For over a decade, the World Bank Institute has been designing tools for health care policy makers, providing training in over 50 countries.Â
Carefully selecting local partners has been crucial in building capacity at the regional and national levels, as they bring technical expertise on local and regional health issues and strategic capacity to influence change.
Demand for training has increased dramatically over the last ten years, and high satisfaction ratings show that the program has helped create a common language among diverse stakeholders and reached key people in Ministries of Health.
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April 7, 2009 —Â Health care is a public policy lightning rod, fraught with complexity, controversy, and tough choices. To make the right choices, policymakers need the right tools. For nearly 12 years, the World Bank Institute has helped provide these tools in more than 50 countries.
Through its Flagship Program in Health Sector Reform and Sustainable Financing, the World Bank Institute (WBI) has nurtured networks and communities of practitioners across 100 countries, and since 1997 has delivered more than 314 learning activities for nearly 19,000 policymakers, health managers, NGOs, academicians, donors and Bank staff. The program has also helped national institutions become centers of excellence as knowledge brokers on health systems development.
Group work in Egypt
Designing for Success
The program dates back to the mid-1990s, when a burgeoning interest in health financing reform prompted a number of donors to ask WBI to develop a capacity-building program for low- and middle-income countries. Recognizing that top-down “knowledge transfer” was yielding mixed results, WBI set out to design a program that would help country clients compare and share perspectives on how to improve performance, develop their own regional and local training capacities, and foster an evidence-based approach to reforms.
“The plan was ambitious,” says Paul Shaw, a former WBI staffer and program founder. “It involved developing and delivering a global course once a year at Bank headquarters using state of the art learning materials; six yearly regional courses; country-specific courses on priority themes; distance learning activities through videoconferencing, and then later a web-based learning program.”
A year-long consultation with donors, government officials, training institutions, and Bank staff helped shape the program. A key objective was to make sure that WBI’s activities matched and supported the Bank’s operational lending in countries.
“We didn’t just jump in and start lecturing, because it was clear that one size did not fit all,” says Hadia Samaha, WBI Senior Operations Officer. “And with only 6 staff on our health team we knew we couldn’t do it alone. So we created an internal advisory group of Bank task team leaders and sector managers from all the regions. We also set up an external advisory group with leading training institutions and consulting firms that had  practical experience with health systems in client countries. Harvard University, York University, Bitran y Asociados, for example.”
A video conference lecture in the Philippines
Leveraging Strategically
Within two years after the program was launched with a "global core course" at Bank headquarters, six regional implementation partners were co-delivering the same course, with variations, around the world. They took the lead in translating and adapting course materials to local conditions, preparing case studies, enlisting local experts, and identifying the right participants. The China Health Economics Network, Chulalongkorn University, Bitran y Asociados, the American University of Beirut, Capetown and Witswatersrand Universities, and Semmelweis University were covering Africa, Asia, Central and Eastern Europe, and the Middle East.
These carefully selected partners have been the driving force in building capacity at the regional and national levels. They had the technical expertise on local and regional health issues; the strategic capacity  to influence change; and a willingness to deliver training wherever it was needed.Â
Since 1999, the American University of Beirut has delivered 12 regional flagship courses to 457 leading health professionals from the Middle East and Northern Africa, and has collaborated on 14 national courses reaching some 560 health professionals in Iran and Egypt.
The China Network for Training and Research in Health Economics and Finance includes 27 network-affiliated Chinese universities and colleges. In 10 years, the China Network has delivered 34 national Flagship courses to almost 2,500 health officials and today it operates a fully-fledged flagship learning program at the national level.
Country-specific intensive training activities tackle topics of immediate policy relevance. In Iran, courses have been designed and delivered for nearly 350 health officials and managers; and materials were translated into Farsi and disseminated to more than 2,000 health workers at provincial and district levels.
“Without WBI support through training of trainers, content development, and continuous hands-on capacity building, the Flagship Program’s partner at Semmelwies University would not be an internationally recognized training institute in Central and Eastern Europe and beyond,” notes Tamas Evetovits, Senior Finance Specialist at WHO/EURO and former Flagship Coordinator at the Health Services Management Training Center.
These country-specific capacity building programs, jointly designed and delivered with Bank staff and country counterparts, are always closely aligned with Bank project implementation: training project staff on relevant topics and updating them on new policy approaches. Programs in Bangladesh have reached 224 participants, Egypt (335), India (361), Philippines (280), Turkey (617), Russia (202), Indonesia (80), and Senegal (120).
Having fun with a group project
Getting Results
Demand for flagship training has increased dramatically over the last ten years with strong and often oversubscribed enrollment. Satisfaction ratings show that more than 80 percent of alumni believe the course is directly relevant to their work.
In a  tracer study, 100 high-level state and federal officials from India said they felt that the program had created a common language among diverse stakeholders, trained hundreds of managers in key provinces, and reached politically important people in the Ministries of Health. Noted one participant: “After this training, I vigorously pursued the policy changes in the Health Department and I successfully changed the payment system to service providers from a fixed salary system to a salary plus performance-based incentive system.”
Managers of the China Health Economic Network claim that collaboration with the flagship program has helped raise network membership from an original seven institutions to twenty-seven today, and has resulted in the training of more than 1,400 ministry executives and more than 700 academics and trainers.Â
A cohort of Russian graduates
Looking Ahead
In recent consultations, alumni, partners, and Bank operational staff in the regions all agreed that health systems have evolved, highly complex challenges persist, and clients are more demanding than ever on the “how to do it” of health reform.
“I joined WBI last October and have had the privilege of seeing more closely what the Bank has accomplished in building country capacity to strengthen health systems,” says Maria-Luisa Escobar (Lead Economist and Health Program Leader in WBI. “I found that WBI had developed and implemented a comprehensive knowledge exchange and capacity-building strategy in client countries. Results show that the strategy has paid off. Now it‘s time to reflect on how it can be sustained and improved to continue addressing client needs in an ever changing global environment.”
WBI, the Bank's Health, Nutrition, and Population team, and external partners are updating the program with case studies and cutting edge technical tools. And to meet strong demand in Asia, WBI has started to build an Asian network of institutions to promote south to south knowledge exchange and the local design and delivery of flagship activities.
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