University of Pennsylvania
Graduate Program in Public Health
MPH Degree Program
Course Syllabus – Spring 2011
Title: PUBH 551 (NURS 640 / SWRK 793) – Global Health Policy and Delivery
Course Units: 1.0 c.u.
Course Description: This participatory interdisciplinary seminar course examines contemporary
issues in global health policy and delivery. The overall organizing framework for the class is the
social determinants of health. The class will consider evidence that inequalities in education,
income, and occupation influence health status. Students will develop skills in policy analysis,
policy brief development, and policy impact monitoring. The public policy process will be
explored using a variety of contemporary global health case studies which focus on content areas
such as maternal health, HIV policy, refugee health and global healthcare delivery. Finally, we
will examine the global health workforce and the impact of widespread global migration of
health professionals on receiving and sending countries.
Placement / Room Assignment:
Monday, 4:00 – 7:00 PM
Course Director:
Carol McLaughlin, MD, MPH, MSc
carolmc@sp2.upenn.edu
3815 Walnut Street r.401
Office Phone: (215) 898-4995
Office Hours: By Appointment
Wendy Voet, MPH
wvoet@exchange.upenn.edu
Anatomy-Chemistry Building, Room 146
3620 Hamilton Walk
Philadelphia, PA 19103
Office Phone: (215) 573-3439
Office Hours: By Appointment
Pre-requisites: There are no prerequisites. The course is designed for graduate students in the
social and behavioral sciences, health professions, public health, business and law. Advanced
undergraduate students will be admitted with permission.
Confirmed Guest Speakers:
 Allisyn Moran, Director of Research, Save the Children
 Jen Cohn, HIV Policy Advisor, Doctors Without Borders
 Marjorie Margolies-Mezvinsky, Founder, Women’s Campaign International
 Nomi Montgomery-Fuchs, US Representative, Marie Stopes International
 Sarah Zlotnik, Senior Strategist for Communications and Partnerships, PolicyLab
1





Allison Buttenheim, RWJ Health and Society Scholar
Steve Sammut, Health Care Management Lecturer, Entrepreneurial Programs, Wharton
Gregg Alton, Executive Vice President Corporate and Medical Affairs, Gilead Sciences, Inc.
Linda Aiken, Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and
Director of the Center for Health Outcomes and Policy Research, School of Nursing
Others invited: See syllabus for additional details
Course Objectives:
- Critically examine key issues and controversies in contemporary global health policy and
delivery (e.g. priority setting, design of health systems, primary health care, equity
considerations)
- Explain how epidemiology and burden of disease, socioeconomic, cultural, and structural
factors influence the design of evidence-based policy and interventions.
- Analyze and apply frameworks for the effective delivery of health interventions and
services to low-resource areas including public-sector, private-sector, and community
channels and partnerships.
- Develop skills in the assessment of policy and program impact for both continuous
improvement as well as formation and dissemination of best practices.
Teaching Methods: Interactive seminar course with guest faculty from policy, implementation,
research and evaluation, and community engagement and advocacy. Topics from maternal health
and child survival will be used as case studies throughout the course.
Evaluation Methods:
30%
40%
20%
10%
Policy briefs (3)
Policy Analysis Paper
Class Participation/Discussion leader
Group Case Presentation
Course Assignments:
1.) Policy Briefs (3): During the course, each student will prepare 3 short policy briefs
concisely summarizing issues, policy alternatives, and key considerations for action. Topics
will be given during class for briefs due the following week. For written briefs -maximum 2
pages, 1.5 spaced, 12-point font, based on guidelines provided in class.
- Brief 1: Due Feb 7th - Students will be assigned a country and topic (child survival).
Prepare a brief addressed to the Minister of health of the assigned country on major
burden of disease and policy/interventions recommendations.
- Brief 2: Due Feb 28th - Students will choose a country and develop a policy brief
which outlines key recommendations for addressing maternal mortality and related
gender issues in their selected country. Priorities should take into account the
strategic objective frameworks of the audience who will be utilizing the information.
Audience – international funders such as USAID.
- Brief 3: (oral) Due March 28th - Innovations in delivery – Students will be assigned a
case study of an innovation in delivery for which they will prepare an oral (35minute) briefing summarizing the success factors/challenges and implications for
scale-up or use of the model in other settings. Audience – implementing organization.
