BUILDING THE FUTURE’S HEALTH LEADERS20 YEARS OF HEALTH POLICY, PLANNING AND FINANCING

This publication is a journey across 20 years of the history of Health Policy, Planning and Financing (HPPF), of LSE and LSHTM. Through the biographies of some HPPF alumni, the memories of some of the faculty and staff who have been running the programme, and many other bits of history, we hope to be able to show the breadth of the success of this unique programme and the hard work behind it. We shall not pretend to give the full picture. Many outstanding students and their achievements, as well as many faculty and staff, will not

fi nd a space here, but we hope they will do in the next edition in 20 years time (or maybe sooner…). We want to thank, among many others, Anne Mills, Kim Jones (HPPF ’06), Yoko Laurence (HPPF ’06), Errol Lobo, and Anthea O’Sullivan for their invaluable help in realising this publication.

Franco Sassi, LSE Department of Social Policy, and Dirk Mueller, LSHTM Department of Public Health and Policy

1989

-90

1990

-91

1995

-96

1988

-89

1987

-88

Howard DaviesDirector, LSE

Andy HainesDirector, LSHTM

1

Some of the HPPF graduates have continued, or moved on to, a career as a health professional. For them too HPPF has made a difference, opening up new perspectives in the practice of medicine and other health professions.

The MSc HPPF has for twenty years been at the forefront of postgraduate health policy programmes and I hope that this publication will prove a fi tting tribute to the work carried out by the teachers and students on the MSc programme over these years. Equally, I hope that the events that will celebrate the 20th Anniversary of HPPF will enable staff, students and alumni to renew old friendships and build some new ones. On behalf of LSE I would like to extend a warm welcome to all those who will join the newly established Health Alumni Network, which hopefully will improve communication and collaboration in the future.

Celebrating 20 years of success…

The MSc in Health Policy, Planning, and Financing has an internationally recognised track record in training leading health policymakers from a wide range of countries. It was launched following many months of planning by Brian Abel-Smith and John Carrier from the London School of Economics and Political Science and Jenny Roberts and Anne Mills from the London School of Hygiene & Tropical Medicine. Originally the title was restricted to ‘Planning and Financing’ and the word ‘Policy’ was introduced into the title after Lucy Gilson took over from Anne Mills as Course Director in 1992.

The fruitful partnership between LSE and LSHTM has endured for 20 years and is still in robust health. Uniquely it brings together complementary expertise from the two institutions and gives students access to an impressive and well-rounded range of disciplines relevant to the topic area. The continued success and high profi le of the HPPF MSc is a tribute not only to those far sighted individuals who set it up two decades ago but also to the outstanding staff from both institutions who have taught on the course over the years. It is the combination of multi-disciplinarity, academic rigour,

LSE and the London School of Hygiene & Tropical Medicine have offered this year for the 20th consecutive time their joint graduate programme in Health Policy, Planning and Financing. This Masters of Science was created in 1986 under the leadership of LSE’s late Professor Brian Abel-Smith and has since established itself as one of the leading health policy programmes worldwide. It is one of the earliest examples of institutional collaboration for the two University of London Colleges, and one that has been successful throughout. The programme has attracted large numbers of students since its early years, from all continents. This booklet shows the breadth and the importance of the many achievements by the almost one thousand graduates from the programme. In many countries and international organizations, HPPF Alumni have become leaders in the fi eld of health policy. They have made a difference in academic research, in the management of health care organizations, in the development and implementation of policy.

…and looking forward to the next 20 yearsoutstanding teaching skills and breadth of the experience which has resulted in sustained success.

The course has also attracted outstanding students, many who have gone on to prominent careers in a range of institutions including, universities and research institutions, governments, international agencies or NGOs. It has succeeded in equipping its graduates not only with the methodological tools to understand trends in health and disease and the potential impacts of policies on health outcomes, but also the tools to apply what they have learnt in their day-to-day work.

I would like to express my thanks to Franco Sassi and Anne Mills for their contributions to HPPF and for their roles in organising this publication. As well as looking back at the successes of the past, we also look forward to the next 20 years of the course and the expectation that it will continue to provide superb academic experience for future leaders in the fi eld.

Working together for the future of health careFranco Sassi

HPPF is an exceptional programme. From any perspective HPPF stands out as an extraordinary asset for the Schools that offer it and an extraordinary opportunity for the students who choose to enrol in it. It is arguably the longest established health policy programme in the UK, and one of the oldest worldwide. It is taught by two colleges that have been at the forefront of the social sciences and public health for many years. LSE and LSHTM have engaged in a successful and long-lasting partnership of a kind that is not often seen in a competitive academic world.

Hilary Goodman, at LSHTM, and I took over from Lucy Gilson in 1995 as programme directors. It was a daunting task. With very few exceptions, students were older than me and their experience in health policy was impressive. It took a lot more than Italian-style shoes and initials embroidered on my shirts to keep their interest alive and be recognised as their course leader. But the rewards have always been far greater than the efforts, and I was lucky enough to share this role with excellent colleagues, Hilary fi rst and Paul Jacklin later, in particular.

I was asked to develop what used to be the second half of the health economics course. This changed from a broad Economic analysis for management, policy and evaluation into a more narrowly focused course on Cost-effectiveness analysis in health care. I remember the bewildered looks of some of the students when I fi rst introduced a rather unfriendly software to help them build decision trees. We now use more sophisticated instruments but, most of all, none of the students is taken by surprise at the sight of a decision or cost-effectiveness model because the concept and the language have become commonplace in health policy making in so many countries.

