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Prof. PhD Kaspar Wyss

Department of Public Health
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Projects & Collaborations

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Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania

Research Project  | 5 Project Members

Social health protection through Universal Health Coverage is the aspiration that all people will obtain the quality health services they need while not suffering financially as a result of seeking health care. In Ghana and Tanzania the major challenges are to understand how to increase and sustain coverage, expand the benefits package for people in the informal sector, and ensure effective coverage with services and financial risk protection to the poorest segments of the population. In addition to the need for more funding, it is important for both countries to develop effective approaches to define eligibility criteria and better identify and target the excluded poor, and to ensure that the rights of citizens who are less likely to be covered are properly addressed. This requires health system governance conducive and responsive to all population groups. Governance in health systems design is rarely studied and little is known about how civil society can improve governance and coverage of social health protection. The project intends to address two related challenges: how can the excluded population be better identified and reached to include them in financing protection mechanisms; how can accountability mechanisms and civil society improve health system governance to support the implementation of inclusive and sustainable social health protection systems. The project will use mixed methods approaches combining collection and analysis of both quantitative, experimental, and qualitative data as well as participatory approaches. It will be composed of two main parts. Part 1 will address the questions of who is excluded from social health protection, why, and the cost and health system implications of including them. It will first investigate the characteristics of the population that is not benefiting from social health protection in Ghana and Tanzania, and the main determinants of exclusion. Secondly, it will assess the health benefits of inclusion in social health protection and which health system factors are crucial. Thirdly, it will identify and validate predictors of inclusion/exclusion that could be used to monitor the performance of social health protection systems. Fourthly, it will investigate in depth the reasons why certain population groups are excluded from social health protection and what could be done to include and engage them. Lastly, it will develop a model to predict the impact of extending social health protection under different scenarios for the health systems in terms of both financial resources and service delivery changes required. Part 2 will focus on evaluating approaches to improve targeting of the poor and governance (with a focus on voice, transparency and accountability) for promoting a more inclusive social health protection. It will first identify the recent experiences and approaches to extend social health protection in Ghana and Tanzania, analyzing them using a health system governance framework. This analysis is expected to reveal opportunities or problems with regard to governance, in particular involving the civil society, in enhancing design and implementation of social health protection. Secondly, it will develop mechanisms to better identify the excluded population groups - expected to be mainly the most poor -and to improve the governance of the health systems. Then the effectiveness and the implementation feasibility of the mechanisms will be tested.

Project cover

Projektevaluation: Prävention psychosozialer Belastungsfolgen in der Somatik: ein Modellprojekt zur kollaborativen Versorgung (SomPsyNet)

Research Project  | 6 Project Members

Evaluation des Projekts: Prävention psychosozialer Belastungsfolgen in der Somatik: ein Modellprojekt zur kollaborativen Versorgung (SomPsyNet)


Das durch Gesundheitsförderung Schweiz finanzierte Projekt wurde durch eine Evaluation begleitet. Das Ziel dieser war, die von Gesundheitsförderung Schweiz vorgegebenen Evaluationsbereiche (Konzept, Input, Umsetzung, Output, Outcome Multiplikatoren, Outcome Patient:innen, Impact) abzudecken. Das Vorgehen orientierte sich am Dokument «Wirkungsevaluation von Interventionen» von Gesundheitsförderung Schweiz. Die Evaluationstätigkeiten fanden im Zeitraum Januar 2020 bis Dezember 2023 statt und es wurden verschiedene Methoden verwendet. Die Konzept, Input, Umsetzung und Output-Evaluation, beinhaltete eine Kostenanalyse, sowie zwei Serien von Interviews beim Spitalpersonal zur Wahrnehmung der Situation von psychosozialen Belastungen bei somatischen Patient:innen sowie Erfolgsfaktoren und Hindernisse bei der Umsetzung des SCCMs. Der Outcome wurde durch eine On-line Umfrage bei rund 100 in das SCCM involvierten Personen erfasst. Des Weiteren, wurde die Wirksamkeit (Outcome sowie Impact) mittels einer Stepped Wedge-Studie, die unter der Verantwortlichkeit des Projekträgers stand, bewertet. Die Studie evaluierte unter anderem, Veränderung der Lebensqualität von somatischen Patienten mit PB/PS sowie die Auswirkungen auf die monatlichen Behandlungskosten von Patient:innen mit psychosozialer Belastung.

