Flagship Course on Health Systems Strengthening and Health ...

Report on the
<strong>Flagship</strong> <strong>Course</strong> on Health Systems
Strengthening and Health Financing
An Introduction to the World Bank’s Framework for Health Sector
Reform & Health Financing Analysis
Convened by
World Bank Institute; Asia Network for Capacity Building in Health Systems
Strengthening; Nossal Institute for Global Health and Fiji School of Medicine
Novotel, Suva, Fiji
June 13 th to 17 th , 2010

Summary
The <strong>Flagship</strong> <strong>Course</strong> on Health Systems Strengthening and Health Financing was held
for the first time in the Pacific region, in Suva, Fiji from 13 th – 17 th June 2010. The
course was a joint initiative of the Fiji School of Medicine, the World Bank Institute, the
Asia Network for Health Systems Strengthening, and the Nossal Institute for Global
Health (through the AusAID-funded Health Policy and Health Finance Knowledge Hub).
Adapted from the World Bank Institute’s <strong>Flagship</strong> <strong>Course</strong> held annually in Washington
D.C., this course was designed to provide policymakers and other stakeholders in the
Pacific region with a basic introduction to the ‘Control Knob’ framework for health sector
reform and financing. The course also provided opportunities for participants to discuss
the framework’s applicability to specific issues they face within their own country
contexts.
There were 43 participants from Vanuatu, Tuvalu, Tonga, Solomon Islands, Samoa,
Papua New Guinea, New Caledonia, Nauru, Kiribati, Fiji, Federated States of
Micronesia, and Australia. Government health departments, the WHO Regional Office,
UNFPA, SPC, AusAID and NZAID were all represented.
Dr Chen Ken, the WHO representative for the Pacific Region, delivered an opening
address. Other guest presenters were Professor Philip Davies from the University of
Queensland, Dr Mahendra Reddy from the University of the South Pacific and Dr
Graham Roberts from the Fiji School of Medicine. The course curriculum was taught by
faculty of the Nossal Institute for Global Health, the World Bank Institute and the Asia
Network for Health Systems Strengthening.
For this first presentation of the <strong>Flagship</strong> principles in the Pacific region, five expert
reviewers from the Solomon Islands, Samoa and Fiji stayed for an extra day to provide
critical reflection on the course content and presentation and its relevance to the Pacific
context.
Feedback indicated that additional Pacific <strong>Flagship</strong> <strong>Course</strong>s would be of interest, to
address more of the ‘Control Knob’ concepts. The Nossal Institute for Global Health and
the Fiji School of Medicine, plan to gather a library of Pacific case studies to integrate
into future course curriculum. It is anticipated that another <strong>Flagship</strong> course will be held
in the region sometime in mid-2011.
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Table of Contents
1 Introduction ......................................................................................................................... 4
2 Proceedings ........................................................................................................................ 4
3 Conclusions ........................................................................................................................ 6
3.1 <strong>Course</strong> Evaluation Summary - Participants .................................................................. 6
3.2 <strong>Course</strong> Evaluation Summary – Reviewers ................................................................... 7
4 Annexes .............................................................................................................................. 9
4.1 Timetable / Program .................................................................................................... 9
4.2 List of Participants, Presenters, and Secretariat ..........................................................11
4.3 Speech by WHO regional representative ....................................................................13
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1 Introduction
The <strong>Flagship</strong> <strong>Course</strong> on Health Systems Strengthening and Health Financing was collaborative effort of
the World Bank Institute, the Asia Network for Capacity Building in Health Systems Strengthening, the
Nossal Institute for Global Health and the Fiji School of Medicine. The <strong>Course</strong> introduced participants to
methods for identifying and diagnosing problems in their own health systems. The course particularly
focused on health financing issues for health systems in developing countries and used practical
exercises to introduce the World Bank Institute’s “Control Knob” framework for developing and analysing
policy responses health sector issues raised by course participants.
2 Proceedings
A complete timetable for the course is attached in the appendix. A brief synopsis of the proceedings of
the course is stated briefly here.
Day One – Sunday, 13 th June:
The course officially started at 4pm with a welcome by FSMed. The opening address was delivered by Dr
Chen Ken, the WHO representative for the Pacific Region (Dr Chen Ken’s opening address is attached in
the appendix). This was then followed by two presentations:
i) <strong>Course</strong> Introduction by Leonardo Cubillos; and
ii) Pacific Context by Philip Davies
A dinner concluded the proceedings for day 1.