The curriculum of studies has been adapted to the changing needs of students and employers in the health sector. A review of the programme that led to the change of its name, overseen by Lucy Gilson in 1992-93, was followed by two further reviews in more recent years. The range of courses offered to students kept expanding and so did their contents. Choice increased constantly as the two Schools got more and more involved in the teaching of health policy and related subjects and moved to a modular teaching structure. The LSHTM Department of Public Health and Policy was the fi rst to develop a new programme on its own in the early 1990s, the MSc in Health Services Management, now subsumed as a stream under the new Public Health programme. The LSE Department of Social Policy launched an MSc in International Health Policy in the mid-1990s, to which a specialist Health Economics stream was added more recently, as well as a MSc in Health, Population and Society. For every new programme introduced by either School, new options became available to HPPF students. What continues to amaze me is how HPPF was always strengthened, rather than weakened, by the introduction of new programmes at the two Schools. Numbers of applicants and students on the course never went down because of this, rather they kept steadily on an increasing trend. The students on the programme have been its most valuable asset. Almost every year we have participants from all continents who bring to the programme invaluable experiences and a strong commitment to improve health policy throughout the world. The average student age has decreased, mainly because of a growing number of bright young students from North America, many of whom taking a break in their medical studies. We have increasing numbers of applicants from European countries, including Eastern Europe, and from Asia. As a result, the ‘development’ component

of the programme has progressively broadened its focus to what is now a global health perspective. Being part of the HPPF class has always been listed as the best aspect of the MSc in all end-of-year student evaluations during my time as programme director.

Both LSE and LSHTM have invested heavily in health policy research since the establishment of HPPF. LSHTM developed such initiatives as the Health Economics and Financing Programme, in 1990, and more recently ECOHOST, a research centre on health and health care in Eastern Europe and the former Soviet Union, and the Consortium for Research on Equitable Health Systems. LSE launched the research centre LSE Health in the early 1990s, also thanks to the efforts of Brian Abel-Smith, which merged in the year 2000 with the Personal and Social Services Research Unit to become LSE Health and Social Care.

After responding so well to so many challenges over the last twenty years, the programme now faces new challenges. Health care reforms have been designed and implemented throughout the world, in industrialised as well as developing countries. A key challenge today is providing rigorous evidence of the impact of such reforms, enabling all those involved in the making of health policy to understand what works and what does not and why. An increasing emphasis is being placed on the social determinants of health, leading to a growing recognition of the role of factors outside health care as determinants of health and disease. Health Policy studies, accordingly, will have to expand their focus well beyond the boundaries of health care systems. Interactions between health systems and the rest of the economy, as well as macroeconomic dynamics impinging on the health sector, will also become the focus of increasing attention within health policy studies. We are all ready for the new challenges.

2

From any perspective HPPF stands out as an extraordinary asset for the Schools that offer it and an extraordinary opportunity for the students who choose to enrol in it. It is arguably the longest established health policy programme in the UK, and one of the oldest worldwide.

3

A painful but rewarding birthJenny Roberts

The birth of MSc Health Planning and Financing in 1986 was the result of a long and difficult gestation. Beginning in early 1984 with an angry memo from me, typed by Tricia Foley, to the Teaching Policy Committee at LSHTM with a copy to Brian Abel-Smith and the Social Science and Administration Department at LSE. LSE and LSHTM had a long history of collaboration in teaching (Jerry Morris, Richard Titmuss, Brian Abel-Smith and others jointly teaching in both institutions). An earlier suggestion of mine for a joint degree had been met with a lukewarm response. Now a new degree in Health Policy and Planning had been submitted for approval to the University by another college. The two institutions with greatest expertise in the health were likely to be sidelined.

This time I did get a reaction and indeed considerable support from Brian Abel-Smith at LSE and Gordon Smith and Patrick Hamilton at LSHTM. First we had to explore the University requirements that had to be met before a new degree would be sanctioned and then proposals had to be presented to teaching committees at each School so that the proposal could enter the hierarchy of meetings that made up the administrative process. Each meeting was a battle as the new degree unexpectedly intruded on other people’s agendas and territories. By November 1984 the proposal was submitted to the University via the Board of Studies in Social Administration and it subsequently proceeded through the University committees. In the late spring of 1985 we got University approval. For me it had been a painful birth!

It was rewarding, however, especially when we won a University New Initiative Post to support the course. This was advertised in December 1985 – Anne Mills was appointed.

A formal Joint Policy Committee of those closely involved with the programme – Brian Abel-Smith, Patrick Hamilton, John Carrier, Anne Mills, and myself (with others to advise on their subject areas) was set up to refi ne the curriculum, produce bibliographies and allocate responsibilities and handle the publicity. Handbooks were prepared, timetables agreed and a welcome letter sent out. We were ready.

The course began in October. We had 18 students who named themselves the pioneers! Anne was pregnant and after a short initial stint as co-ordinator had to take leave. I took over with the stalwart support of John Carrier at LSE. There was no modularisation in those days and no charge for auditing courses so many of the students attended more than the required courses and turned up for both developed and developing country seminars. Some explored courses in development economics and public fi nance as well as our rich agenda of courses in Social Dimensions of Health, Health and

Society, Basic Community Health, Health Planning and fi nancing and Health Economics. Tricia Foley who became course secretary at LSHTM did a magnifi cent job of supporting us all in those early years.

Another unexpected development at this time was the establishment of the research degree programme, MPhil/PhD Health Planning and Financing. This was encouraged by Kenneth Warren who as a visitor to LSHTM had seen the potential for developing a programme based on HPF that would attract ‘outstanding people who are likely to occupy key positions in the future health related sectors of their countries’. Gordon Smith (then Dean of LSHTM at the time) and myself worked, in his smoke fi lled room, throughout Maundy Thursday – then a holiday – to get the proposal into Rockefeller to meet a deadline. We were successful in getting the funds from the Rockefeller Foundation and University approval. This was a great boost to the programme, it funded staff and attracted some very talented students.

I enjoyed being associated with HPF (HPPF) programme in those early years. I had the pleasure of working with some wonderful colleagues and some very remarkable students. We had fun: carnivals, trips to Italy; and established a network of friends from all parts of the world.

