A number of Australian public health programs have taken steps to address the shortfall in health systems teaching from a global perspective. We describe and analyse the Australian experience of teaching about health systems focused on developing countries in a number of the most prominent public health academic programs in Australia. When reviewing the programs, we aimed to address the following core issues: a) what types of courses included health systems components focused on developing countries and what content did they include; b) what pedagogical methods were employed; c) which approach to understanding health systems was adopted.
In 2009, the University of Sydney’s Masters of International Public Health program offered, for the first time, a course called “Health Systems in Developing Countries.” This course is structured around the WHO building blocks with case studies as well as a focus on health systems research. The unit endeavours to move beyond diagnoses of challenges to identify evidence-based solutions and to prepare students to analyse, evaluate and implement health system interventions and reforms. The course provides lectures addressing key LMIC health systems debates such as the role of community health workers in service delivery, migration of health professionals, the appropriateness of user fees in resource-poor settings, health insurance models and sector-wide approaches to health governance. Students are asked to develop their own health systems research questions for a developing country context and to propose a methodology for answering that question. Guest lectures are provided by World Bank and AusAID representatives and by practitioners involved in improving health systems.
The interest in the course was very high – especially from international students. About half of all students enrolled in the University’s Masters of International Public Health program opted to take the course as an elective, more than 65% of whom are from low and middle income countries. Students came from a wide range of backgrounds including: medicine, nursing, political science, law and management. In student evaluations, 97% of students stated the unit was relevant and 100% rated the content as ‘excellent’ or ‘good’.
In addition, the University of Sydney offers a Masters of Health Policy that focuses on domestic health reform issues but includes international examples and a course on “Global Health Policy.” This program emphasises political science, policy processes and economic evaluation.
The University of Queensland (UQ) offers, through its School of Population Health, a postgraduate course on ‘Health Systems’ which is compulsory for all students studying for a Masters of Public Health. The content encompasses most aspects of health systems but does not have a primary global health focus. Lectures on health systems topics including financing and human resources, address issues that are directly relevant to less developed countries whereas other lectures focus on issues which are of more direct domestic concern (such as Aboriginal and Torres Strait Islander health). The course typically attracts between 80 and 120 students per semester, with approximately 50% international students. The UQ MIPH, for students interested in global health, does not have a specific course on health systems but the topic is mentioned in several courses.
Beyond the School of Population Health, the UQ Faculty of Business, Economics and Law offers a Masters of Health Economics program with an option to specialise in ‘Health and Development’. While the program draws heavily on Population Health courses, it also includes courses on ‘Globalisation and Economic Development’ and ‘Health & Economic Development’. To the extent that such a course might be considered as relevant to health systems it raises questions about the natural academic ‘home’ for such teaching.
The University of Melbourne’s masters level global health systems teaching is integrated within other global health subjects. A core component within the global health stream of the MPH is the subject ‘Primary Health Care in Developing Countries’ offered (unusually) as a subject co-accredited with Monash University and described below. An alternative is a residential study option “Primary Health Care, Jamkhed, India” which consists of a practical, experiential course offered for three weeks in central India. Other subjects relevant to global health integrate health systems concepts where relevant to the topic theme, notably “International Child Health” and “Public Health Leadership Management”. Other health systems elective subjects within the MPH are titled “Health Systems” and “Health Policy”, however these focus on the Australian health system rather than addressing global health system issues. This university, through the Nossal Institute of Global Health, has introduced a new subject, available to MPH students and other students interested in global health, in 2012. This is titled “Systems for Global Health” and aims to develop skills in using analytic tools, applying health system frameworks, and use of evidence in policy change for health system reform. The subject focuses on LMICs, their health and development context, health systems, health financing, use of financing to improve equity, and modes of influencing health policy.
Monash University has a diverse MPH program and a parallel Masters of International Health. The subject ‘Primary Health Care in Developing Countries’ offered through the Burnet Institute, acts as a primer on global health issues and incorporates health system frameworks, global health actors, health system strengthening approaches, and health financing options. It is compulsory for international health students. At Monash University, health systems are taught in a cross-cutting manner. MPH subjects integrate global health systems concepts appropriate to LMICs and relate these to the technical focus of the subject (for example, “Control of Communicable Disease in Developing Countries” or “Women and Children’s Health in Developing Countries”). Since 2011, the subject “Health Policy and Prevention in a Global World” has included global health system perspectives using the “control knobs” framework promoted by the World Bank and Harvard University. All these subjects attract a sizable cohort of international students and are among the most popular course offerings.
The University of New South Wales School of Public Health and Community Medicine offers a Masters of Public Health, Masters of International Public Health and Masters of Health Management. Health systems are integrated within many of the course units but are brought to the fore, for example, in the course on International Health. This course integrates health systems thinking and approaches, and highlights not only the policy dimensions, but the importance of equitable, responsive and efficient health systems. The course explores the use of evidence and the sensitivity of context, and considers also the different interests which operate within health systems and service delivery environments. Short courses on human resources, health and social aspects of disasters, and on maternal, neonatal and child health also highlight systems issues.