See Page 7 of the syllabus for more details.
2
2.) Policy Analysis Paper: 10-15 pages, double spaced due at the end of the semester. Topic
can be chosen by the student and submitted the week of March 21st. The paper should: 1)
identify a problem, challenge, or need related to global health or health policy; 2) discuss its
significance; 3) review relevant literature; 4) summarize policy options/alternatives; 5)
provide your policy recommendations and reasoning. Literature must be cited using APA or
comparable standardized format.
3.) Group delivery case presentation - students will be broken up into team of 3-4 students and
will work together to prepare their best answer to a global health delivery case (as assigned
by instructor). The team will present a short 5 minute PowerPoint briefing to the class on
April 28th.
4.) Class Participation: students are expected to attend and participate in all classes.
Participation includes:
- Preparation of reading assignments prior to each class and participating in the
discussion each week
- Each student will also lead a class discussion based on the assigned readings. The
student leader will send discussion questions to the group the Friday before the class.
- Feedback on policy briefs of fellow students (guidelines will be discussed in class).
Required Reading:

Hilts, Phillip. Rx for Survival: Why We Must Rise to the Global Health Challenge.
Penguin Press, New York, 2005. (Available as an e-book or on-line as hardback or
paperback)

Bardach E. A practical guide for policy analysis: The eightfold path to more effective
problem solving. Washington, DC: CQ Press; 2009.

Articles as assigned in the syllabus for each class
Academic Integrity: Students are expected to adhere to the University’s Code of Academic
Integrity. Care should be taken to avoid academic integrity violations, including: plagiarism,
fabrication of information, and multiple submissions. Students who engage in any of these
actions will be referred to the Office of Academic Integrity, which investigates and decides on
sanctions in cases of academic dishonesty.
See link for more information: http://www.upenn.edu/academicintegrity/index.html
MPH Academic Standing Policy/Academic Probation: According to University policy, a
graduate student must maintain a ‘B’ average or better to be considered in good academic
standing. A student who does not meet the University policy of a ‘B’ /3.0 average will be
reviewed by the MPH Program Director, the Associate Director and the Academic Progressions
Committee. A student may be put on academic probation for a period of 1 semester to improve
his/her overall average may be put on academic probation for a period of 1 semester to improve
his/her overall average.
Any course in which the student receives a grade below a B- will not be applied toward
the Master of Public Health degree. The record of any student who receives an unsatisfactory
grade (less than a ‘B-‘) in a course or who does not meet the University policy of a ‘B’ /3.0
average will be reviewed by the MPH Program Director, the Associate Director and the
3
Academic Progressions Committee. A student may be put on academic probation for a period of
1 semester to improve his/her overall average
Students may continue to take other courses during the probation period and the student
must make arrangements with the course director to remediate any grades lower than a B-. These
arrangements must be approved by the MPH Program Director with input from the Academic
Progressions Committee as needed. Any student who is on academic probation for a period
greater than 1 semester will be referred to the Academic Progressions Committee for review and
recommendation. This committee is authorized to dismiss the student or allow the student to
remain in the program on a probationary basis. A return to good academic standing is contingent
on receiving an acceptable grade (B or higher) in all remaining courses.
The MPH grading policy is at the discretion of the individual course instructors.
Please find below the generally used grading scale for the MPH Program.
A+ 97-100
B+ 87-89
C+ 77-79
A
93-96
B
83-86
C
73-76
A- 90-92
B- 80-82
C- 70-72
F
Please note that an A+ carries the same weight (4.0) as an A.
0-69
Incomplete Grade: It is expected that a matriculated Master of Public Health student shall
complete the work of a course during the semester in which that course is taken. A student who
fails to complete a course within the prescribed period shall receive at the instructor’s discretion
either a grade of I (incomplete) or F (failure). If the incomplete is given, the instructor may
permit an extension of time up to one year for the completion of the course. In such cases, any
course which is still incomplete after one calendar year from its official ending must remain as
incomplete on the student’s record and shall not be credited toward the MPH degree. Students
who receive two or more incompletes within a semester may not register for the subsequent
semester(s) without the permission of the Department.