Jenny Roberts and Tricia Foley

4

1986-1996

‘Joining the staff of LSHTM in autumn 1985, I soon learnt about the new Masters’ degree that Jenny Roberts and others had planned. Coming

from the Open University, I was particularly attracted to it as, unlike the MSc Community Health, it was going to be open to non-medics. One of the four planned linear courses was entitled ‘Basic Community Health’, and no one had been identifi ed to run it. This was too tempting an opportunity, particularly when I learnt that whoever took on the responsibility for running it could, to a large extent, determine the curriculum. Together with Colin Sanderson, I put together a course that was essentially health services research and for the next fi ve years or so I thoroughly enjoyed being involved in what was an exciting, innovative endeavour.’ Nick Black, LSHTM

1987 A new Department of Public Health and Policy is created at LSHTM. Patrick Vaughan becomes the fi rst Head of Department.

At the same time… AZT, the fi rst antiretroviral drug, is approved by the Food and Drug Administration in the US, fi ve years after the disease was given its current name and amidst growing public anxiety.

The World Bank endorses user charges for fi nancing public health services in developing countries.

1986 LSE and LSHTM offer for the fi rst time a joint graduate programme in Health Planning and Financing. The nine month MSc has two core courses – Basic Community Health (mainly taught by Nick Black) and Health Planning and Financing (mainly taught by Brian Abel-Smith) – and a number of options, among which Health Economics and Social Dimensions of Health. A course in Epidemiology and Health Care was also planned but will only be offered from the following year. The fi rst intake consists of eighteen students.

At the same time… The fi rst WHO International Conference on Health Promotion is held in Canada, and the Ottawa Charter is adopted outlining fi ve action strategies on health promotion to help achieve Health for All by 2000.

A major accident at a nuclear plant in Chernobyl, in the former Soviet Union, exposes a vast area and population to the effects of radiation. A radioactive cloud sweeps across Europe prompting an unprecedented health emergency.

1989 The HPF class makes its fi rst study trip abroad, to lake Como, Italy (photo above). Approximately 20 students and 6 members of the faculty participate in the trip. This will be repeated in subsequent years and has now become a regular feature of the MSc. The latest HPPF classes have tended to organise trips to Geneva to visit the main international health organisations.

1990 The Health Economics and Financing Programme is created within the Department of Public Health and Policy at LSHTM, with funding from the Overseas Development Agency (subsequently renamed DFID). Anne Mills is the director of the programme.

At the same time… The NHS and Community Care Act establishes an internal market system within the NHS and drives the creation of GP fundholding. The GP Contract emphasises the role of GPs in public health and offers incentives for them to work in health promotion clinics.

Romania’s new government legalises abortion and maternal mortality immediately declines to 40 per cent of 1989 fi gure.

5

1995 LSE celebrates its fi rst centenary, having been founded in 1895 by Beatrice and Sydney Webb. Ralf Dahrendorf, director of LSE from 1974 to 1984, writes the volume ‘LSE: a history of the London School of Economics and Political Science 1895-1995’ to mark the anniversary.

Franco Sassi (LSE) and Hilary Goodman (LSHTM) become HPPF Programme Directors marking the end of the joint role previously played fi rst by Anne Mills and then by Lucy Gilson.

Anne Mills and Nick Black are promoted to Professors, and Harrison Spencer becomes Dean at LSHTM.

LSE Health and LSE Department of Social Policy obtain funding from the European Commission to develop a Jean Monnet module in European and Comparative Health Policy. This would later evolve into a course on Health Systems and Policies and become a core component of the HPPF curriculum.

At the same time… The EMEA (European Medicines Agency) is created in London as a decentralised body of the European Union. Elias Mossialos, LSE, will be a member of its management board from 2000 to 2003.

Germany’s universal Long-Term Care Insurance Program begins.

The United Nations’ World Summit for Social Development is held in Copenhagen, ending with the Copenhagen declaration and ten commitments to drive global social progress and development.

1993 – Julian Le Grand joins the Department of Social Policy at LSE. ‘I was appointed the Richard Titmuss Professor of Social Policy following Brian Abel-Smith’s retirement. I’ve taught on HPPF ever since, with the exception of the last two years when I was on secondment to No 10 Downing Street as health policy adviser to the Prime Minister. I value many things about HPPF, including the range of subject matter and the breadth of teaching that the link between the two Schools allows. But, during all my time on the course, the most impressive thing about it has been the students. Their diversity, quality and dedication is quite exceptional in my experience as a teacher.’ Julian Le Grand, LSE

1992 Lucy Gilson takes over from Anne Mills as Course Organiser for HPF. She organises the core course and introduces a Study Unit on the Political Economy of Health and Development. Lucy will direct the programme for three years.

At the same time… The Chinese government carries out international competitive bidding for TB drugs and save 70 per cent on UNICEF’s published prices.

A major reform of the Italian National Health Service devolves responsibility for the organisation and management of health systems to the regions.

The Indian Government launches a National AIDS Control Project.

1993 Charles Normand takes over from Patrick Vaughan as head of the Department of Public Health and Policy at LSHTM.

Following an intercollegiate review of the programme during the academic year 1992-93, the name of the MSc is changed into Health Policy, Planning and Financing. The core course is also revised and renamed Foundations of Health Policy.

At the same time... The Clinton Administration attempts to implement a major reform of the US health care system. The attempt will prove unsuccessful.

Free choice of sickness fund and increased competition among sickness funds is introduced by the Gesundheitsstrukturgesetz (GSG/Health Structure Reform Act) in Germany.

The WHO declares tuberculosis a ‘Global Emergency’.

The World Bank issues its World Development Report – Investing in Health. This will mark an important change in the Bank’s approach to the development of health care systems throughout the world, the impact of which will be felt for many years. Richard Feachem, Dean of LSHTM, plays a major role in this endeavour.

1994 LSE Health is established as a research centre within the LSE Department of Social Policy and Administration, affi liated with the European Institute and the Department of Social Psychology. Elias Mossialos is the Director. Brian Abel-Smith is the main inspirator and a driving force behind its early development.

1996 Brian Abel-Smith dies in London, having been involved in the life and work of the Department of Social Policy and LSE Health, and in the teaching of the MSc Health Policy, Planning and Financing until the very last days of his life. He was Emeritus Professor of Social Policy since his retirement in 1991.

LSE Health is recognised as a Collaborating Centre of the WHO on Health Policy and Pharmaceutical Economics.

