According to the World Health Organization:
“The poor state of health systems in many parts of the developing world is one of the greatest barriers to increasing access to essential health care. Some countries have large populations without access to care because of inequitable arrangements for social protection. Others are struggling with escalating costs because of inefficient use of resources.”
A major focus for the School of Public Health is to provide strategic research and technical assistance to support the development of international health systems. Faced with daunting challenges, low- and middle-income countries remain committed to improving their health systems despite limited resources. These countries grapple with extreme poverty, weak healthcare infrastructures, a lack of skilled clinicians and public health leaders, as well as high disease burdens ranging from HIV/AIDS and malaria to cardiovascular disease and diabetes.
Around the globe, 30,000 children under five years die each day. Scientific and technological resources are available to dramatically change this situation. However, without effective delivery systems--hospitals, clinics, physicians and nurses deployed efficiently--we cannot provide quality healthcare to the people who need it most.
Countries at similar income levels differ greatly in how they promote health. Unlike the study of disease, however, there are few standard methods for studying and developing key components of effective health systems.
It is clear that density of healthcare workers is directly linked to health outcomes – and there are simply not enough healthcare workers in most developing countries. To build strong, effective healthcare delivery systems, the need to facilitate the development of trained health care workers cannot be overstated.
The Yale School of Public Health has contributed significantly to developing global health systems through both applied research and direct on-the-ground efforts. We are assisting local communities and governments, hospital leadership, and Ministries of Health to recognize how they can best allocate their resources in countries like China, Ethiopia, Liberia, Morocco, Mozambique, South Africa, and South Korea. In Ethiopia, for example, a team of Yale-Clinton Fellows piloted the application of global budgeting principles at the hospital level, demonstrated the potential for more cost-effective delivery of health services, and then facilitated systematic improvement as the Ministry of Health adopted global budgeting policies and strategies across the country. In China, Yale is addressing issues of health finance and insurance reform, hospital operations and management, as well as economic evaluation of health care and public health programs. We are working with governments in Africa and Asia to establish healthcare priorities, and have developed strategic academic partnerships with local universities to ensure a sustainable pipeline of health workers, educators, and researchers. Yale is also working with governments to strengthen the governance of health systems through legislation, public policy, regulation, and oversight, as well as through the redistribution of scarce resources and the creation of public goods.
Improvement in health and health care requires the integration of principles, approaches, and tools from diverse disciplines and departments. Yale has some of the strongest schools and departments in areas vital to this work, such as the Schools of Public Health, Medicine, Law, Management, and Nursing, and the Department of Economics. Existing programs are expanding and new programs are planned. Creating a nexus for these activities will reinforce Yale’s world-leadership in international health work and expand the vision of Yale as a global university.
What We Hope to Achieve
Yale is committed to sharing in the development of essential tools for strengthening health systems as we strive to cultivate a cadre of leaders who can ensure a healthier future for their nations. We will achieve this by working to continually integrate the three roles that Yale has the capacity to play in the emerging field of global health. These three roles are that of an educator, a researcher, and a practitioner.
As educators: We will expand our educational activities to include Yale undergraduate and graduate programs related to global health as well as certificate-based programs in developing and developed countries to train the next generation of healthcare leaders. International education activities will employ internet-based innovations in education so that we can provide low-cost but resource-rich training.
As researchers: We hope to broaden our research activities so we can include faculty from a range of departments and schools at Yale, thereby providing opportunities for novel and effective collaborations to create new approaches to research and scholarship.
As practitioners: We will develop applied programs, which are natural extensions of our education and research efforts. Most often these take the form of evidence-based interventions with subsequent monitoring and evaluation. This being the case, Yale is in the unique position to advise and support the development of health systems by creating programs which translate research findings into practice in almost real time.
Partnership for Change
Yale is uniquely poised to bring academic rigor and innovation to the challenge of strengthening health systems in developing countries. To build on our existing strengths, several priority areas require support:
- Revitalization of the Global Health Concentration at the Yale School of Public Health as a training ground for tomorrow’s leaders in strengthening of health systems
- Support for the Global Health Leadership Institute, including innovative programs at Yale and overseas focused on supporting health leaders to improve the performance of health systems through leadership development, quality improvement programs, and health systems research
- Creation of an international research training program to bring together a select group of physicians and scholars from around the world to improve health and healthcare systems through improved research capacity
- Development of distance learning resources, and web-based distribution of Yale curricular materials
- Support for program staff to oversee strategic growth and to leverage synergies between interdisciplinary research, education, and service initiatives