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Title: Strengthening Disrupted Health Systems – Developing context-specific strategies to strengthen health systems in protracted crises
Keywords: Resilience
Health systems
Health Policy
Governance
Conflict affected setting
Country: Netherlands
Institution: The Netherlands - Royal Tropical Institute (KIT), Amsterdam
Course coordinator: Elisabeth Kleipool
Date start: 2024-09-23
Date end: 2024-12-13
About duration and dates: 12 weeks in total, of which: - 9 weeks interactive learning - 1 week working on mid-term assignment - 2 weeks working on final assignment On average 12,5 hours per week, 150 hours in total. Applications to the course can be done as of one year prior to the course.
Classification: advanced optional
Mode of delivery: Distance-based
Course location: Distance based via E-learning platform
ECTS credit points: 5 ECTS credits
SIT: 150 hours total:
• 60 hours interactive learning (peer-to-peer learning and tutor facilitated sessions)
• 55 hours self-study
• 10 hours formative assessment
• 25 hours summative assessment
Language: English
Description: At the end of the course, students will be able to identify and appraise different options to strengthen (elements of) a health system in protracted crises.

Specific objectives:
1. Explain the nature of protracted crises and their effects on health and health systems
2. Discuss health systems theory and the role of health systems thinking
3. Analyse and appraise options to strengthen elements of a health system in a protracted crisis and propose context-specific recommendations to strengthen elements of a health system in a protracted crisis
4. Critically appraise each other’s work on content and performance, and critically self-reflect student’s own cultural competence, motivation, practice and values working in an international peer-group.
Focus or specific features:
In 2024, the course will be a tailor-made e-learning course for groups (min. 10 participants)
Assessment Procedures: Summative:
⮚ Mid-term assignment (20%): a video pitch on a statement related to strengthening disrupted health systems (individual mark)
⮚ End-assignment (80%): a group presentation with a reflection of options on how to address key issues and its consequences in a provided case study of a disrupted health system (group mark). Students will be working on the assignment throughout the course and individual participation will be monitored. All students should be able to answer questions from a panel at the end presentation. The students will be provided with clear instructions of what they have to present and discuss.

In case of failure student groups are allowed to redo an assignment within 3 weeks after announcement of the exam results.

Formative:
⮚ Students have to provide each other feedback on the video-pitches. This is a requirement to pass the course
⮚ Throughout the course students can do self-quizzes as well as answer questions related to that week’s topic, to apply to their case study. This helps the students to work towards the final presentation, but the answers will not be marked in between.
Content: OBJECTIVE ISSUES COVERED
1: Explain the nature of protracted crises and their effects on health and health systems
• Types of crises
• Concepts of fragility
• Disruption of a health system
• Multi-sectoral perspective
• Geopolitical dimension and response
• Inequities (SDH)
• Governance
2: Discuss health systems theory and the role of health systems thinking • HD-Nexus
• Aid architecture
• Examples of SP models (eg. contracting out).
• Resilience
• Policies
• UHC and SDGs
• Systems’ thinking
3: Analyse and appraise options to strengthen elements of a health system in a protracted crisis and propose context-specific recommendations to strengthen elements of a health system in a protracted crisis
• Localisation of interventions
• Building blocks / people-centered
• Mental health
• Gender
• Community perspective
• Case studies
Summative assessments:
• Mid-term pitch
• Final presentation
4: Critically appraise each other’s work on content and performance, and critically self-reflect student’s own cultural competence, motivation, practice and values working in an international peer-group Formative assessments:
• peer-to-peer feedback on mid-term pitch
• Presence and participation at weekly check-in meeting
Methods: Lectures, interactive discussions, exercises, case studies, group work, self-study, presentations, videos, podcasts:
- Interactive learning: 60 hours → working on a case study building on participants’ experiences, weekly check-ins and discussions on the online forum
- Self-study: 55 hours → attending pre-recorded lectures, in-course reading assignments (including pod casts, videos, self-quizzes) to support the lectures, case studies and group discussions.
- Formative assessment: 10 hours
- Summative assessment: 25 hours
Prerequisites: The following criteria will be used for the selection of participants:
- a degree equivalent to Bachelor’s level in medicine, public health, social sciences or related disciplines
- at least two years of relevant work experience in, or relevant for low and middle-income settings.
- For academic credit an English competency exam is required (TOEFL paper-based test: 550, computer-based test: 213 or IELTS academic version: 6.0).
Attendance:
25 students
Maximum number of TropEd students: 10
Selection:
We will use a first come first serve approach for applications that fulfill admission criteria.
Fees:
€ 2160
Early bird fee € 2.000 (payment deadline=23.06.2024)
tropEd fee : € 1.710
Scholarships:
Fellowships available through Nuffic
Major changes since initial accreditation: Any changes in course coordinator, objectives, content, learning methods, assessment procedures need to be described with a short explanation about the reason for this change.

Goal of revising structure and methods:
The course has been updated to keep students more on track and engaged by ensuring more interaction among students and with facilitators. The assignment has been aligned more with student profile/needs. At the same time the course maintains the self-learning nature of the course which allows a certain type of student to join.

New learning/teaching methods:
 Introduction of a number of case studies (4/5) at the beginning of the course. Students can sign up (choosing a top-2) for a case study to focus on during the course of the program. Students will work in groups on a case study. Case study groups can also be made based on time-zones.
 Facilitators need to be aware of the case studies but it is up to the students to make the connection between the theory and their case study. Per Learning Unit (LU), the students can look at their case study from a certain angle from the theoretical framework. Facilitators can formulate a couple of questions (see formative assessment) for the students to apply to their case study.