At the same time… Brazil begins a national distribution of anti-retroviral drugs.

6

1996-2006

1997 Sociologist Anthony Giddens (above) becomes LSE Director, taking over from John Ashworth. He will remain director until 2003.

At the same time… The US Congress passes legislation to create a State Children’s Health Insurance Program (SCHIP).

1998 Mrigesh Bhatia becomes HPPF Programme Director at LSE. He will play this role for three consecutive years and again in 2004-05.

The European Observatory on Health Care Systems is established as a partnership of the WHO European Offi ce, the governments of Norway and Spain, the European Investment Bank, the World Bank, LSE and LSHTM. The two Schools form the London hub of the Observatory. HPPF Alumnus Josep Figueras (HPPF ’89) is appointed Head of the Observatory Secretariat. (right)

At the same time… The NHS celebrates its 50th birthday.

2000 Andy Haines becomes Dean of LSHTM.

Franco Sassi is awarded a Harkness Fellowship in Health Care Policy by the Commonwealth Fund (NY, US). This is the fi rst such award for a member of LSE, even though others, including future director Howard Davies, held Harkness Fellowships before these were targeted to the fi eld of health policy. Panos Kanavos will be awarded the same Fellowship the following year, Anna Dixon and Adam Oliver in 2005.

LSE Health and the Personal and Social Services Research Unit at LSE merge into a new centre called LSE Health and Social Care. The centre draws upon the multidisciplinary expertise of 45 staff

members, 15 associated academics and a number of postgraduate students. Elias Mossialos and Martin Knapp (left) are co-Directors.

At the same time... The UN Millennium Declaration sets out the Millennium Development Goals.

The WHO establishes a Commission on Macroeconomics and Health (CMH). Anne Mills is one of 18 leading world experts called upon as commissioners. ‘The Commission provides evidence that investments in global health will save 8 million lives a year by 2010 and generate at least a $360 billion annual gain during the period 2015-2020, several times the costs of scaling up the health interventions themselves, counting both the donor and recipient country efforts.’ (WHO)

The Bill and Melinda Gates Foundation is established ‘to help reduce inequities in the United States and around the world’. LSHTM will receive funding from the Foundation to establish the Gates Malaria Partnership.

7

2006 Dirk Mueller (HPPF ’04) takes over from Paul Jacklin as HPPF Programme Director at LSHTM. For the second time an alumnus becomes course organiser.

LSE and LSHTM organise a joint conference on 29 and 30 June to celebrate the 20th anniversary of HPPF and the achievements of the almost one thousand graduates from the programme. The conference will focus on ‘20 Years of Health Policy Studies. What Difference Have We Made?’.

2001 Paul Jacklin (HPPF ’99) takes over from Hannah-Rose Douglas as HPPF programme director at LSHTM. He will hold this position for fi ve years.

Alistair McGuire takes on a joint position

between LSE and King’s College London as Professor of Health Economics. He will gradually move entirely to LSE and will become head of the Social Policy Department in 2006.

At the same time… WTO member governments adopt the ministerial Declaration on the TRIPS Agreement (on Intellectual property rights) and Public Health in Doha, Qatar, as a response to concerns about the availability of drugs to patients in poor countries.

‘Mental Health: New Understanding, New Hope’ the 2001 WHO World Health Report draws attention to the under-recognised burden of mental disorders.

2002 A new major review of HPPF is undertaken. This will lead to a change of the programme from a nine month to a one year MSc with a compulsory dissertation (from 2004-05), and to a change in its structure from 2003-04. Two half unit courses will make up the new core, Foundations of Health Policy, and Health Systems and Policies. Students will be able to select options to ‘specialise’ in health economics, health policy and management, or epidemiology and health trends.

At the same time... HIV/AIDS is the leading cause of death worldwide for those aged 15-59.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria is formally established as an ‘innovative approach to international health fi nancing’. Richard Feachem (photo above) is appointed Executive Director of the Fund.

2003 Elias Mossialos (left) becomes the fi rst Brian Abel-Smith Professor of Health Policy. Howard Davies becomes director of LSE.

Gill Walt becomes head of the Public Health and Policy Department at LSHTM, succeeding in this role to Nick Black. Nick Mays (left) joins LSHTM as Professor of Health Policy, upon his return from New

Zealand, and is appointed Chair of the HPPF Exam Board.

At the same time… Canada begins major health system reform with agreement on the 2003 First Ministers’ Accord on Health Care Renewal. During the previous year the Romanow Commission published its Report on the Future of Health Care in Canada, recommending major changes to ensure the long-term sustainability of Canada’s health care system.

Cases of polio are reported in six countries: Nigeria, India, Pakistan, Afghanistan, Niger, Egypt.

The WHO issues its 2003 Report, Shaping the Future (a return to primary health care).

8

Brilliance, modesty and compassion are terms that continually come to mind when we refl ect on the life of our great friend and colleague Brian Abel-Smith. One of his most amazing qualities was his ability to do everything so well yet with such genuine modesty, whether it be entertaining, skiing, or advising governments. On a personal level, he radiated warmth in a way which made it impossible not to notice his presence when he walked into a room.

Brian’s genius was evident from the very beginning of his career. When he joined LSE as Lecturer in 1955, he was already prominent in the fi eld of social policy thanks to a memorandum to the 1953 Guillebaud inquiry into the costs of the National Health Service (NHS). Written with his mentor Richard Titmuss, whom he succeeded as Professor of Social Administration at LSE in 1961, it showed that spending on the still infant NHS, far from spiralling out of control as the Treasury feared, was actually falling as a percentage of gross national product: and that the pressures of demography and advances in medical science meant that more needed to be spent on it, not less. It was the NHS which earned his particular devotion. He did more than anyone to acquaint others with the reasons for its existence – and how it had to be adapted to new circumstances.

Brian was tremendously active at the international level having visited more than 60 countries as a Consultant for the World Health Organization and other international organisations; in consequence, there is hardly a national system in the developing world that does not bear the stamp of his advice and his contributions undoubtedly made him more infl uential elsewhere than in his own country.