Day Two – Monday, 14 th June:
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There were four presentations on day two:
i) Introduction to the cycle of health system reform (Shanlian Hu)
ii) Intermediate and ultimate outcomes (Nicholas Khumthong)
iii) Market and governance failures (Mahendra Reddy)
iv) Diagnostic Tree (Shanlian Hu)
The participants were given their first group exercise: to use the diagnostic tree to determine the possible
causes of an identified health issue/problem in the region.
Day Three – Tuesday, 15 th June:
There were three presentations on day three:
i) Introduction to control knobs
ii) Introduction to the financing control knob
iii) Introduction to social health insurance
Group work continued with participants asked to identify the control knobs that are influential and directly
related to the issue/problem identified in Day 1
Day Four – Wednesday, 16 th June:
There were three presentations on day four:
i) Resource allocation and efficiency (Rohan Sweeney)
ii) Resource allocation Equity (Peter Annear)
iii) Provider Payment Methods (Yip)
Group work continued with groups finalizing their presentations for Day 5.
Day Five – Thursday, 17 th June:
There was one presentation on Day 5 - National Health Accounts and presented by Leonardo Cubillos.
The rest of the day included group presentations, awarding of certificates to participants, and closing
remarks from the course organisers and coordinators.
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3 Conclusions
3.1 <strong>Course</strong> Evaluation Summary – Participants
<strong>Course</strong> participants’ final evaluation forms were reviewed and presented in the following summary.
What is the overall
relevance of the <strong>Flagship</strong>
<strong>Course</strong> in the Pacific?
What should be the length
of future courses?
What are the preferred
modes of delivery and
learning approaches?
Which of the sessions
from this course should be
included in future
courses?
Which sessions were least
useful?
Which new sessions
should be in future
<strong>Flagship</strong> <strong>Course</strong>s in the
Pacific?
How could the course be
made more relevant to the
Pacific region?
The evaluation forms indicated that the course was considered very relevant,
with all participants rating the course between 3 and 5 in terms of relevance to
their current work, and the majority rating it either 4 or 5.
Most participants regarded the course as too short to cover the content
included. The majority of participants also thought that more content should be
added to the course curriculum. This may indicate that a longer course or a
range of short courses would be more appropriate.
The large majority of participants indicated that they would like the course to be
more participatory and to include more time for discussion, group work and
sharing of experiences.
Presentations were considered by most people to be too long.
Participants would like the course to include a balance of theoretical and
practical approaches.
Feedback indicated that all sessions were useful to most participants. In the
final evaluation, almost every session was cited as the most useful session.
Group work was highly rated.
In the final course evaluation forms, the Social Health Insurance session was
most commonly cited as least useful. However, in the daily evaluation forms,
most people indicated that it was a useful session.
The large majority of participants reported that they would like future Pacific
<strong>Flagship</strong> <strong>Course</strong>s to address all of the control knobs (including those not
addressed this time). The organization and behaviour control knobs in
particular were of interest.
Other topics suggested included:
• National Health Accounts;
• Application of the control knobs;
• Public-Private Partnerships;
• Models of Health Sector Organization – e.g. SWAPs.
• The Leadership, Governance and Human Resources aspects of
Health Sector;
• WHO framework; Efficiency; and
• Managing donors and donor funding.
The large majority of participants suggested that more Pacific examples should
be included within presentations.
It was also suggested that allowing more time for participants to share their
experiences would increase regional relevance.
Some participants suggested that smaller Pacific countries should be grouped
separately, and that it is important to consider the diversity of Pacific countries.
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3.2 <strong>Course</strong> Evaluation Summary – Organizers & Reviewers
1. What do participants and reviewers feel? Overall relevance and coverage?
Overall, the course was considered relevant by the participants and reviewers. The course was seen as
helping participants understand the language used by the World Bank in reforming health systems, and
this common understanding of technical language assisted the participants to discuss common problems.
Reviewers agree that the course is relevant, and that the next one should run for up to two weeks and be
more tailored to the Pacific context.
