel who will link back main elements of the group work and discussion to the theory covered in class

22 hours: Self-study time needed for pre course preparation, preparation for sessions, preparation for presentation of case study, preparation for exam
Prerequisites: ● a Bachelor’s degree or equivalent in medicine, public health, social sciences or related disciplines
● at least 5 years of work experience in humanitarian action or health systems development, preferably in contexts affected by crisis (tropEd students are exempted from this pre-requisite)
● -Proven proficiency in spoken and written English academic TOEFL or IELTS test. A minimum written TOEFL score of 550, iBT TOEFL score of 80, computer based TOEFL score of 213, or an IELTS academic score of 6.0 is required. Please note that candidates must take the Academic test and not the General one.
● KIT requires all applicants, who have not completed their education in Canada, the United States, the United Kingdom, Ireland, New Zealand, Australia, Ghana, Nigeria, Kenya, South Africa, Zambia, Uganda, Philippines, India, Tanzania, Malawi, Botswana, Zimbabwe, Sierra Leone, Liberia, or who have not obtained an International Baccalaureate or European Baccalaureate diploma, to enclose proof of English language proficiency in the form of the internationally recognised TOEFL or IELTS tests. We only accept official TOEFL or IELTS test results, which are not older than 3 years.
Attendance: A minimum of 80% attendance (for the face-to-face component) is required
Maximum number of students: 30
Minimum number of students: 10
Maximum number of tropEd students: 4
Selection: Places will be allocated on a ’first come first served’ basis
Fees: Normal fee EUR 2.100
Early bird fee EUR 1.790
tropEd fee EUR 1.680
Scholarships:
Scholarships: For this course funding from the Orange Knowledge Programme (OKP, former NFP) is available for applicants from OKP countries. Additional information available at: https://www.kit.nl/health/study/okp-orange-knowledge-programme/
Major changes since initial accreditation: - The course was originally accredited with a weight of 4 ECTS credits. This is a two-week course. In order to fulfil the SIT requirements to reach the 4 credits, participants were expected to invest 20 hours of pre-course reading. Over the years it became clear that few students are able to invest that time.
For this reaccreditation round we are proposing to reduce the pre-course reading to 6 hours. This reduction in SIT means that the course will now be worth 3 ECTS credits. The course coordination thinks that this proposal reflects better the pre-course work that is/can be done by participants.
- Previously, the objectives and description of the group work (case-study) asked students to develop a rather complete health systems analysis. This tends to have a negative effect on the students’ level of stress and on the quality of their presentations. The limited time to work on the case study resulted in high levels of stress and affected group dynamics. The large information gaps common to fragile settings often encouraged students to hide gaps during their presentations. These resulted in products of lower quality.
Since 2017, the objectives and description of the case study were reviewed. Groups are now expected to do a desk-review and deliver a preliminary health systems analysis. Part of the presentation is dedicated to highlight the information gaps found and to suggest ways to address such gaps (assuming that an in-country team can take up the suggestions and complete the work).
This new format has improved the quality of the presentations and also resulted in less stress among groups.
- The course did not run in 2020 due to lack of applications/participants largely related to the COVID-19 pandemic. In 2021 the course did run but with adaptations as participants were unable to travel to the Netherlands. Given the nature of the course and the importance of interaction between participants, the preferred mode of delivery will remain face-to-face, hoping that travel restrictions will be lifted in the future.
- Participants have highlighted the need of providing them with tools and skills to capture the perspective and needs of the community in their analysis of the health system. This is a valid request. The course coordination plans to review how to include this component in the course content and to implement it for the course running in August 2022.
Student evaluation: During the ADHS participants complete evaluations at the end of each session and at the end of the module. Feedback is similar to what we have received in the past.
- Overall, the course and teaching methods (especially the in- class discussion, and role-plays) are appreciated.
- Participants find that a strong point of the course is the rich mix of participants and their ample experience in the field.
- The contents of the course are felt to reflect “reality”
- Participants felt that the course helped them to expand their view about perspectives and opportunities while analysing health systems.
- Course participants have at least 5 years of field experience. On the other hand, tropEd students have less experience. This diversity within the group creates some challenges while facilitating a session. So far, the approach has been to inform in advance all tropEd students about this situation and to offer support whenever possible. In general, participants with more experience tend to support their classmates. This remains a challenging point for the course coordination.
Lessons learned:
See earlier point
tropEd accreditation:
Accredited in May 2012. Re-accredited in December 2016. This accreditation is valid until December 2021; re-accredited EC Telco Nov 22, 2021. Valid until Nov 2026.
Remarks:
Course is conducted in collaboration with Centers for Disease Control and Prevention USA, Save the Children, WHO.
Email Address: F.Maldonado@kit.nl
Date Of Record Creation: 2012-06-26 14:28:15 (W3C-DTF)
Date Of Record Release: 2017-10-09 18:34:33 (W3C-DTF)
Date Record Checked: 2021-11-25 (W3C-DTF)
Date Last Modified: 2021-11-25 09:49:25 (W3C-DTF)