In Europe, Brian advised all the countries of the European Community and made a signifi cant contribution to policy development at Community level. He was Special Adviser to a former European Commissioner for Social Affairs, and sat as an independent expert on the EEC Committees on Social Protection and Pharmaceutical Consumption. Brian undertook many studies for the European Commission, looking particularly at the organisation, fi nancing and cost of health care as well as cost containment in health care systems. He played a leading role in a major study on ‘Choices in Health Policy: An Agenda for the European Union’, and up until his death was involved in a LSE Health study on ‘Priority Setting in Public Health and Health Policy in the EU’.

But his contribution was not only to health services. He worked on various aspects of housing and social security policy.

His work that probably made the most political impact was on poverty ‘The Poor and the Poorest’, written with Peter Townsend and published in 1965. By demonstrating that despite 20 years of a welfare state, poverty still persisted, especially among children and the elderly, it challenged the social and political complacency of the day. It led directly to the formation of the Child Poverty Action Group and, more broadly, to an awareness that a coalition of politically aware academics and welfare activists with a single cause to fi ght for could lead to change.

(Edited from obituary published in Eurohealth, 1996)

Although many individuals were responsible for the HPPF MSc coming to fruition, the main inspiration came from the involvement of Brian Abel-Smith.

His work for the British Department of Health and the WHO convinced him of the importance of social science principles informing health policy decisions at international, national and local levels; and the advantage to social scientists of understanding the implementation of theoretical ideas at the pragmatic and policy making levels.

To this end, the multi-disciplinary nature of the HPPF MSc evolved and was helped by several equally important factors. First and obviously, the academic and practical contribution of Brian through his writings, his infl uence on government and his encouragement of students. His ability to cross interdisciplinary boundaries and place developed and developing country systems in context was demonstrated by his seminal book Value for Money in Health Services.

Secondly, the quality, mix and experience of the students coming on to the MSc. They come, literally, from all over the world and from all disciplines – developing and developed countries; social scientists and clinicians; senior civil servants and recent university graduates. The MSc attempts to place health, its determinants and the components of medical and non-medical health care within the widest economic, sociological and public policy contexts. Many of its graduates go on to successful careers in academic and health care settings.

The productive link with LSHTM is a major component of the MSc allowing the exchange of ideas between clinically and non-clinically trained students, to the benefi t of all; and I have no doubts that the teaching and research staff benefi ted from the enthusiasm, experience and commitment of the students to the core values of the MSc. I feel it has been a privilege to have been associated with HPPF.

John Carrier, LSE

Brian Abel-Smith1926-1996

‘There are few academics who have changed the world – and even fewer who have changed it for the better. Brian was one of that select group.’

‘Although we now celebrate the course as a programme in health policy… in the mid 1980s, the language was of planning and fi nancing. The era of health care reform brought in new jargon – new public management, purchaser provider split, contracting out – but many of the fundamental issues remained the same.’

9

The birth of the MSc Health Planning and Financing now seems very long ago! Though in fact I recall it vividly given that it virtually coincided with the not altogether straightforward birth of my first child – in fact, Jenny Roberts had been hoping that I would start immediately as course director, but instead had to stand in both as a programme director and lecturer since I got rushed into hospital in the first term and then ordered to rest before going on maternity leave after Christmas. A false alarm, as it turned out, but rather disruptive at the time!

The start was preceded by many months of planning, involving mainly, as I recall, Brian Abel-Smith, Jenny, John Carrier, and myself. We were successful not only in planning the programme, drawing up the regulations, and getting it approved, but also in applying to the university for funding to pay the course director for three years (I recall termed a ‘new blood’ initiative – to fund new staff for an initial period, after which School funds had to take over). I was successful in competing for the position, so not only acquired the MSc to run, but also moved on to university funding from research programme funding. As those of you who are familiar with LSHTM know well, this is a signifi cant event, eliminating the regular cycle of raising one’s salary from research grants.

I remember very few problems in getting the programme through the administration of the Schools, no doubt due to Brian’s authority and Jenny’s familiarity with both Schools, though I was fortunate not to bear the brunt of the negotiations. I don’t think we even had a formal agreement between the Schools about the collaboration – that came later. Issues tended to be solved as they arose rather than thought through in advance – I recall the problems when the new degree certifi cate carried only the LSE name, since LSE was handling admissions and examinations, and we then had to work out a way of getting the names of both schools on the certifi cate.

Although we now celebrate the course as a programme in health policy, in fact the word policy was not introduced into the title until after Lucy Gilson took over from me as course director, in 1992. In the mid 1980s, the language was of planning and fi nancing. The core disciplines/subjects were considered to be health economics, health services, epidemiology, and sociology, as applied to the health sector. The two

core courses were health planning and fi nancing, run at LSE, and health services, run at LSHTM. Health economics, although optional, was taken by virtually everyone. In many ways the core course has remained covering many of the same issues as the course we planned back in 1985 – determinants of health, health inequalities, sources of fi nance, approaches to organising health services, and planning methods. The era of health care reform brought in new jargon – new public management, purchaser provider split, contracting out – but many of the fundamental issues remained the same.

As originally conceived, the course director held a part-time post in each School. So I moved between them, with an offi ce in each place. Certainly the early years of running the course are now hazy in my memory – possibly deliberately! My fi rst child was born in late 1986 and the second in early 1989, so for all the time I was course director I was juggling babies and a full time job, as well as in 1990 starting the Health Economics and Financing research programme with a DFID (then ODA) research programme grant. I recall wonderful course secretaries, Sheila followed by Janice at LSE and Patricia at LSHTM, who bore the brunt of day to day organisation of the course.

I handed over as director in 1992, not without some regrets. But it is good to bring in fresh thinking every now and again, and under Lucy Gilson there was a complete review of the course, and a considerable strengthening of the health policy orientation and content.