Project cover

Health systems governance for an inclusive and sustainable social health protection in Ghana and Tanzania

Research Project  | 5 Project Members

Social health protection through Universal Health Coverage is the aspiration that all people will obtain the quality health services they need while not suffering financially as a result of seeking health care. In Ghana and Tanzania the major challenges are to understand how to increase and sustain coverage, expand the benefits package for people in the informal sector, and ensure effective coverage with services and financial risk protection to the poorest segments of the population. In addition to the need for more funding, it is important for both countries to develop effective approaches to define eligibility criteria and better identify and target the excluded poor, and to ensure that the rights of citizens who are less likely to be covered are properly addressed. This requires health system governance conducive and responsive to all population groups. Governance in health systems design is rarely studied and little is known about how civil society can improve governance and coverage of social health protection. The project intends to address two related challenges: how can the excluded population be better identified and reached to include them in financing protection mechanisms; how can accountability mechanisms and civil society improve health system governance to support the implementation of inclusive and sustainable social health protection systems. The project will use mixed methods approaches combining collection and analysis of both quantitative, experimental, and qualitative data as well as participatory approaches. It will be composed of two main parts. Part 1 will address the questions of who is excluded from social health protection, why, and the cost and health system implications of including them. It will first investigate the characteristics of the population that is not benefiting from social health protection in Ghana and Tanzania, and the main determinants of exclusion. Secondly, it will assess the health benefits of inclusion in social health protection and which health system factors are crucial. Thirdly, it will identify and validate predictors of inclusion/exclusion that could be used to monitor the performance of social health protection systems. Fourthly, it will investigate in depth the reasons why certain population groups are excluded from social health protection and what could be done to include and engage them. Lastly, it will develop a model to predict the impact of extending social health protection under different scenarios for the health systems in terms of both financial resources and service delivery changes required. Part 2 will focus on evaluating approaches to improve targeting of the poor and governance (with a focus on voice, transparency and accountability) for promoting a more inclusive social health protection. It will first identify the recent experiences and approaches to extend social health protection in Ghana and Tanzania, analyzing them using a health system governance framework. This analysis is expected to reveal opportunities or problems with regard to governance, in particular involving the civil society, in enhancing design and implementation of social health protection. Secondly, it will develop mechanisms to better identify the excluded population groups - expected to be mainly the most poor -and to improve the governance of the health systems. Then the effectiveness and the implementation feasibility of the mechanisms will be tested.

Project cover

The Governance of Health Systems

Research Project  | 6 Project Members

Abstract: Governance is increasingly recognised as being a core determinant of the performance of health care, especially in low-income countries. This project seeks to analyse key factors determining the quality of health governance, with detailed case studies in Tanzania and Tajikistan. Background: Pioneering work by the World Health Organisation (WHO) and others has begun to underline the importance of governance for health care systems. However, there is still a huge need to define what the governance of health systems means, i.e. to elaborate a comprehensive analytical framework that is applied and tested in country case studies. One difficulty is the complex nature of governance systems, which requires an interdisciplinary approach to capture the big picture (e.g. the legal or regulatory framework) as well as health-sector-specific factors (e.g. the burden of disease). The combined expertise and networks in governance, public health and epidemiology of the Basel Institute of Governance and the Swiss Tropical Institute are ideally suited to overcome these problems. The case-studies of Tanzania and Tajikistan will provide valuable information on specific governance problems of two regions that face substantial health challenges. Objective: The main goal of the project is to elaborate, apply and test an interdisciplinary framework to assess the governance of health systems in Tanzania and Tajikistan. The project will, firstly, elaborate a health systems-specific governance framework that has been validated in two countries; secondly, substantially advance the understanding of health systems and allow for better-informed health sector reforms; thirdly, support capacity-building and knowledge-exchange on health systems governance on a national, regional and international level; and lastly provide new empirical data on relevant dimensions of health systems in Tanzania and Tajikistan. Importance: The project is spearheading efforts for a more evidence-based and dynamic understanding of how health systems function in low-income and transition countries. Ultimately, the aim is to contribute to a better understanding of critical governance factors of health systems in general, and to the improvement of health care policies, health care delivery as well as access to health care.