Title: Health Systems Strengthening in Low and Middle-Income Countries
Keywords: Planning and programming (incl.. budgeting and evaluation)
Health systems
Governance
Country: Germany
Institution: Germany - Heidelberg Institute of Global Health, University of Heidelberg
Course coordinator: Dr. Revati Phalkey
Date start: 2021-05-24
Date end: 2021-05-28
About duration and dates: 15 hours pre and post-course work 5 days of in presence sessions
Classification: advanced optional
Mode of delivery: Distance-based
Course location: Heidelberg, Germany
ECTS credit points: 2 ECTS credits
SIT: 60 hours SIT (30 contact time and 30 self-study hours)
Language: English
Description:
The key objective of the course is to help participants develop an understanding of how health care systems work and what the key issues are in the current functioning of health and healthcare systems worldwide. Using the WHO Six Building Blocks Framework as the main point of departure, we will introduce contemporary themes in “systems thinking” approaches to health systems strengthening.

At the end of the short course, participants should be able to:
• Outline theoretical and practical aspects of HSS in the context of LMICs, including the critical review of conceptual frameworks, strategic approaches to HSS, and political and economic aspects that determine health policy choices.
• Evaluate operational aspects of HSS, including approaches and methods to diagnose gaps in health systems performance, design interventions and measure the performance of health systems strengthening interventions and programs.
• Specifically:
1. Identify mechanisms of healthcare financing and prioritization.
2. Understand the principles of governance and leadership.
3. Analyse the importance of health information systems and data for evidence informed decision-making.
4. Identify issues in management of human resources for health.
5. Review challenges to access to essential medicines globally.
6. Identify the challenges with health service delivery, utilization, and quality.
Assessment Procedures:
(i) 40% Group-work PPT presentation:
The group work consists of a 20 minutes group presentation at the end of Day 5 as part of reflections based on the Health Resources Allocation board game.
(ii) 60% individual written assignment:
Essays will be between 1500-2000 words. Participants will be asked to select one of the six building blocks of the WHO Framework for Strengthening Health Systems, and critically analyse a national healthcare system of their choice in relation to that topic.
Suitable topics are:
• Governance and leadership
• Financing and priority setting
• Health Information Systems (HIS)
• Access to medicines, equipment and diagnostics
• Human Resources for Health (HRH)
• Service delivery

Participants should develop critical arguments of the main issues and challenges identified and appraise the strengths and weaknesses of the country’s current approach in handling them and recommend steps for improvement.
Participants will have the opportunity to discuss the outline and structure of their essays with the course coordinator throughout the week. Essays have to be submitted within one week after the end of the course.
Detailed assignment guidance and marking scheme (60 Marks) is as attached and includes:
• Background including key SE, demographic and health indicators for the country (10 Marks)
• Situational analysis including review of the structure of the HSS and key challenges the chosen building block within the country (15 marks)
• Critical appraisal of the strengths and weaknesses of in-country efforts to address identified challenges (15 marks)
• Recommendations based on the analyses above alongside barriers to implementation (20 marks).
If the student fails to reach the passing grade of 60% (average from both assessments), s/he will be able to re-submit the individual written assignment not later than 2 weeks after receiving coordinator’s comments.
Content:
• Overview of key concepts, frameworks, values and principles and their application to diagnose and respond to health system issues
• Assess gaps in health system performance
• How does the health system deliver healthcare? Understand the structure, function and operations within a healthcare system including supply factors that are necessary for healthcare delivery
• Overview of the importance of health information systems and data for decision making
• Introduction to key concepts in governance, leadership and change management
• Introduction to the underlying principles of healthcare financing including approaches to assess and address issues in healthcare financing and prioritization from a systems perspective
• Introduction to human resources for health and workforce management
• Introduction to global challenges in access to essential medicines, diagnostics and technologies
• Introduction to principles of integrated health services provision and quality of care
• Applying systems thinking approaches to health systems strengthening
• Mapping links across the WHO six building blocks
Methods:
The course facilitates an active participatory learning process. The sessions will be led by both health care practitioners and academics and will involve a mix of taught sessions, group work activities and interactive discussions. Facilitators use a mixture of interactive lectures, individual assignments, case studies, group work and presentations.
30 hours contact time:
• Interactive lectures 20 hours
• Tutored group work 10 hours
• Assessed group presentations 3 hours
30 hours individual work:
• Preparatory reading 20 hours
• Developing group presentations (PPT) 10 hours
Prerequisites:
Evidence of adequate English language skills (TOEFL score of at least 550 points paper-based or 213 points computer-based, or an equivalent approved test)
Attendance:
Max Number of participants :25. (no limit for tropEd students)
Selection:
First come first served
Fees:
Course fee: € 750
Reduced fee for participants enrolled in the tropEd programme: € 500 (proof of tropEd student status needs to be provided)
Scholarships:
None available
Major changes since initial accreditation: adjustments to the descriptions of the objectives and exam topics
Student evaluation: sometimes I missed a little bit more theory/overview; more practical work experience regarding HSS via case studies from field work from experienced lecturers - overall, the course was too theoretical
Lessons learned: Clarification of objectives
tropEd accreditation:
Accredited in Barcelona, February 2017. Re-accredited Hamburg Oct 2020
Remarks: Catalytic role of health systems strengthening (HSS) for improving population’s health and protecting against health-related financial risks in low/middle-income countries (LMICs) is well-documented. During the last few decades international donor and technical agencies intermittently used the disease-specific (“vertical”) and system-specific (“horizontal”) strategies for providing health support to LMICs. While the epidemiologic impact of the former has been impressive, sustaining results, due to poorly performing health systems, has been a challenge. The integrated approach has recently emerged as a more effective strategy, where investments in disease-control programs and HSS complement each other. The ‘diagonal’ approach, which implies designing system-related solutions to address disease-related challenges, has been embedded in the global Sustainable Development Goals framework (SDGs 2016-2030), which places increased emphasis on achieving universal health coverage through improved performance of countries’ health systems. Moving further the course will introduce a system’s thinking approach to health systems strengthening including diagnosing and responding to challenges in a constantly evolving complex adaptive system.
Email Address: grys@uni-heidelberg.de
Date Of Record Creation: 2017-03-06 16:47:43 (W3C-DTF)
Date Of Record Release: 2017-03-06 22:01:00 (W3C-DTF)
Date Record Checked: 2018-06-10 (W3C-DTF)
Date Last Modified: 2021-03-19 11:41:09 (W3C-DTF)

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