The early daysAnne Mills

10

Juliet Bataringaya-Wavamunno(HPPF, ‘99) In June 2005, I joined a colleague from WHO Headquarters and travelled to the Republic of Yemen to undertake a country evaluation of WHO. As part of the evaluation process, we met and had discussions with various stakeholders

in the health sector. It was with much delight that by the end of the evaluation we realised there were a total of fi ve HPPF graduates, all from different years, around the table: Annie Vestjens (HPPF ’97), First Secretary for Public Health, Royal Netherlands Embassy in the Republic of Yemen; Maria Santamaria (HPPF ’01), Medical Offi cer, Offi ce of Internal Oversight Services, WHO Headquarters – Geneva; Jamal Nasher (HPPF ’02), Director General, Health Policy, Focal Point for National Health Accounts and Macroeconomics and Health Ministry of Public Health and Population Republic of Yemen; Stefan Pahls (HPPF ’03), Consultant, Health Sector Reform, and Formerly Team Leader, Support to Health Sector Reform Programme in the Republic of Yemen funded by European Commission; and myself (HPPF ’99) National Professional Offi cer, Health Systems Development WHO Country Offi ce – Uganda. We would like to convey our thanks to LSHTM and LSE for such a wonderful course. It is without doubt that we shall keep bumping into colleagues scattered all over the world, working towards improving health outcomes and health development.

Patrick Kadama (HPPF, ‘89) is a Health Planner and Health Economist. He earned a Medical degree from Makerere University in 1976 and specialized in Clinical Tropical Medicine (MSc degree) at the London School of Hygiene and Tropical Medicine in 1985. Patrick

pursued a research degree (MPhil) in Health Planning and Financing under the joint programme at LSE and LSHTM from 1987 to 1989. He then studied health care management at the Harvard School of Public Health in

1994. He was involved in Health Policy development and Health Planning in Uganda for over 15 years as head of health sector planning in the Ministry of Health. Patrick has also been involved with public expenditure reviews; with the development of national health accounts; poverty reduction strategies; burden of disease and health sector performance assessments; the development of health fi nancing strategies and sector wide approaches for health development. He is currently working at the World Health Organization Headquarters in Geneva, in the Department for Health Policy, Development and Services.

Maximillian Mapunda (HPPF, ‘92) has worked for over 16 years in health systems planning and managing projects in the health sector. He has led developments in health fi nancing initiatives in Tanzania by participating in the design and implementation of cost sharing

initiatives, a National Health Insurance Scheme and a Community Health Fund. He also participated in the design of health sector reform strategies in Tanzania and became the fi rst Team Leader of the Health Sector Reform Secretariat. Maximillian is currently working with the World Health Organisation Country Offi ce for Tanzania as National Professional Offi cer for Health Systems Development.

The World Health Organization was created in 1948 as an Agency of the United Nations. Its aim is the attainment by all peoples of the highest possible level of health, defi ned as a state of complete physical, mental and social well-being. The secretariat of WHO is based in Geneva, but the organisation operates through a network of Regional and Country Offi ces, employing around 8,000 people. A large number HPPF graduates have been and are currently employed at WHO at all levels of the organisation. HPPF graduates have played a key role in the establishment and running

of the European Observatory on Health Systems and Policies, a partnership between the European Offi ce of WHO and a number of organisations, including LSE and LSHTM. Josep Figueras (HPPF ‘89) is the Head of the Observatory. Julia Blau (HPPF ‘04) is a research offi cer at the Brussels offi ce, Elke Jakubowski (HPPF ‘97) is research associate at the Observatory and acting Regional Adviser, Futures Fora, at WHO Europe. In addition, a number of HPPF graduates have been working at LSE hub of the Observatory.

HPPF@WHO

In this page we only present a small selection of HPPF Alumni working at WHO, it would have taken a whole new publication to list all those who have worked and are currently working in the Organization, and illustrate their achievements. Hopefully, there will be other opportunities to do this.

Kamel Senouci (HPPF ’03) is a Medical offi cer at the WHO headquarters, based in Lyon, France. His main focus is on the implementation of the new International Health Regulations at the national level. He provides help to individual countries to strengthen

their capacities for surveillance and response against infectious diseases of potential international public health concern, and participates in WHO missions during outbreaks.

Ole Doetinchem (HPPF ‘02). When studying on HPPF, we would at times joke that the health policy and the fi nancing bits of the master’s programme received more attention than the planning aspect. Consequently, it was more by chance than by planning that I found myself back in my native Germany working for GTZ after graduation. After a happy three years there, however, it was time for a change of scene. So, in 2005 I took up the post of health systems analyst in the health fi nancing department at the WHO headquarters in Geneva. In a nutshell, this job entails seeking and disseminating information on how to best organise the fi nancing function of health systems, both in general terms (what systems exist, how do different policies work, what choices need to be made, etc.) and in country-specifi c settings (reviewing proposed laws, assessing the fi nancial implications and options given a countries’ circumstances, capacity building, etc). The work at WHO is very much demand-driven. I don’t have one specifi c geographical focus but work to satisfy the needs of WHO member states and regional bodies. This allows me to assess health fi nancing in a wide range of different places, eg, recently in Yemen, Rwanda (see photo, above, taken during the mission, with Jean de Dieu Ntabakirabose) and the Philippines. The HPPF programme has given me an invaluable and thorough grounding in exactly the area that I now work in. What’s also great about it is that you invariably meet other HPPF graduates along the way…

Alexandra Pitman (HPPF ’98)Studying on HPPF was an extremely valuable experience. I learnt as much about the principles of health policy, health economics, health services management, and epidemiology from fellow students as from the lecturers. Armed with this knowledge, I went straight back to the beginning and started at Imperial College School of Medicine the following autumn. Whilst there, terms like ‘sixth stool guiac’ and ‘list cancelled’ developed a little more context, and I began to understand the forces guiding individual clinicians at the micro-level of decision-making. Most importantly, I realised that for practising clinicians, any decision made about an individual patient does not seem ‘micro’ at all. I witnessed how policies issued from up high were received on the ground, and how important it was to consider implementation if policy-making was not to be a complete waste of time.