Contact hours vs. self-study:
 There will be a weekly 1 hour check-in with the respective LU facilitator of that week. Students can ask questions about the materials of that LU and discuss progress on their case studies.
 Students use the discussion forum each week to discuss with their peers and to pose questions to be addressed in the weekly check-in.
 The timing of the weekly check-in will be different each week to allow everyone to join, with the requirement for presence of 70% of the sessions.
 There will be 3 Q&A sessions with different experts throughout the course.
 Apart from the 1 hour weekly check-in and the expert sessions the course remains self-learning.

Assignments:
Summative:
 Mid-term assignment (20%) will remain a video pitch (individual mark)
 End-assignment (80%): a group presentation with a reflection of options to address key issues in the case studies and its consequences (group mark). Students will receive clear instructions upfront. For the end assignment we move away from the policy brief as the nature of this assignment was not sufficiently focused on what to apply in practice and did not align with the students’ profile. Hence a more applied assignment will be provided.

Formative:
 Providing each other feedback on the video-pitches is a requirement to pass the course.
 Working on the case study throughout the course by answering questions related to each LU and applying this to their case study. This can help the students to work towards the final presentation, but the answers will not be marked in between.

Goal of revising course content: The current revision was done to make the course more practice oriented, less leaning towards governance and policy. Also, the course was made more up to date in terms of materials and more manageable for students.

 Strengthening disrupted health systems (instead of rebuilding): moving away from idea of post-conflict. That is too optimistic. Most crises are protracted. Rebuilding comes from motion of disaster, after which you start rebuilding. In war/fragile situations that is not how it works. Protracted crises lasts for years, so you should not wait to work on the system.
 Transition model: as country in conflict you are often not really moving up in transition to sustainable development, but are stuck on one spot on the framework. The SDHS is focusing on settings that are ‘stuck’ in a protracted crises where you can already introduce elements of systems strengthening without waiting for the country to enter a development stage.
 In addition to this model we can consider a dimension of multisector, natural/crisis, economic (what makes it a crisis from patient/people perspective).

Changes in objectives: The objectives are now built up in a way that better introduces the concepts and context of crises and fragility, as many students take this course as a stand-alone course. There is more emphasis on systems thinking within and beyond the health system. There is a wider focus on elements of systems that can be strengthened beyond governance and policy. There is an objective added about self-development of students.

New course coordinator: Elisabeth Kleipool, advisor Health Systems Strengthening replaced Maaike Flinkenflogel.
Student evaluation: Provide a summary of the student evaluations (positive and negative aspects) and any other major feedback received.

The evaluation of the course in 2021 showed that students especially needed more interactive moments with the lecturers and each other, and the updating of the literature. From teacher evaluation sessions we have concluded that the course needs a stronger conceptual basis and better alignment with other courses (KIT ADHS course as well as competing courses).

Examples from student evaluations 2021:

“In my opinion, other one or two online meeting could be organized to recapture the attention that seemed to decrease in the second part of the course”

“Responsive tutors and course coordinator. I would have appreciated to have more real time engagement with tutors and fellow students.“

“I liked the assignments, but would have appreciated more interaction with tutors/experts like in the case of Afghanistan. Especially during the last weeks (after the mid-term pitch), there was little variation in teaching approaches. I liked the variety of teaching approaches, with narrated PPTs (very nice!), videos/podcasts, and the learning module on finance (which was not specific for fragile contexts, but very insightful) etc...”

“Overall good content, but I found that relatively much priority was given to policy (LU1&2) even though I recognize its importance. I was slightly surprised with the proportion of reading materials that were at least 10 years old. I have been wondering what the reason is: Is there little progressive insight in this field? Are these the 'standard' authors/articles everyone in the field knows about?”
Lessons learned: The course is designed for self-paced learning by the students. The course is offered part-time and generally the students have a job or study alongside it. The students follow the course online from different time zones. These are reasons why this course has few synchronous contact hours with lecturers and fellow students and that learning is mainly on an individual basis. However, from experience we also learned that it is difficult for students to stay motivated for self-learning and that they need more variety in teaching methods. In terms of the students‘ profiles we learned that many of them are in a more practice oriented job at MoHs, NGOs or multilaterals. Some of them are academically oriented, but we have learned that currently the final assignment (a policy brief) was not the best fit for the expectations of students, who are generally expecting more hands-on tools for ‚rebuilding‘ health systems. By changing the course name and by changing the final assignment we hope to better align with the student expectations and needs. In addition in this revised edition the learning activities should better lead up tot he assignments and students should have more opportunity to work on a topic that is applicable to their jobs.
tropEd accreditation:

Accredited at Antwerp, Oct 2017, Re-accredited Bagamoyo June 2022
Email Address: courses@kit.nl
Date Of Record Creation: 2017-10-22 15:31:41 (W3C-DTF)
Date Of Record Release: 2017-10-22 19:51:03 (W3C-DTF)
Date Record Checked: 2018-07-18 (W3C-DTF)
Date Last Modified: 2024-03-26 10:07:05 (W3C-DTF)

Fifteen years of the tropEd Masters in International Health programme: what has it delivered? Results of an alumni survey of masters students in international health

L. Gerstel1, P. A. C. Zwanikken1, A. Hoffman2, C. Diederichs3, M. Borchert3 and B. Peterhans2

1 Royal Tropical Institute, Amsterdam, The Netherlands
2 Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
3 Institute of Tropical Medicine and International Health, Charite – Universit€atsmedizin Berlin, Berlin, Germany