Health Care Systems in Low and Middle Income Societies – University of Copenhagen

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Health Care Systems in Low and Middle Income Societies

Health care systems are core social institutions with a vital role in reducing suffering and illness and promoting health, and consequently carry a central responsibility in the efforts to eradicate poverty around the world. However, health care systems in low and middle income countries are generally under severe strain, and lack of resources, not least human resources, impedes delivery of quality health care services to those population groups that need them the most.

This course is constructed around the WHO building blocks for health systems, covering all aspects from financing to service delivery and technologies. Students will become familiar with the models, approaches and tools used to understand and strengthen health care systems in a low-resource setting. Special emphasis is given to leadership and management, as well as cross cutting themes, such as disaster situations, gender, human rights and equity.

The course is tailored to meet the needs of professionals currently working or preparing to work with health care in a low-income context.

You will meet a range of lecturers: researchers from the University of Copenhagen, international experts, consultants and important global stakeholders. This gives you the opportunity to build a strong professional network with fellow students, health systems researchers and global health professionals from across the world.

Application deadline is 10 December 2013 - APPLY ONLINE NOW !


Copenhagen School of Global Health, University of Copenhagen
The course takes place in Copenhagen, Denmark

Course coordinator:

Assistant Professor Britt Tersbøl


3 February - 4 April 2014.
Full-time lectures and exercises, including a few days of individual or group study.

ECTS credits:





By the end of the module, the student should be able to:


  • Analyse the historical, cultural, organizational, economical and political aspects of health care systems in low- and middle-income societies from an interdisciplinary perspective.
  • Discuss central health systems challenges and priorities in relation to service delivery, the health workforce, information, tools and technologies, financing, leadership and governance.
  • Evaluate central mechanisms for health systems strengthening in terms of service delivery, human resources, information, tools, products and technologies, financing, leadership and governance.


  • Independently retrieve, analyse and compare academic literature on health systems
  • Appraise examples of health systems interventions that aim to strengthen health and equity
  • Identify health systems theories, models and tools and assess their strengths and weaknesses with a view to applicability in a low- and middle income setting


  • Assess and discuss complex health systems related challenges and propose new solutions
  • Apply change management tools and approaches to a hypothetical case
  • Take responsibility for own academic development and specialization during the module


The course takes as a point of departure the WHO framework "Six Building Blocks of Health Systems". This framework assists an understanding of the interaction between the different dimensions and steering mechanisms of health systems. The students will also devote time for a critical assessment of this WHO framework.

The students will work with each of the Building Blocks. Lectures, assignments and seminars built coherency and ensure critical reflection on the inter-related nature of the Building Blocks.

The following content is included in the module:

A) Introduction to Health Care Systems

  • Typology of Health Care Systems
  • WHO framework "Six Building Blocks of Health Systems"
  • Guiding values and principles (e.g.
  • Paris declaration, Ata Alma Declaration)
  • Aid modalities
  • Priority setting
  • Anthropology of Health Care Systems
  • Equity and human rights
  • Gender equality
  • Pro-poor approaches
  • Ultimate outcomes

B) Six Building Blocks of Health Systems

  1. Leadership and Governance
    • Introduction: central mechanism for health systems strengthening
    • Health sector reform - Decentralization
    • Policy
    • Project management
    • Change management
    • Monitoring & evaluation
    • Quality assurance
    • Accountability
    • Transparency and good governance
    • Donor funding, harmonization, alignment
  2. Financing
    • Health care market
    • Basic concepts of economics
    • Common types of economic analysis
    • Costing of health work force
    • Financing methods
    • Equity
    • Priority setting
    • Health insurance models
    • Provider payment models
    • Public-private sector
  3. Health work force
    • Human resources
    • Distribution
    • Performance, management and monitoring
    • National and international brain drain
    • Supervision and accountability
    • Motivation and retention
    • Anthropological perspectives on work force motivation, commitment and performance
  4. Service Delivery
    • Quality of Care,
    • Efficiency & productivity
    • Access (accessibility, acceptability, affordability)
    • Vertical vs. horizontal programs
    • Demand and coverage
    • Service delivery models
    • Health promotion and prevention
    • Primary health care
  5. Medical Products, Vaccines and Technologies
    • Global and national policies
    • Political and ethical perspectives: Equal and universal access
    • Product selection and procurement
    • Requirements planning and forecasting
    • Quality and safety
    • Inventory management
    • Rational use of products
    • Development of new products (Example given by Malaria vaccine researchers)
    • Essential drug program
    • Anthropology of medicines and medical technologies
  6. Information and health communication
    • National Health Information Systems (models and central concepts)
    • SWAP - donor requirements, Paris Agenda
    • National surveillance and response
    • Standards, methods and tools applied
    • Analysis and application of national health information systems data
    • IEC (information, education, communication) approaches
    • Core theories and principles in health communication

C) Cross cutting assignment work and seminars
(four assignments/ 1 mid-term seminar)

  • Health, human rights and equity
  • Health sector reform and gender
  • Health work force - attrition and motivation
  • Anthropology of the interface between health system and communities
  • Seminar: Financing & policy - Reaching the marginalized


The module is organised with three 45-minute lectures in the morning four days a week and with one study day a week. There may occasionally be two lectures or organised group- or individual work in the afternoon until 15.00. The lectures include student involvement in discussions and facilitated group work. Apart from lectures, a mid-term seminar takes place which aims to synthesise the different topics taught so far and underline the interrelated nature of e.g. policy and financing, health information systems and governance. The students have to work with four minor assignments during the module that aim to strengthen the students ability to reflect critically on the content of lectures, the obligatory literature and discussions in class. These are not formally assessed (graded), but students receive written and/or oral feedback on their work.

TropEd accreditation:

Accredited 2011 in Barcelona.

Assessment Procedures:

The course is concluded with an individual 48-hour exam. The exam is a written assignment, which will be graded according to the Danish 7-scale with external moderation.


The applicants must live up to the Master of International Health admission criteria.

Class size:

The number of participants is limited to 30. The course may be cancelled if there are less than 12 participants.


Reduced fee: DKK 30,000
For students from EU/EEA or Switzerland.

Normal fee: DKK 45,000
For all other students.

For approximate exchange rates between DKK (Danish Krone) and other currencies please contact your bank or visit this website. All fees are subject to regulation.


We do not offer any scholarships, nor can we assist in finding funding, but on our page about scholarships we have collected some information that might be useful.