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Online course

Introduction to the Health Systems Course

Future Health Systems

This is a 10 unit short course developed by David Bishai of Johns Hopkins University and the Health Systems Board under the sponsorship of Future Health Systems.


Health systems (plural) are the overlapping institutions that determine how a population organizes preventive and curative activities to guard health and cure disease.  Health systems are to the maintenance of population health similar to what organ systems are to the health of the human body.  There are multiple systems and breakdown of one affects the breakdown of others.   Health systems deploy health workers, drugs, facilities, financing, and governance.   Like organ systems, health systems break down in predictable patterns and lead to syndromes that can be diagnosed and addressed.

Dysfunctional health systems are why thousands of effective low-cost health interventions remain on the shelves while people suffer and die.  Dysfunctional health systems leave people vulnerable to financial catastrophe.  Failure to manage health resources judiciously permits not just waste, but the delivery of inappropriate or harmful services.  While many lament how little research addresses the development of “new cures” for the diseases of the poor, the inexcusable tragedy is the world’s failure to deliver affordable and effective “old cures” to treatable and preventable diseases.  Diarrhea, pneumonia, TB, malaria, are all easily and cheaply treatable. Their persistence around the world is a testament to failed health systems more so than a lack of scientific prowess.


  1. The Building Blocks of Health Systems
  2. Agents, Units, Institutions
  3. Service Delivery
  4. Health Workforce
  5. Quality and Governance
  6. Financing 1 - Introduction to health insurance
  7. Financing 2 - Social and private insurance
  8. Supply chain
  9. Information Systems
  10. The Role of Households in Health Systems
  11. Further reading



 To familiarize students with the syndromic study of  health systems



 Upon completing this course students will be able to:

  • Apply the theory of economic systems to the study of health sytems
  • Distinguish the principal institutions, agents, and units that constitute a nation’s health systems
  • Identify the principal syndromes of dysfunction in health system
  • Critically evaluate promising attempts to manage dysfunctional health systems and how the social and political context can affect reform
  • List ways to engage the policy reform process and how to adapt this process locally


Reading materials

Future Health Systems

  • Carrin, G., E. Gray, et al. (1998). Coping with ill-health in a rickshaw puller's household in Chittagong, Bangladesh. Geneva, World Health Organization
  • Carter, W. B. (1990). Health Behavior as a Rational Process. Health Behavior and Health Education. K. Glanz, F. M. Lewis and B. Rimer. San Francisco, Jossey-Bass: 63-91
  • Donabedian, A. (1978). "The quality of medical care." Science 200(4344): 856-64
  • Eichler, R. and R. Levine (2008). Pay for performance in the private sector. Technical Partners Meeting on the Role of the Private Sector in Health Systems, New York, NY
  • Ford, E. W. and D. P. Scanlon (2007). "Promise and problems with supply chain management approaches to health care purchasing." Health Care Manage Rev 32(3): 192-202
  • Garcia-Prado, A. (2005). "Sweetening the Carrot: Motivating Public Physicians for Better Performance " World Bank Policy Research Working Paper No. 3772 3772
  • Gauthier, B. and W. Wane (2007). Leakage of public resources in the health sector : an empirical investigation of Chad. Washington, DC, World Bank
  • Gertler, P. (2000). Final Report: The Impact of Progresa on Health. Washington, DC, International Food Policy Research Institute 
  • Getzen, T. E. (2007). Health Insurance: The Benefits of Risk Pooling. Health Care Economics. Hoboken, NJ, Wiley: 73-91
  • Global Health Workforce Alliance (2008). The Kampala Declaration: An Agenda for Global Action. Geneva, WHO.
  • Grossman, G. (1967). The System: Institutions and Problems. Economic Systems. Englewood Cliffs, NJ, Prentice-Hall: 15-35
  • Justice, J. (1983). "The invisible worker: the role of the peon in Nepal's health service." Soc. Sci. Med 17(14): 967-70 
  • Kremer, M. (2002). "Pharmaceuticals and the developing world." J Econ Perspect 16(4): 67-90
  • Leonard, K. L. and M. C. Masatu (2007). "Variations in the quality of care accessible to rural communities in Tanzania." Health Aff (Millwood) 26(3): w380-92
  • Mankiw, G. (1997). Ten Principles of Economics. Principles of Economics. Philadelphia, Harcourt Brace: 3-16
  • Mankiw, G. (1997). Thinking Like an Economist. Principles of Economics. Philadelphia, Harcourt Brace: 17-33
  • Oladepo, O., K. Salami, et al. (2007). "Malaria treatment and policy in three regions in Nigeria: The role of patent medicine vendors." FHS Working paper 1, Nigeria Series 
  • Palmer, N., D. H. Mueller, et al. (2004). "Health financing to promote access in low income settings-how much do we know?" Lancet 364(9442): 1365-70
  • Peabody, J. W., O. M. Rahman, et al. (1999). Financing and Allocating Public Expenditures: Leveraging Public Resources to Meet Objectives and Increase Private Participation. Policy and Health: Implications for Development in Asia. New York, Cambridge University Press: 135-184
  • Peabody, J. W., O. M. Rahman, et al. (1999). Toward better equity and access: persistent poverty, inadequate interventions, and the need for better data and solutions. Policy and Health: Implications for Development in Asia. New York, Cambridge University Press: 184-231 
  • Rolfe, B., S. Leshabari, et al. (2008). "The crisis in human resources for health care and the potential of a 'retired' workforce: case study of the independent midwifery sector in Tanzania." Health Policy Plan 23(2): 137-49 
  • Soeters, R., C. Habineza, et al. (2006). "Performance-based financing and changing the district health system: experience from Rwanda." Bull World Health Organ 84(11): 884-9 
  • WHO (2000). World Health Report. Geneva