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Health Systems: Goals, Functions, Actors

Course description
Course Title
Health Systems: Goals, Functions, Actors
Course code

HSRM 551

Teaching/learning methods

Lectures and Group work

Assessment methods

Exam questions + group work presentation
Credit points

Semester (1 / 2)


Course objectives/ Learning outcomes:

The aim of the course is to enable students to systematically understand, analyse and evaluate heath systems in different countries of the world. The course will introduce the main frameworks, concepts, and ideas of international health systems research to lay the theoretical foundations for students to work in this field. It will highlight links to other courses of the MPH/MPhil programme. In addition, students will be expected to use the theoretical concepts to illustrate and analyse the functioning of health systems in different regions of the world.


Length of course

Block course for 2 weeks

2019, Sept 24th

2019, Oct 3rd

SPH combined class (in the School of Medical Sciences (SMS) building)

Wilm Quentin & Daniel Opoku (TU Berlin)

Course coordinator

Daniel Opoku (TU Berlin), Emmanuel Appiah-Brempong (KNUST)

The course provides a structured overview of the main building blocks and goals of health systems, following the health systems framework of the World Health Organization (WHO). Following a general introduction, the first part of the course covers (1) health systems financing (briefly), (2) workforce, (3) service delivery, (4) medical Products, vaccines and technologies, (5) leadership/governance. The second part focuses on the goals of health systems, including intermediate goals (access/coverage, quality/safety) and final goals (improved health, responsiveness, social and financial risk-protection, and improved efficiency). The course consists of lectures and exercises with group work, where students use the introduced concepts to analyse health systems in various countries.



Examination will be based on group presentation (20%) + written mid-term exam (20%) and written final exam (60%).

Grading system

Fail = below 50%
Grade C = 50% – 59%
Grade B = 60% – 69%
Grade A = 70% and above  



Lecture/topics/subjects/academic catalogue:

Subject (Time)
Introduction, expectations, groups [1]
Frameworks 1 [2]
Frameworks 2/ Financing 1 (triangle) [3]
Financing 2 + 3 [4]

Health workforce [5]
Information [6]
Service delivery [7]
  Medical products and technologies [8]
Group work (triangle Ghana health system)
Leadership, governance, stewardship [9]
  Preliminary summary [10]
Group work presentation (graded)
Access and coverage [11]
Group work (access, coverage – Ghana health system in cube) Quality and safety [12]
Improved health [13]
  Financial protection and equity in financing [14]
Group work (health system goals, ranking, weighting)

Self-study for mid-semester exam

Efficiency and responsiveness [15]
  Health system performance assessment (summary) [16] Mid-term exam (30 min) + final questions

Departure of non-KNUST students

1st Semester – Week 1
08:00 - 10:00

Public Holiday + Arrival of non-KNUST student participants
 Frameworks 2/Financing (triangle)
Service delivery

10:30 - 12:30
Medical products and technologies
13:00 - 15:00
Introduction, expectations, groups

Health workforce
Group work (triangle Ghana health system)
Leadership/ governance   
15:30 - 17:30
Frameworks 1

 Optional supervised group work

Preliminary summary
1st Semester – Week 2
08:00 - 10:00
Improved health

Efficiency and responsiveness
Departure of non-KNUST student participants
10:30 - 12:30
Access and coverage
Financial protection and equity in financing
Health system performance assessment (summary)
13:00 - 15:00
Group work (access, coverage – Ghana health system in cube)
Group work (health system goals, ranking, weighting)
15:30 - 17:30
Group work presentation (graded)

Quality and safety
Self-study for mid-semester exam
 Mid-term exam (30 min) + final questions




Literature (required/additional readings)

Introduction and frameworks

Papanicolas I (2013). International frameworks for health system comparison. In I. Papanicolas & P. C. Smith (Eds.), Health System Performance Comparison. An agenda for policy, information and research, pp. 31-75. Berkshire: Open University Press.

