33083 Capacity Enhancement b r i e f s S H A R I N G B E S T P R A C T I C E S A N D L E S S O N S L E A R N E D WBI-CHINA HEALTH SECTOR PARTNERSHIP Fourteen Years and Growing Chialing Yang, Consultant, WBIHD, Hu Shanlian, Professor, Fudan University, and Abdo S. Yazbeck, Lead Economist, WBIHD Structural transformation of China's economy in the 1980s and its impact on the health sector created a critical need for skills and research capacity in health economics and financing. In 1989 the Government of China (GOC) enlisted the World Bank Institute (WBI) to work with China's Ministry of Health (MOH) to organize senior policy seminars addressing emerging health issues and to establish a network of institutions to train academic faculty and government officials. In 1991 GOC launched the China Health Economics Network, which in fourteen years has expanded membership from seven to nineteen institutions, offered health sector courses, and led to the training of more than 2,100 executives and trainers. Network research and senior policy seminars have supported critical government policy decisions. Replication of this successful network model is possible in large countries. The fourteenth annual China Health Economics Need for the Network Network met in Beijing in January 2004. Structural transformation of the Chinese economy Represented were ministry staff, nineteen Chinese in the 1980s exposed the health system. Market partner training institutions, and staff of bilateral economics began to replace the state planning and multilateral donors, including WHO, UNICEF, model, for which service delivery sectors such as and the World Bank. They met to plan health sector health were unprepared. Authorities lacked analyti- training, including courses for faculty and policy- cal information and skills to formulate new poli- makers, senior policy seminars, and dissemination cies. Implementation suffered from a critical short- of health economics research and agreed on a work age of officials, trainers, and researchers program reflecting China's needs in the health sec- knowledgeable in health economics and financing. tor and operational priorities of the World Bank Health economics as a discipline was virtually and development community. The two-day event nonexistent in China. highlighted the network's robust training and A series of government policy statements and a capacity enhancement program supporting basic World Bank health sector study noted the clear needs and emerging policy; a fourteen-year part- need for health economics and financing skills and nership with WBI (until 1999 known as EDI); and research capacity. Human resource capacity devel- the network's strong support from GOC and the opment was a critical need for developing the sec- development community. This brief summarizes tor and sustainable institutional structures were the rationale, the process that WBI pursued, and essential to ensure long-term capacity building and lessons for replication. knowledge diffusion. One government policy state- ment specifically mentioned WBI as the agency to help build capacity. F E B R U A R Y 2 0 0 4 NUMBER 4 Getting Started sultation with government ministries and helped In 1989 WBI agreed to help organize senior pol- formulate the network's annual programs. WBI's icy seminars addressing emerging health issues support has helped the network become a profes- and establish a network of institutions to train aca- sional association producing remarkable outcomes demic faculty and compile training materials to be (see Box 1) that attracted donor-supported projects used by Chinese trainers to train government offi- and domestic clients, making the network more cials. An initial needs assessment found that: self-sustaining and creating a natural exit strategy · 240,000 health executives needed training. for WBI. MOH has taken its partnership with the Bank · Most leaders in central and local government seriously. The minister or vice-minister of health were medical doctors with little health econom- chairs the network's steering committee, which ics, management, or policy analysis skills and guides annual planning decisions. Planning and knowledge. Finance authorities contribute to all decisions on · Most health finance staff were accountants with important network events. Even after the technical limited economics knowledge. assistance grant was exhausted, GOC continued its · Only twenty-eight faculty members in the six financial allocation and committed to providing the medical colleges under MOH worked in health matching fund. Ad hoc financial or in-kind support economics and financing; many without ade- also comes from local governments. quate health economics and finance training. The China Network for Training and Research in Health Economics and Financing was launched in Box 1: The Network's Product Line June 1991. WBI hired consultants to help develop the network's architecture and content and · Training of trainers (TOT). Training existing faculty builds assisted the network and MOH in developing a knowledge of health economics and financing and practi- cal skills for training government officials. WBI has also five-year action plan and a proposal for a World financed network faculty to join its annual courses over- Bank technical assistance grant ($1.35 million for seas, leading to training opportunities by other donors 1992­95). The government allocated RMB400,000 and institutes. for the first year, later increasing it to RMB1 mil- · Training of new trainers. Expansion of network member- ship has increased demand for training new faculty lion (approx. $122,000) a year as a matching fund members. Mostly senior faculty teach annual courses for supporting the network's operational activities in new trainers. China. · Training of government executives. Courses for high- and intermediate-level government policymakers and execu- Network Growth and Development tives are adapted from TOT courses, linked with priori- tized policy issues, and usually replicated in several The network originally began to build the capac- regions in China. ity of seven institutions--management training · Senior policy seminar. In consultation with Health, centers in medical universities throughout China Planning, Finance, Labor and other Ministries, policy seminars focus on the most urgent policy issues facing and the national health economic institute--which the country in the health sector. would in turn: · Policy research and advisory services. A short- and long- · Provide in-service training for government offi- term policy research program provides consultants to cials central and local government offices for research and advice on policy decisions. Network faculty members are · Conduct policy research major contributors to China's public health and health economics journals. · Advise government on policy and reforms · Maintain a forum for health policy dialogue. To build momentum, WBI helped organize the first senior policy seminar, featuring world-class Outputs, Outcomes, and Impact experts to discuss China's most urgent health Consistent and long-term investment has financing issues. increased network membership from the original Since 1991 WBI has provided the network with seven institutions to nineteen (see Box 2), brought consistent technical assistance and funding in con- to forty-eight the number of health sector courses offered since 1991, and led to the training of more F E B R U A R Y 2 0 0 4 NUMBER 4 than 1,400 executives from various ministries and The most visible impact of the network on provinces and more than 700 academics and train- China's health system is the recent introduction of ers. These specific outputs have led to significant reforms by policymakers assisted by network outcomes: research and senior policy seminars: Research · About thirty network-trained researchers have funded by UNICEF and other agencies on the fail- become recognized senior advisors to central ures of the current system and the impoverishing and local governments on policy decisions in effect of health spending on rural populations led China. to GOC's announcement in October 2002 of its pol- · Attraction of China's policy and academic com- icy on rural health. In the early 1990s a senior pol- munity to network courses has led to explo- icy seminar on rationalizing the roles of govern- ration of technology (China's internal video ment and markets in health helped the government conferencing system) to expand reach to more navigate critical policy decisions during rapid pri- policymakers with good content (given the size vatization in the economy. While the evidence of and needs of the country). outcomes and outputs is impressive and the vignettes about impact are convincing at some · Translation of network training materials for use level, it should be noted that a full impact evalua- in network courses has led to their adaptation tion of the network has never been conducted and for use in regular graduate and undergraduate will be needed to help the network in the future. courses by training centers and universities. · Researchers in health economics and finance Lessons and Potential for Replication have used the network's annual meeting to Understanding the network's success can deter- exchange findings and ideas and to build mine the potential for its replication elsewhere. The teams for seeking research grants. most obvious factor has been GOC's commitment to · The international development community, network investment and strong leadership of par- including the World Bank, WHO, and UNICEF, ticular individuals. Also important have been con- increasingly rely on network researchers to tinual assistance from WBI and Bank operations, conduct policy research in the health sector and the blessing of the development community, and assist them in their operations in China. solid needs analysis leading to shared understand- ing of objectives among partners and strong com- mitment to a long-term investment. These factors led to financial support from GOC and both WBI Box 2: Network-Affiliated Institutions, 2003 and Bank operations, which attracted technical expertise and competence used by WBI and the net- China Health Economics Institute, Beijing work to staff policy seminars and develop state-of- Medical School of Beijing University the art content. To coordinate among the different Harbin Medical University local and international partners and ensure that Shandong University activities met China's health needs, open and Tongji Medical College Xi'an Jiaotong University transparent meetings on annual network planning Huaxi Medical University attracted all players and interested parties in China Fudan University and the donor community. These meetings pro- Dalian Medical University vided a forum for interdepartmental and intermin- Xiangya Medical School Beijing University of Traditional Chinese Medicine isterial exchanges, reflecting the complex and Weifang Medical College intersectoral nature of health sector reform and Anhui Medical University development in China. Jiangxi Medical College Replication of the China network model would Jiangsu Medical Information Institute China Health Economics Journal require certain prerequisites, realistic expectations, China Academy of Preventive Medicine, Beijing and patience to achieve returns and a mature qual- Medical College of Wuhan University ity of work. Prerequisites include a large country Zhongshan Medical University (e.g., India, Brazil, Russia, and Nigeria) or regional group of countries (e.g., Central Asian nations of the former Soviet Union) with social, cultural, technical assistance is necessary for designing political, and structural similarities with a clear institutions and governance structures. Time and need and demand for capacity building and exist- patience is also important in ensuring strong foun- ing structures, such as academic and training insti- dations for the investment, avoiding unrealistic tutions, on which to build. Commitment of expectations, and creating an environment for resources and staff time by the government(s) con- creativity and learning. cerned and both WBI and Bank operations is also key. Early stages are the most critical, most expen- Peer Reviewers: Elizabeth Lule, sive, and least productive in terms of outputs and Population/Reproductive Health Adviser, HDNHE outcomes, so these types of investments take time and Fadia Saadeh, Sector Manager, EASHD before they begin to produce results; they should References be seen as medium-term investments. Network World Bank. 1984. China: The Health Sector. Washington, building is a tricky business, so early and good D.C.: World Bank. About World Bank Institute (WBI): Unleashing the Power of Knowledge to Enable a World Free of Poverty WBI helps people, institutions, and countries to diagnose problems that keep communities poor, to make informed choices to solve those problems, and to share what they learn with others. Through traditional and distance learning methods, WBI and its partners in many countries deliver knowl- edge-based options to policymakers, technical experts, business and community leaders, and civil society stakeholders; fostering analytical and networking skills to help them make sound decisions, design effective socioeconomic policies and programs, and unleash the productive potential of their societies. WBI Contacts: David Potten, Lead Specialist, Country Programs Tel: 202-458-7873, Email: dpotten@worldbank.org Imtiazuddin Ahmad, Sr. Operations Officer Tel: 202-458-1878, E-mail: Iahmad2@worldbank.org Visit our website for more information and download the electronic copies of all Capacity Enhancement Briefs: http://www.worldbank.org/capacity F E B R U A R Y 2 0 0 4 NUMBER 4