2. What skills gaps exist?
It was noted that there is a need to more clearly specify the intended audience for the course. This time,
the course was advertised as suitable for a range of government and health professionals. A wide
audience attended, and the content didn’t always match people’s skill levels/types. The course content
should vary according to the target audience.
A limited understanding by some presenters of the Pacific context was another gap. Presenters who can
both deliver the course and who understand the Pacific context would be ideal.
Reviewers noted that learning about health systems theory is not enough to enable change. Is there
scope within the <strong>Flagship</strong> course to assist in moving from knowledge to implementation? One suggestion
is that the presenters work closely in developing the course with partners who understand the context and
can add more practical content.
3. Length of future course? Frequency of the course
Reviewers agreed with participant feedback that in order to cover the <strong>Flagship</strong> framework sufficiently, a
longer course is needed. However, it is important to first be clear about the content that needs to be
covered, and then consider the length. The maximum length for a course would be 2 weeks. It is
suggested that a train-the-trainers course could be held, and a 1 week course for senior Ministry of Health
personnel. It was noted that agencies providing funding for attendees should have clear criteria for
participant selection.
4. Preferred modes of delivery and learning approaches?
Reviewers agreed with participant feedback that a participatory teaching style is preferred with lots of
discussion, short classroom-style presentations, sharing of experiences and a balance of theory and
practical. <strong>Course</strong> coordinators suggested that discussions need to be focused and that case studies must
clearly relate to the theory. Building up a library of regionally specific cases is a worthwhile investment
and can be material for the next course. There was strong participant feedback that presentations must
be shorter than they were this time. Material could be broken up into shorter sessions. For example, one
45-minute lecture, followed by group work, then case studies taken home and discussed the next morning.
5. Which sessions should be included?
All sessions were considered useful.
6. Which new sessions could be included?
- Public and private partnerships
- National Heath Accounts
- Sector-Wide Approaches
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- Human resource management
- WHO framework
- Managing donor funds
7. How should the course be made more relevant to Pacific Island Countries?
Suggestions by participants and reviewers for making future courses more relevant to Pacific Island
Countries included:
- Increased Pacific examples within presentations;
- More opportunities for participants to share their experiences ;
- Some people suggested splitting the course participants into country groups or countries that are
similar, or even running separate courses for each country. However, through discussion it was
agreed that sharing learning between countries is useful;
- FSMed as coordinating centre;
- Using Alumni to engage people; and
- Establishing a Pacific Network for Health Systems Strengthening.
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4 Annexes
4.1 Timetable / Program
Sunday 13th
08:30 –
10:00am
10:00 –
10:15am
10:15am –
12:00
12:00 –
1:00pm
1:00 –
2:30pm
2:30 –
2:45pm
2:45 –
4:30pm
June
4:00pm
Opening
Welcome from
FSM and opening
address by WHO
representative
(15mins)
<strong>Course</strong>
Introduction (1hr
30mins)
Presenter:
Leonardo Cubillos
Pacific Context:
Challenges for
Health Systems
(1hour 15 mins)
Presenter: Phillip
Davies
Monday 14th June Tuesday 15th June Wednesday 16th
June
Introduction to the Introduction to 5 Allocative
Cycle of Reform Policy ‘Control Efficiency in Health
Presenter: Shanlian Knobs’
Presenter: Rohan
Hu
Presenter: Shanlian Sweeney
Hu
Health system and its
ultimate and
Intermediate Goals
Presenter:
Chanetwallop
Nicholas Khumthong
Market and Market
Failures/ Government
and Government
Failures
Presenter: Mahendra
Reddy
2.45pm
Group work #1:
Diagnostic Tree with
an example, also
looking at market and
government failures
that may explain their
health system
problems.
Facilitator: Shanlian
Hu
Introduction to
Financing control
knob (various forms
of financing, including
tax revenue, user
fee, etc. introduced)
Presenter: Winnie
Yip
Social Health
Insurance: theories,
implementation,
international
experience and.
Presenter: Peter
Annear
Case study: Fiji’s
plan - Graham
Roberts.