World Health Organization (2000). World Health Report Health systems: improving performance. Geneva: WHO Document Production Services. http://www.who.int/whr/2000/en/ [17]

World Health Organization (2007). Everybody’s business: Strengthening health systems to improve health outcomes. WHO’s framework for action. Geneva: WHO Document Production Services. http://www.who.int/healthsystems/strategy/everybodys_business.pdf [18]


Health care financing

Thomson S., Foubister T., Mossialos E. (2009.) Health care financing in the European Union. In S. Thomson, T. Foubister, E. Mossialos (Eds.), Financing health care in the European Union. Challenges and policy responses, pp. 23-26. Copenhagen. http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm [19] 

Kutzin J. (2008). Health financing policy: a guide for decision-makers. Health financing policy paper. Copenhagen: WHO Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0004/78871/E91422.pdf [20]

Mills A (2014). Health Care Systems in Low- and Middle- Income Countries. The New England Journal of Medicine 370 (6): 552-557 http://www.nejm.org/doi/full/10.1056/NEJMra1110897#t=article

World Health organization (2010). Health Systems Financing. The path to universal coverage. Geneva: WHO Press. Retrieved from http://www.who.int/whr/2010/10_summary_en.pdf?ua=1 [21].

Busse R. Figueras, J., Robinson R., & Jakubowski E. (2007). Strategic purchasing to improve health system performance: key issues and international trends. HealthCare papers, 8, 62-76. https://www.mig.tu-berlin.de/fileadmin/a38331600/2007.publications/HP_vol8_SpIssue_busse_purchasing.pdf [22]

Mathauer I, Dale E, Meessen B. Strategic purchasing for Universal Health Coverage: key policy issues  and  questions.  A  summary  from  expert  and  practitioners’  discussions  Geneva:  World  Health  Organization; 2017. http://apps.who.int/iris/bitstream/10665/259423/1/9789241513319-eng.pdf [23]

Ellis, R. P. & Miller, M. M. 2009. Provider Payment Methods and Incentives. In: CARRIN, G. (ed.) Health systems policy, finance, and organization. Amsterdam: Elsevier Academic Press:

Kronick R, Casalino LP, Bindman AB (2015): Introduction. Apple Pickers or Federal Judges: Strong versus Weak Incentives in Physician Payment. Health Serv Res. 2015 50(2):2049-56

Mathauer I, Wittenbecher F (2013): Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries. Bulletin of the World Health Organization 2013;91:746-756A. doi: dx.doi.org/10.2471/BLT.12.115931 [24]

Quentin, W., D. Scheller-Kreinsen, M. Blumel, A. Geissler and R. Busse (2013). "Hospital payment based on diagnosis-related groups differs in Europe and holds lessons for the United States." Health Aff (Millwood) 32(4): 713-723.



Sidibé M, Campbell J (2015) Reversing a global health workforce crisis. Bulletin of the World Health Organization, Geneva: 93:3. Available at: http://www.who.int/workforcealliance/media/news/2015/reversing_crisis/en/ [25]

The Economist (2012). Squeezing out the doctor. The role of physicians at the centre of health care is under pressure. Retrieved from http://www.economist.com/node/21556227 [26].

The Guardian (2014). Task shifting explained: a viable solution to health worker shortage?, Retrieved from https://www.theguardian.com/global-development-professionals-network/2014/may/12/task-shifting-health-development-shortage [27].


Leadership and governance

Greer L S., Wismar M., Figueras J. (2016). Strengthening Health System Governace. Better policies, stronger performance. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0004/307939/Strengthening-health-system-governance-better-policies-stronger-performance.pdf [28].

Busse R., von der Grinten T., Svensson P. (2002). Regulating entrepreneurial behaviour in hospitals: theory and practice. In Saltman R. B., Busse R., & Mossialos, E. (Eds.), Regulating entrepreneurial behaviour in European health care systems, pp. 126-146. Buckingham: Open University Press.



Masseria C., Irwin R., Thomson S., Gemmill M. & Mossialos E. (2009). Primary care in Europe. Policy brief. Retrieved from https://lms.fu-berlin.de/bbcswebdav/pid-3266487-dt-content-rid-5323452_2/courses/CUB_BSPH_Sem2_HPE1/LSE%20%282009%29%20Primary%20care%20in%20Europe_policy%20brief.pdf [29].