For additional information on academic policies, please refer to the corresponding sections in the
Student Handbook.
4
Course Outline / Assignments:
Class Date Class Topics
1
1/24
Readings & Homework Due
Global Health Policy
Introduction to the
Required Reading:
Course, the Social
a. Wilkinson, R., Marmot, M. “Social
Determinants of Health,
Determinants of Health: The Solid
the global health policy
Facts” World Health Organization 2003
landscape, and resources
(http://www.euro.who.int/document/e813
for global health.
84.pdf)
b. Marmot, M. et al. “Closing the Gap in a
Generation: Health equity through
Action on the Social Determinants of
Health.” World Health Organization
2009 (read executive summary)
c. Garrett, L. The Challenge of Global
Health
http://www.lauriegarrett.com/blog/media/
1/20070112-garrett.pdf
d. How to Promote Global Health – A
Foreign Affairs Roundtable. In this
special Web feature, Paul Farmer, Jeffrey
Sachs, Alex de Waal, Roger Bate &
Kathryn Boateng, and Laurie Garrett
discuss Garrett's essay "The Challenge of
Global Health" and debate how best to
help the world's poor and sick.
http://www.foreignaffairs.com/discussion
s/roundtables/how-to-promote-globalhealth
e. The US global Health Initiative: Key
Issues. Policy Brief. April 2010.
http://www.kff.org/globalhealth/upload/8
063.pdf
Recommended Reading:
a. Kates J, Fischer J, Lief E. The U.S.
Government’s Global Health Policy
Architecture: Structure, Programs, and
Funding. Kaiser Family Foundation;
April 2009.
http://www.kff.org/globalhealth/7881.cf
m
b. Millennium Development Goals
(http://www.un.org/millenniumgoals/)
5
2
1/31
Policy Analysis
Overview: Policy Brief
and Guideline
Development
Invited Guest Speaker:
Sarah Zlotnik from
PolicyLab
3
2/7
Case Studies from
Tanzania and Zimbabwe
(the development of the
Essential Maternal and
Neonatal Health
Guidelines and the
Zimbabwe National
Family Planning
Guidelines)
Evidence based Policy Child Survival and case
of community based
treatment of pneumonia.
This class focuses on the
evidence and policy
debate/issues
surrounding the use of
antibiotics/anti-malarias
by lay-community health
workers.
Required Reading:
a. Bardach E. A practical guide for policy
analysis: The eightfold path to more
effective problem solving. Washington,
DC: CQ Press; 2009. 1-59. Appendix
A:111-125.
b. Policy Briefs as Assigned during Week
#1
Recommended Reading:
a. Institute of Medicine. The U.S.
Commitment to Global Health:
Recommendations for the Public and
Private Sectors. Washington, D.C.: The
National Academies Press; 2009.
http://www.ncbi.nlm.nih.gov/books/NBK
23801/
Required Reading:
a. Lancet series on Child Survival (series of 5
articles giving background on child survival)
1. Black, R et al. “Where and why are 10
million children dying every year?” The
Lancet. 28 June 2003. Vol. 361 (9376):
2226-34.
2. Jones, G et al. “How many child deaths
can we prevent this year?” The Lancet, 5
July 2003. Vol. 362 (9377): 65-71.
3. Bryce, J et al. “Reducing child mortality:
can public health deliver?” 12 July 2003.
The Lancet. Vol. 362 (9378): 159-164.
4. Victoria, CG et al. “Applying an equity
lens to child health and mortality: More
of the same is not enough.” 19 July 2003.
The Lancet. Vol. 362 (9739): 233-241.
5. The Bellagio Study Group of Child
Survival. “Knowledge into action for
child survival.” July 26, 2003. Vol. 362
(9380): 323-327.
b. Community case management of pneumonia:
at a tipping point? David R Marsh, Kate E
Gilroy, Renee Van de Weerdt, Emmanuel
Wansi, Shamim Qazi. Bulletin of WHO
2008
http://www.who.int/bulletin/volumes/86/5/07
-048462.pdf
6
c. Global Health Council. Research Brief:
Community Case Management of Childhood
Pneumonia. May 2010. can be downloaded
from:
http://www.globalhealth.org/view_top.php3?
id=621
Recommended Reading
a. Haines A, Sanders D, Lehmann U, et al.