2.45pm
Group work #3:
Alternative financing
options for improving
their health system
Facilitator: Shanlian
Hu & Winnie Yip
Resource
allocation: Equity,
Targeting and
Reaching the poor
Presenter: Peter
Annear
Introduction to
Payment Incentive
control knob
Presenter: Winnie
Yip
2.45pm
Group work #4:
Alternative provider
payment method
for improving their
health system
Facilitator:
Shanlian Hu, &
Winnie Yip
7:00pm
Welcome Dinner
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PROGRAMME FOR THURSDAY 17 th June
Time
8:30AM – 10:00AM
Session
National Health Accounts
Presenter: Leonardo Cubillos
10:00 – 10:15AM Morning Tea
10:15AM – 11:45AM Group Presentations from Groups 1, 3 and 5
Each group is allowed 10 minutes for presentation and then 10 minutes for
comments and questions (total of 20 mins for each group)
11:45AM – 12:45PM
Lunch
12:45 – 2.15PM Group Presentations from Groups 2, 4 and 6
Each group is allowed 10 minutes for presentation and then 10 minutes for
comments and questions (total of 20 mins for each group)
2:15 – 2:45PM Voting on Presentations
<strong>Course</strong> Evaluation
2:45 – 3:45PM Entertainment Performances from Groups
3:45 – 4:15PM Closing Ceremony:
Presentation of Certificate
Prize-giving for Presentations
Closing remarks from World Bank Institute; Nossal Institute for Global Health;
and Fiji School of Medicine.
4:15PM Onwards
Afternoon Tea
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4.2 List of Participants, Presenters, and Secretariat
Given Name Family Name Country Organisation
Email Address
(currently
residing)
Viran Tovu Vanuatu MoH vtovu@vanuatu.gov.vu
Ielemia Laloi Tuvalu Government of Tuvalu lkapua@gov.tv
Ika Viliami Tonga MoH vika@health.gov.to
Carl
Susuairara
Solomon
Islands MoH csusuairara@moh.gov.sb
Lester Ross
Solomon
Islands MoH lross@moh.gov.sb
Tenneth Dalipanda
Solomon
Islands MoH tdalipanda@gmail.com
Kwabena Larbi
Solomon
Islands WHO larbik@wpro.who.int
Christine Saaga Samoa
Ministry of Foreign
Affairs and Trade, New
Zealand
Christine.Saaga@nzaid.govt.nz
Gaualofa Matalavea Samoa MoH gaualofam@health.gov.ws
Adele Keil Samoa MoH adelek@health.gov.ws
Sina Faaiuga Samoa MoH sinaf@health.gov.ws
Elva Lionel PNG MoH elva_lionel@health.gov.pg'
Ellen Kulumbu PNG World Bank ekulumbu@worldbank.org
Lara Studzinski
New
Caledonia
Secretariat of the Pacific
Community
LaraS@spc.int
Riwata Obetaia Kirabati MoH robetaia@gmail.com
Kenneth Tabutoa Kirabati MoH rose_sanree@yahoo.com
Marutaake Karawaiti Kirabati MoH mkarawaiti@gmail.com
Martina Pellny Fiji WHO pellnym@wpro.who.int
Monica Fong Fiji WHO fongm@wpro.who.int
Khan Idrish Fiji MoH ikhan001@health.gov.fj
Tudravu Jemesa Fiji MoH jemesa.tudravu@govnet.gov.fj
Cevamava Eroni Fiji MoH ecevamaca@health.gov.fj
Laite Cavu Fiji MoH laitec@govnet.gov.fj
Sisalo Otealagi Fiji MoH sotealagi@govnet.gov.fj
Peter Zinck Fiji UNFPA zinck@unfpa.org
Kamal Kishore Fiji Fiji National University kamal.kishore@fnu.ac.fj
Paraniala
Silas Lui Fiji Fiji National University Paraniala.lui@fnu.ac.fj
Jalal Mohammed Fiji Fiji National University jalal.mohammed@fnu.ac.fj
Berlin Kafoa Fiji Fiji School of Medicine berlin.kafoa@fnu.ac.fj
Paulini Sesevu Fiji AusAID Paulini.Sesevu@dfat.gov.au
Margaret Logavatu Fiji AusAID Margaret.Logavatu@dfat.gov.au
Lesu Waqaniburotu Fiji AusAID Lesu.Waqaniburotu@dfat.gov.au
Salaseini Tamani Fiji
Secretariat of the Pacific
Community
SalaT@spc.int
Robert Verebasaga Fiji
Secretariat of the Pacific
Community
RobertV@spc.int
Wayne Irava Fiji Fiji School of Medicine Wayne.Irava@fnu.ac.fj
Graham Roberts Fiji Fiji School of Medicine g.roberts@fsm.ac.fj
George Malefoasi Fiji SPC georgem@spc.int
Juliet Fleischl Fiji WHO fleischlj@wpro.who.int
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Federated
Emi
Chutaro
States of
Micronesia
Secretariat of the Pacific
Community
emic@spc.int
Rachel Musson Australia
South Eastern Sydney
and Illawarra Health
Service
Rachel.Musson@health.nsw.gov.au
Susan Ivatts Australia World Bank sivatts@worldbank.org
Rob Condon Australia Consultant rob.condon@bigpond.com