My research interests are now focused on mental health policy, specifi cally on suicide prevention, as a psychiatrist on the Charing Cross Hospital Training Scheme. The research base for this is scant, both because suicide is a relatively rare event and because it is a behaviour rather than a diagnosis. Using the experiences and knowledge I obtained while studying on HPPF, I am trying to fi nd a way to develop clinical guidelines that are the best refl ection of the evidence available, applicable to specifi c sub-groups, presented in a clear and up-to-date format, and acceptable to clinicians.

Anne Philpott (HPPF ‘99)After fi nishing the HPPF course part-time, I resumed work for an international sexual and reproductive health NGO for a short while before moving to Sri Lanka. There, I served as the Director of International Programmes for an international NGO that works in Asia and Africa but is based in Colombo. Following this, I went on to work for the Female Health Company, the sole manufacturer of the female condom, as the Team Leader for their global public sector programmes. They have a low cost agreement with UNAIDS for work in low income countries, which gave me the opportunity to travel extensively in Africa and Asia introducing this new health technology. I worked on building government and service delivery organisation skills to promote and deliver the product, helped it to achieve regulatory approval, oversaw donor negotiations, and helped shift the fi rst stage of manufacturing to India. While doing this, I was based in Sri Lanka and Thailand, with extensive travel in India and elsewhere. I then moved back to the UK and am now working as the

Health advisor in the AIDS team at the Department for International Development (DFID). I advise on international policy issues, work with multi-laterals and country programmes, provide advice to spending departments on Health/AIDS issues, and deal with parliamentary business and briefi ngs to Ministers and Senior Management. So since HPPF I have covered all bases by working for NGOs, in the private sector, and now as a civil servant.

11

12

Here is a small selection of publications in scientific journals and books by HPPF Alumni. Just one of the many ways in which the programme and those who graduated from it have made a difference in health policy worldwide.

GENERATING NEW SCIENCE FROM KNOWLEDGE AND EXPERIENCE

13

Paul Jacklin

Dirk Mueller

Lorna Guinness

Valeria Oliveira Cruz

Natasha Palmer

14

The London School of Hygiene & Tropical Medicine (LSHTM) is Britain’s national school of public health and its Department of Public Health and Policy has hosted the MSc HPPF since its inception together with LSE. A number of graduates of the MSc HPPF have joined the staff of LSHTM either in the Health Services Research Unit (HSRU) or the Health Policy Unit (HPU). The research performed in HSRU ranges from epidemiological and economic assessment of specific health technologies, through sociological studies of approaches to providing care, to the evaluation of health sector reforms. The Health Policy Unit focuses on comparative health policy and health systems analysis, health economics and international public health; its work is particularly concerned with Low- and Middle-Income Countries. The Unit hosts four main programmes: health economics and financing, health systems development, violence and public health as well as modelling and public health.

Paul Jacklin (HPPF ’99) was based in HSRU from September 1999 to December 2005. He worked as a health economist on the world’s largest RCT of telemedicine and became Course Organiser for the MSc HPPF in 2001, a position which he held until the end of last year before leaving to take on the role of senior health economist at the National Collaborating Centre for Women’s and Children’s Health. He continues to have links with LSHTM with a honorary lectureship. Natasha Palmer (HPPF ‘96) joined the Health Economics and Financing Programme in 1997. Her research interests include: public/private mix of health service provision, contracting, barriers to access of health service and systematic review of fi nancing research. Christoph Kurowski graduated from HPPF in 2000 and joined the same year a HPU based team that performed the analytical work of Working Group 5 (Improving Health Outcomes of the Poor) of the Commission on Macroeconomics and Health. He also studied the human resource implications of achieving health related Millennium Development Goals in

Sub-Saharan African countries until he left HPU to join the World Bank as a Young Professional. Valeria Oliveira Cruz (HPPF ‘00) started working immediately following her graduation from HPPF also as part of the operational team of Working Group 5 of the Commission on Macroeconomics and Health. Later she joined the Health Systems Development Programme of HPU and has focused her work on the topic of aid effectiveness in the health sector. Lorna Guinness (HPPF ‘96) joined the Health Policy Unit in 2001 and is a Wellcome Trust Research Fellow. Her research focuses on the economics of scaling up HIV prevention programmes in South India. Dirk Mueller (HPPF ‘04) joined HPU in 2004 to work on a review of health fi nancing research. Being part of the Health Economics and Financing Programme, he has since carried out several cost-effectiveness studies with a particular focus on methods of malaria prevention in East and West Africa. Since 2006, he is also LSHTM Course Organiser for the MSc HPPF. Among other HPPF Alumni who have worked and are working at LSHTM are Ros Plowman (HPPF ’93) in the Health Services Research Unit, and Cathy Zimmerman (HPPF ’99) in the Health Policy Unit.

HPPF @ LSHTM

Anna Dixon

Left to right: Kate Henderson, Tom Foubister, Sarah Thomson,

Derek King, Franco Sassi

Several HPPF alumni have found employment at LSE Health and Social Care, a multi-disciplinary research centre in the Department of Social Policy at LSE, and the European Observatory on Health Systems and Policies. The Observatory supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health systems in Europe. It is a partnership between the WHO Regional Office for Europe, the governments of Belgium, Finland, Greece, Norway, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Luxembourg, LSE and LSHTM.

Vanessa Davey (HPPF ’02) has been a Research Offi cer at LSE Health and Social Care since 2002. She has been focusing on the impact of social care commissioning on service user control and choice. She is currently leading an evaluation of the introduction of cash payments to service users for the UK Department of Health. Anna Dixon (HPPF ’98) has been a Research Offi cer and Lecturer in European Health Policy from 1998 to 2006. Anna is completing a Harkness Fellowship in Health Care Policy in the United States on the use of information by patients. Upon her return to the United Kingdom she will take up the post of Deputy Director of Policy at independent health foundation the King’s Fund. Her current research interests focus on patient choice and activation, health information and health care regulation. Tom Foubister (HPPF ’03) has been a Research Offi cer since 2004. He has analysed the UK’s private health insurance market for the UK Department of Health and health fi nancing in Central and Eastern European countries for WHO. He is currently looking at issues of access to health care in the European Union. Kate Henderson (HPPF ’02) has been a Research Offi cer since 2002. She focuses on intermediate care, the interface between health and social care, resource allocation within residential and nursing homes and residential care provision.