Achieving child survival goals: potential
contribution of community health workers.
Lancet. 2007 Jun 23;369(9579):2121–31.
4
2/14
5
2/21
* Policy Brief #1 due in class
HIV Policy and Delivery: Required Readings
Access to Care and
a. An assessment of interactions between
Health System
global health initiatives and country
Strengthening
health systems by World Health
Organization Maximizing Positive
Guest Speaker: Jen Cohn,
Synergies Collaborative Group, Lancet,
MD
June 20, 2009
b. Michael E Porter, et al. Partners in
Health: HIV Care in Rwanda. Harvard
Business School Case, 2009. Download
for $6.95 at
http://hbr.org/product/partners-in-healthhiv-care-in-rwanda/an/709474-PDFENG?Ntt=Joseph+Rhatigan
c. Joseph Rhatigan, Sachin Jain, Joia S.
Mukherjee, and Michael E. Porter.
Applying the Care Delivery Value Chain:
HIV/AIDS Care in Resource Poor
Settings. Harvard Business School
Working Paper, 2009.
http://www.hbs.edu/research/pdf/09093.pdf
d. World Health Organization. Everybody
business: strengthening health systems to
improve health outcomes : WHO’s
framework for action. 2007.
http://www.who.int/healthsystems/strateg
y/everybodys_business.pdf
Maternal Mortality and
Required Readings:
Gender Mainstreaming
a. Thaddeus S, Maine D. Too Far to Walk:
Maternal Mortality in Context. Soc Sci Med.
Watch Witness: Birth in
1994 Apr;38(8):1091-110.
7
Nepal
(http://www.youtube.com
/watch?v=qZ76DB1NSf
E) if time allows
6
2/28
Post-disaster response
and realities: Use of
evaluation and evidence
to guide policy and
b. Lancet series on maternal survival
http://www.womendeliver.org/assets/Matern
al_Lancet_series.pdf
1. Ronsmans C, Graham WJ. Maternal
mortality: who, when, where and
why. Lancet 2006; published online
Sept 28. DOI:10.1016/S01406736(06) 69380-X
2. Campbell O, Graham WJ. Strategies
for reducing maternal mortality:
getting on with what works. Lancet
2006; published online Sept 28.
DOI:10.1016/S0140-6736(06)693811.
3. Koblinsky M, Matthews Z, Hussein J,
et al. Going to scale with professional
skilled care. Lancet 2006; published
online Sept 28. DOI:10.1016/S01406736(06)69382-3.
4. Borghi J, Ensor T, Somanathan A,
Lissner C, Mills A. Mobilising
financial resources for maternal
health. Lancet 2006; published online
Sept 28. DOI:10.1016/S01406736(06)69383-5.
5. Filippi, V et al. Maternal health in
poor countries: the broader context
and a call for action. Lancet 2006;
published online Sept 28.
c. Shaping policy for maternal and newborn
health: A compendium of case studies. A
joint production of JHPIEGO, Maternal &
Neonatal Health, Save the Children, and
Family Care International (2003).
http://www.jhpiego.org/resources/pubs/mnh/
MNHPolComp.pdf.
Recommended Reading:
a. Reproductive Health, Gender and Human
Rights: A Dialogue. Chapter 3
(http://www.path.org/files/RH-GHRDialogue.pdf)
Required Reading:
a. Atkins D, Siegel J, Slutsky J. Making policy
when the evidence is in dispute. Health
Affairs, 2005;24(1): 102-113.
8
response frameworks
Guest Speaker: Allison
Buttenheim PhD
b. Habicht JP, Victora CG, & Vaughan JP.
(1999). Evaluation Designs for Adequacy,
Plausibility and Probability of Public Health
Programme Performance and Impact.