John Dewdney Australia UNSW z6701273@unsw.edu.au
Presenters
Mahendra Reddy Fiji
University of the South
Pacific
mahendra.reddy@fnu.ac.fj
Phillip Davies Australia UQ p.davies@sph.uq.edu.au
Winnie Yip China WBI Winnie.Yip@dphpc.ox.ac.uk
Shanlian Hu China WBI hushanlian@hotmail.com
Chanetwallo
p Nicholas Khumthong Thailand WBI cnkhumthong@gmail.com
Leonardo Cubillos USA WBI lcubillosturriag@worldbank.org
Rohan Sweeney Australia Nossal rsweeney@unimelb.edu.au
Peter Annear Australia Nossal pannear@unimelb.edu.au
Secretariat
Amanda Benson Australia Nossal abenson@unimelb.edu.au
Setita Naqelevuki Fiji Fiji School of Medicine setita.naqelevuki@fnu.ac.fj
Nola Vanualailai Fiji Fiji School of Medicine nola.mahevanuai@fnu.ac.fj
Amele Sotia Fiji Fiji School of Medicine
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4.3 Speech by WHO regional representative
Chief Guest Dr Chen Ken – WHO regional representative
Firstly, I would like to welcome you all to Fiji – in particular I welcome the coordinators of this important
program. I also welcome participants from Vanuatu, Tuvalu, Samoa, Papua New Guinea, Kiribati, Nauru,
Federated States of Micronesia, Australia and Fiji. We have a truly ‘Pacific flavor’ to the venue, and the
participants. Their participants from national Ministries of Health, UN Agencies, donor agencies and
academic institutions present a truly sectoral approach to addressing health sector issues of reform and
financing.
This is a landmark opportunity for us in this region – it is the first time the course has been offered in the
Pacific – so it’s a great honour for Fiji and for the Fiji School of Medicine to host this course. The course
has been organized through a partnership of the World Bank Institute, The Asia Network for Health
Systems Strengthening, Fiji School of Medicine and the Nossal Institute for Global Health at the
University of Melbourne. I might mention that the Fiji School of Medicine is celebrating its 125 anniversary
this year – reportedly the oldest institution in Fiji.
This <strong>Flagship</strong> course will therefore feature in the activities of this important celebratory year for the Fiji
School of Medicine. FSMed will be proud of this achievement. The <strong>Flagship</strong> course is well known among
the UN Agencies and the donor community. It has a reputation for assisting the diagnosis of health
systems issues and presenting a context specific policy approach to management.
The course is not prescriptive – it presents a framework for describing the health system as it is and
identifying ways to develop tools and policy options for improving the system. In short, it assists in
analyzing health system challenges and opportunities and develops and critiques policy options for
improvements. I expect that the participants are keen to learn from this experience – as the challenges
we have are not easily resolved – as you will see - and the approaches we have used in the past have
not always been successful. So we are keen to learn and to contribute in group work.
The topics of Reform, Achievable Goals, Health Financing, Social Health Insurance, Resource allocation,
Efficiency and Equity, and Market issues will be the areas on which the concept of ‘control knobs’ is
developed – a method of visualizing our management policy responses to these issues.
I wish the participants well in this course and anticipate that the <strong>Flagship</strong> <strong>Course</strong> facilitators will achieve
their objectives. Please enjoy Suva – you have beautiful location for the course here at the Novotel – so
we anticipate positive outcomes and strengthened relationships and networks. Indeed this is one of the
benefits of working regionally – we are all dealing with the same issues and there is no need to struggle in
isolation – this network – the one that you form this week – will be important as you share your stories
and work towards common successes. I wish you a productive and happy week here in Suva.
Thank you
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