OECD (2017). Health at a Glance 2015: OECD Indicators. Paris: OECD Publishing. Retrieved from http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm [30]


Medical products and technologies

Panteli D, Arickx F, Cleemput I, Dedet G, Eckhardt H, Fogarty E, Gerkens S, Henschke C, Hislop J, Jommi C, Kaitelidou D, Kawalec P, Keskimäki I, Kroneman M, Lopez Bastida J, Pita Barros P, Ramsberg J, Schneider P, Spillane S, Vogler S, Vuorenkoski L, Wallach Kildemoes H, Wouters O, Busse R. (2016). Pharmaceutical regulation in 15 European countries: Review. Health Systems in Transition, 18(5):1–118, http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/special-edition-pharmaceutical-regulation-in-15-european-countries-2016 [31].


Coverage and access

World Health Organization (2013). Research for Universal Health Coverage. Available at: http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf?ua=1 [32]

Evans B. D., Hsu J., Boerma T. (2013). Universal health coverage and universal access. Bulletin of the World Health Organization, 91, 546-546A. doi: http://dx.doi.org/10.2471/BLT.13.125450 [PDF] [33]

Cotlear, D., Nagpal S., Smith O., Tandon A., Cortez R. (2015). Going Universal: How 24 Developing Countries are Implementing Universal Health Coverage Reforms from the Bottom Up. Washington, DC: World Bank.



Legido-Quigley H., McKee M., Nolte E., A Glinos I. (2008). Quality of care: an overview. In Legido-Quigley H., McKee M., Nolte E., A Glinos I. (Eds.), Assuring the quality of health care in the European Union, pp. 1-15. Geneva: WHO Press.


Financial protection

Moreno-Serra R., Millett C., Smith P. C. (2011). Towards improved measurement of financial protection in health. PLoS Med, 8(9), e1001087.

Saksena P, Hsu J, Evans DB (2014) Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges. PLOS Medicine 11(9): e1001701. https://doi.org/10.1371/journal.pmed.1001701 [34]

Thomson S., Figueras J., Evetovits T., Jowett M., Mladovsky P., Maresso A., Cylus J., Karanikolos M., Kluge H. (2014). Economic crisis, health systems and health in Europe: impact and implications for policy. Policy summary. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/257579/Economic-crisis-health-systems-Europe-impact-implications-policy.pdf?ua=1 [35].


Improved Health

Murray, C. J., Salomon, J. A., & Mathers, C. (2000). A critical examination of summary measures of population health. Bulletin of the World Health Organization, 78(8), 981-994. http://apps.who.int/iris/bitstream/10665/57524/1/99-0102.pdf [36]

Mackenbach, Johan P., et al. "Using ‘amenable mortality’as indicator of healthcare effectiveness in international comparisons: results of a validation study." J Epidemiol Community Health (2012): jech-2012. https://www.researchgate.net/publication/231212106_Using_'Amenable_Mortality'_as_Indicator_of_Healthcare_Effectiveness_in_International_Comparisons_Results_ [37]

of_a_Validation_Study [38]



Cylus, J., Papanicolas, I., & Smith, P. C. (2016). A framework for thinking about health system efficiency. Health System Efficiency, 1. http://www.euro.who.int/__data/assets/pdf_file/0004/324283/Health-System-Efficiency-How-make-measurement-matter-policy-management.pdf?ua=1#page=24



Busse, R. (2013). Understanding satisfaction, responsiveness and experience with the health system. Health System Performance Comparison: An Agenda for Policy, Information and Research, 255-80. http://www.euro.who.int/__data/assets/pdf_file/0009/244836/Health-System-Performance-Comparison.pdf [39]


Health System Performance Assessment

Papanicolas I, Smith P (2013): Health system performance comparison: an agenda for policy, information and research. Policy summary , 4 . Open University Press, Maidenhead, UK. http://eprints.lse.ac.uk/54802/1/__libfile_REPOSITORY_Content_Papanicolas,%20I_Health%20system%20performance_Papanicolas_Health%20 [40]

system%20performance_2013.pdf [41]

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