International Journal of Epidemiology,
28(1):10-8.
c. Chapter 1 (pages 1-22) in Gage, A et al. A
Guide for Monitoring and Evaluation of
Child Health Programs.
http://www.coregroup.org/storage/documents
/Workingpapers/ms-05-15.pdf
d. Articles as assigned by Guest Speaker
* Policy Brief #2 due in class
7
3/7
Spring break – no class
Global Health Delivery
8
3/14
Guest Speaker: Nomi
Fuchs, US Representative,
Marie Stopes International
The Global Health
Initiative, Family
Planning, USAID High
Impact Interventions and
MSI’s role in these
programs
Prioritization and
Financing - the US Global
Health Initiative
Burden of disease, cost
effectiveness analysis,
ethics, equity, vertical vs.
horizontal programming
9
3/21
Building Coalitions and
Required Reading:
a. Disease Control Priorities Project. Using
cost-effectiveness analysis for setting health
priorities. March 2008. (Available at:
http://www.dcp2.org/file/150/DCPPCostEffectiveness.pdf )
b. Denny CC, Emanuel EJ. US health aid
beyond PEPFAR: The Mother & Child
Campaign. JAMA. 2008;300(17):20482051.
c. Mayer KH, Hamilton CD. Distributing US
health aid. JAMA. 2009; 301(13) 1339-40.
d. Dugger CW. As donors focus on AIDS,
child illnesses languish. The New York
Times. October 29, 2009.
(http://www.nytimes.com/2009/10/30/world
/30child.html )
Recommended Reading:
a.
http://www.kff.org/globalhealth/upload/804
5_FY2011.pdf (Budget Tracker: Status of
U.S. FY11 Funding for Key Global Health
Related Accounts)
b. Mathers, Colin D., and Dejan Loncar.
“Projections of Global Mortality and
Burden of Disease from 2002 to 2030.”
PLoS Medicine 3 (November 2006): 20112030.
Required Reading:
9
the Political Process
Guest Speaker: Marjorie
Margolies-Mezvinsky,
Women’s Campaign
International
10
3/28
Health care program
development using a
performance and quality
improvement approach
Delivery – Innovations in
reaching the last mile
*Students present oral
briefings on case studies
(see reading list at end of
syllabus – students will be
assigned one innovation
case)
11
4/4
The Role of the Private
Sector in Policy
Development and Service
Delivery
Guest Speakers:
 Steve Sammut,
Senior Fellow,
Health Care
Management
Lecturer,
Entrepreneurial
Programs,
Wharton
 Gregg Alton,
a. Using Performance and Quality
Improvement to Strengthen Skilled
Attendance
(http://www.jhpiego.org/resources/pubs/mn
h/usingPQI.pdf)
b. High Performing Reproductive Healthcare
Sites in Kenya: Why they exceed
expectations
(http://pdf.usaid.gov/pdf_docs/PNACX485.
pdf)
Required Readings:
a. Just and Lasting Change: When
Communities Own Their Futures, D.
Taylor-Ide and C.E. Taylor, Editors.
2002, Johns Hopkins University Press:
Baltimore and London. Chapter 2:
Synopsis of SEED-SCALE
b. Freeman, P., et al., Accelerating
progress in achieving the millennium
development goal for children through
community-based approaches. Glob
Public Health, 2009: p. 1-20.
c. CBIO – community based impact
oriented approach (CBIO) Perry, H., et
al., Attaining Health for All through
Community Partnerships: Principles of
the Census-based, Impact Oriented
Approach to Primary Health Care
Developed in Bolivia, South America.
Soc Sci Med, 1999. 48(8): p. 1053-67
Required Readings
a. The Access Framework: Chapters 2 and
9: in Frost, L & Reich, M Access: How
do good health technologies get to poor
people in poor countries? Harvard
Center for Population Studies, 2008.
b. International Finance Corporation. The
Business of Health in Africa: Partnering
with the Private Sector to Improve
People’s Lives. Pages 1-53.
http://www.ifc.org/ifcext/hia.nsf/Conten
t/AF7EEF14D85250AB852576730052E
022?OpenDocument
c. Bhatia, Pooja. “A Tremor for Haiti’s
Aid Industry.” Foreign Policy,
10
Executive Vice
President
Corporate and
Medical Affairs,
Gilead Sciences,
Inc.
