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DRPS : Course Catalogue : School of Social and Political Science : Postgrad (School of Social and Political Studies)

Postgraduate Course: Health Systems: Strengthening and Reform (PGSP11364)

Course Outline
SchoolSchool of Social and Political Science CollegeCollege of Arts, Humanities and Social Sciences
Credit level (Normal year taken)SCQF Level 11 (Postgraduate) AvailabilityAvailable to all students
SCQF Credits20 ECTS Credits10
SummaryThis course examines health systems strengthening and reform initiatives in developed and developing countries, providing the knowledge and skills required to evaluate health sector policies with respect to their consequences for goals such as equity, efficiency and quality.

In many developed countries, there is a shift away from unified public financing and delivery of health care towards private finance and governance through competitive markets. Processes of privatisation and marketisation are increasingly widespread, as policy-makers aim to reduce health care costs (particularly those borne by the state) while maintaining or improving the standards of care. Such reform programmes have been given new impetus as governments reduce the size and cost of the public sector in response to the economic crisis. They involve the private sector directly in resource allocation decisions, and can have a major impact on the efficiency, accessibility and quality of health care services provided.

However, this course examines a broader range of reform programmes. Taking place alongside market-oriented programmes in high-income countries are reforms in the developing world that reverse a generational trend of state retrenchment, and are focused directly on broadening access to financial protection and to needed care. The move towards strengthening primary care provision is an important case study in this context. We also consider initiatives at the global level, many of which aim to address significant disease burdens through expanding the influence of commercial and civil society actors in health systems. Partnerships such as the Global Fund against AIDS, Tuberculosis & Malaria and the Global Alliance for Vaccines & Immunisation provide a focus for empirical evaluation here.
Course description This course aims to provide students with the knowledge and skills required to evaluate critically health system strengthening and reform efforts in any region of the world -across developed and developing countries-with respect to the consequences for social objectives.

By the end of the course, each student is expected to have:

- a critical understanding of the recent history of reform, in particular the role of the World Bank and IMF in processes of fiscal consolidation and structural adjustment;

- an ability to evaluate critically the ability of public sector health agencies to provide universal health coverage - financial protection and equitable access to health care;

- an ability to evaluate critically the impact of global health actors on the capacity of health systems to address public health need and address health inequalities; and

- a critical understanding of the role of the private sector in the healthcare sector, e.g. via contracts with state purchasers and through public-private partnerships.

Outline content

The course is organised around 10 sessions covering three broad areas of health systems policy debate: the role of international actors; approaches to achieving equity in health systems; and managing markets for health-related products and services.

The course is taught by a combination of lectures, seminars and online discussion fora. In general, each topic is introduced via one 50 minute lecture and is then explored in greater depth in seminars or online. Students are expected to complete essential readings before attending seminars or posting their contributions to the discussion fora, and have the opportunity to receive formative feedback on their contributions throughout the course period.
Entry Requirements (not applicable to Visiting Students)
Pre-requisites Co-requisites
Prohibited Combinations Other requirements None
Information for Visiting Students
High Demand Course? Yes
Course Delivery Information
Academic year 2023/24, Available to all students (SV1) Quota:  42
Course Start Semester 2
Timetable Timetable
Learning and Teaching activities (Further Info) Total Hours: 200 ( Lecture Hours 20, Programme Level Learning and Teaching Hours 4, Directed Learning and Independent Learning Hours 176 )
Assessment (Further Info) Written Exam 0 %, Coursework 100 %, Practical Exam 0 %
Additional Information (Assessment) Assessment will be based on two components:
1) Input to online discussion fora. Students to submit a portfolio of contributions to course discussions, comprising three short written reflections on readings and three examples of engagement in online discussions (30%)
2) Written essay of 3,000 words (70%).
Feedback Feedback on the discussion forum contributions that make up the portfolio component of the assessment will occur throughout the course period. In addition, verbal feedback is provided during the seminars. These sessions include the opportunity for students to seek guidance and feedback on their planned approach to the assessed essay.
No Exam Information
Learning Outcomes
On completion of this course, the student will be able to:
  1. A critical understanding of the recent history of reform, in particular the role of the World Bank and IMF in processes of fiscal consolidation and structural adjustment.
  2. An ability to evaluate critically the ability of user fee-reduction and/or elimination programmes to provide financial protection and equitable access to health care and to evaluate critically the impact of Global Health Initiatives on the capacity of health systems to address public health need and address health inequalities.
  3. A critical understanding of the role of innovative financing mechanisms in addressing disease burdens, and the impact of such mechanisms on wider strengthening efforts.
  4. An ability to evaluate critically reforms in high- and middle-income economies without universal health systems to expand financial protection and improve access.
  5. A critical understanding of the role of the private sector in the delivery of health care services, via contracts with state purchasers and through public-private partnerships.
Reading List
- Saltman et al (Eds) (1998), Critical challenges for health care reform in Europe. Buckingham: Oxford University Press.
- Yip and Hsiao (2009), 'China's health care reform: A tentative assessment', China Economic Review, Vol. 20, pp. 613¿619.
- Macinko J, Guanais FC, de Fátima M, de Souza M. (2006), 'Evaluation of the impact of the Family Health Program on infant mortality in Brazil, 1990-2002', Journal of Epidemiology and Community Health, Vol.60, pp. 13-19.
- Cutler (2002), 'Equality, efficiency, and market fundamentals: the dynamics of international medical care reform'. Journal of Economic Literature; 40: 881-906.
- Stuckler, Basu and McKee (2011). 'The International Monetary Fund and Aid Displacement', International Journal of Health Services, 41 (1), 67-76.
- Nabyonga Orem et al (2012), 'Abolition of user fees: the Uganda paradox', Health Policy and Planning, 26:ii41-ii51.
- Yates R. (2009), 'Universal health care and the removal of user fees'. Lancet, Vol. 373: pp. 2078-2081.
- Biesma R, Brugha R, Harmer A, Walsh A, Spicer N, Walt G (2009), 'The Effects of Global HIV/AIDS Initiatives on Country Health Systems: A Review of the Evidence', Health Policy and Planning, 24(4) 239-252.
- Hanson et al (2008), 'Is private health care the answer to the health problems of the world's poor?' PLoS Medicine, Vol.5 (11), pp. 1528-1532.
- Basu et al (2012), 'Comparative performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: a Systematic Review', PLoS Medicine, Vol.9 (6), online.
- Hollingsworth (2008), 'The measurement of efficiency and productivity of health care delivery'. Health Economics, Vol. 17: pp. 1107-1128.
- Sehkri, N., Feacham, R. and Ni, A. (2011). ¿Public-private integrated partnerships demonstrate the potential to improve health-care access, quality, and efficiency¿, Health Affairs, 30(8): 1498¿1507.
Additional Information
Graduate Attributes and Skills Not entered
KeywordsNot entered
Course organiserDr Emily Adrion
Tel: (0131 6)51 3871
Course secretaryMrs Casey Behringer
Tel: (0131 6)50 2456
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