12
4/11
Delivery - Community
Based Care
Guest Speaker: Allisyn
Moran, Senior Advisor,
Evaluation and Research,
Save the Children
13
4/18
Time in Groups to work
on final project during
second half of class
Refugee, immigrant
(documented and
undocumented) Health
December 7th 2010.
http://www.foreignpolicy.com/articles/2
010/06/30/a_tremor_for_haitis_aid_indu
stry
d. Video: VillageReach and VidaGas
ensure vaccines reach the most remote
areas of the country.
http://www.odemagazine.com/doc/69/vi
dagas/
e. Video: Franchising Healthcare: An
Introduction to HealthStore
http://www.cfwshops.org/
Required Reading:
a. Hilts, Phillip. Rx for Survival: Why We
Must Rise to the Global Health
Challenge. Penguin Press, New York,
2005. Chapters 1-4 (pages 43-164)
b. Alma Ata Declaration (1978). Available
on-line:
http://www.who.int/hpr/NPH/docs/decla
ration_almaata.pdf
c. Readings as assigned by speaker
Required Readings as assigned by Guest Speakers
Guest Speakers:

Sarah Peterson,
Hebrew Immigrant
Aid Society

Joe Garland, Penn
Center for Primary
Care

Susan Kim,
Pennsylvania
Immigrant and
Citizenship
Coalition
14
4/25
Video- Rx for Survival:
Delivering the Goods
Part 1: Health workforce:
overcoming the health
manpower shortage, task
shifting, and policy
Required Reading
a. Chen L, et al. Human Resources for health:
overcoming the crisis. Lancet 2004, 364:
1984-1990.
11
alternatives
Guest Speaker: Linda
Aiken, PhD
Part 2: Group presentations
Case studies for Policy Brief 3 (Students will be assigned one case)
A. Jamkhed (India)
 Arole & Arole (1994). Jamkhed – A Comprehensive Rural Health Project. London:
MacMillan Press and Jamkhed Foundation in North Carolina
 http://www.jamkhed.org/
B. BRAC (Bangladesh )
 Smillie, Ian. Freedom From Want -The Remarkable Success Story of BRAC, the Global
Grassroots Organization That's Winning the Fight Against Poverty. 2009
 BRAC 2009 Annual Report (available at
http://www.brac.net/oldsite/useruploads/files/brac-ar-2009.pdf)
 BRAC Receives Gates Award for Global Health 2004
C. Partners in Health (Rwanda)
 Michael E Porter, et al. Partners in Health: HIV Care in Rwanda. Harvard Business
School Case, 2009. Download for $6.95 at http://hbr.org/product/partners-in-health-hivcare-in-rwanda/an/709474-PDF-ENG?Ntt=Joseph+Rhatigan
 PIH website
D. Care Groups (Mozambique and Cambodia)
 Edward, A., et al., Examining the evidence of under-five mortality reduction in a
community-based programme in Gaza, Mozambique. Trans R Soc Trop Med Hyg, 2007.
101(8): p. 814-22.
 Perry, H., et al., Averting childhood deaths in resource-constrained settings through
engagement with the community: an example from Cambodia, in Essentails of
Community Health, Gofin J and Gofin, R Editors. 2010, Jones and Bartlett.: Sudbury,
MA. P. 169-174.
 Laughlin, M., The Care Group Difference: A guide to Mobilizing Community-Based
Volunteer Health Educators. 2004, Baltimore, MD: World Relief and the Child Survival
Collaborations and Resources (CORE) Group. http://www.coregroup.org/our-technicalwork/initiatives/diffusion-of-innovations/50
E. Hopital Albert Schweitzer (Haiti)
 Perry, H., et al., Reducing under-five mortality through Hopital Albert Schweitzer's
integrated system in Haiti. Health Policy Plan, 2006. 21(3): p. 217-30.
 Perry, H., et al., Long-term reductions in mortality among children under age 5 in rural
Haiti: effects of a comprehensive health system in an impoverished setting. Am J Public
Health, 2007. 97(2): p 240-6
12
F. Gadchiroli – SEARCH (India)
 Bang, AT., Bang RA., Reddy, HM., Home-based Neonatal Care: Summary and
Applications of the Field Trial in Rural Gadchiroli, (1993 to 2003). Journal of
Perinatology 2005, 25:S108-S122.
 www.searchgadchiroli.org
G. Community Directed treatment for neglected Tropical Diseases
 The case of ivermectin and river blindness (APOC)
 Community-directed interventions for major health problems in Africa, 2008.
http://apps.who.int/tdr/svc/publications/tdr-research-publications/community-directedinterventions-health-problems
13