Derek King (HPPF ’98) has been a Research Offi cer since 1998. Derek’s primary area of research is in mental health policy and economics, with a particular focus on service use patterns and the costs of treating schizophrenia. He also works on modelling projections of long-term care expenditure. Other interests include pharmaceutical policy, priority setting in health care and private health insurance markets. Alexandra Pitman (HPPF ’98) was an Occasional Researcher from 1999 to 2000. She worked on cost containment and health impact assessment in Europe and US health care reform while training to be a doctor. She is now a Senior House Offi cer in Psychiatry on the Charing Cross Psychiatric Training Scheme and doing research into suicide prevention policy. Sarah Thomson (HPPF ’98) has been a Research Offi cer since 2000. Sarah works for the European Observatory on Health Systems and Policies and is also involved in a LSHTM-based project providing policy analysis and advice to the UK Department of Health. Most of her research focuses on analysis of public and private sources of health care funding in Europe, in particular the role and impact of private health insurance and user charges.

HPPF @ LSE

16

Viroj Tangcharoensathien (HPPF ’90)I would defi ne myself as a health systems and policy researcher. I currently direct the International Health Policy Program at the Ministry of Public Health in Thailand. After obtaining a Doctorate of Medicine from Mahidol University (1980) and serving seven years in rural district hospitals in Thailand, I decided to pursue doctoral training in Health Planning and Financing and was able to do so in 1987-1990 through a Rockefeller Foundation fellowship. My doctoral thesis, Community Financing: The Urban Health Card in Chiangmai, Thailand, received the Woodruff Medal in 1991 as outstanding PhD thesis of the London School of Hygiene and Tropical Medicine. Upon my return to Thailand, I focused his work on research into fi nancing healthcare and health insurance development and reform. I created the National Health Account and National AIDS Account, and proposed a contract model and estimated capitation rates following the inception of Social Health Insurance in 1991.

I have had a close research collaboration with Anne Mills’ Health Economic and Financing Program since 1992, and recently became a member of the Consortium for Research on Equitable Health Systems. The collaboration has proven very fruitful in aiding the research of young Thai scholars who became instrumental in health systems reforms in Thailand.

I am now on secondment to head the International Health Policy Program, aimed at capacity building in health systems and policy research. I work closely with other Thai policy makers in the reform of the current Universal Coverage system, and I provide technical support to health insurance development in Lao, Vietnam and Cambodia.

Notburga Timmermans (HPPF ’98)Graduating from HPPF helped me to get a job with the British Department for International Development (DFID) in Tanzania as Assistant Health Adviser, where I was able to implement many of my new skills. The aspects of the MSc that turned out to be most relevant to my future career were health sector reform, sector-wide approaches, health fi nancing, and health service management.

Since then, I’ve worked as a freelance consultant in the area of health systems and multi-sectoral HIV/AIDS in Africa and Asia. HPPF has assisted me in obtaining interesting work. Some examples of this include: providing assistance to the Danish Agency for International Development (Danida) in the development of their new fi ve year strategy for support to the health sector and HIV/AIDS interventions in Mozambique; setting up a programme for the creation of a sustainable commercial market for Insecticide-Treated Mosquito Nets in Mozambique; assisting a Mozambican network of HIV/AIDS organisations in developing their fi ve year strategy and mobilising donor funding; developing the strategy for capacity building in fi nancial management of health services in Santiago-Nord province in Cabo Verde; assisting the Swedish International Development Agency (Sida) in developing their fi ve year HIV/AIDS strategy for Mozambique; helping the Mozambican Ministry of Health to develop a system for direct contracting of NGOs for service delivery; developing action plans for urgent malaria interventions in Malawi, Benin and Mali; and taking a secondment to UNAIDS to set up a joint-donor HIV/AIDS Fund in Myanmar.

In Mozambique I also met my husband Danny, whom I married in June last year. A number of former HPPF classmates were present at our wedding (in the photo below, from the left, Derek King, Anna Dixon, Alexandra Pitman and Anne Philpott). I will always remember my year in HPPF for the academic stimulation it provided and the wonderful friendships it

has left me with. Congratulations to the HPPF staff for the 20 years of this wonderful course. May the course continue to provide guidance for many more generations of students from all over the world.

17

I was HPPF course organiser from 1992 to 1995. During that time three cohorts of students passed through the doors of LSHTM and LSE, and the course name changed to include the extra P, adding policy to health planning and financing.

The addition of the extra P resulted from a review of the course as a whole, drawing on staff from both Schools. In part the review sought to update the course to refl ect the changing world environment. The additional P refl ected the recognition that planning is a very political activity, even if also needing technical skills. In addition, the review allowed refl ection on some of the inevitable logistical issues that are associated with any course, especially one run across organisations and on different sites. Having to support it early on in my life as a course organiser was a great baptism into the procedures and approaches of both schools, each of which has its own organisational culture. It also enabled me to get to know my new colleagues at LSE as I was appointed from an LSHTM base into a joint position with LSE.

The review led me to think through the particular roles I wanted to play in the teaching programme – both in terms of organisational approaches and in terms of the topics and issues I felt important to include. Subsequently, I contributed to the revision of the Foundations of Health Policy core course, also running the developing country seminar stream for this course, and developed a module on the Political Economy of Health run at LSHTM, linked to the Term 1 course on Health Policy, Process and Power. The FHP lecturing forced me to come to grips with a wide range of topics – about some of which, I admit, I knew little. I well remember the embarrassing moment when I was asked a question at the end of a lecture on drug policy: I not only had no clue of an appropriate answer but well knew that there were at least 3-4 people in the room with the depth of experience of drug policy that meant that they should have been giving the lecture! However, teaching such a breadth of subjects and, in particular, the development of the political economy module provided me with an excellent basis for the work that I have done since that time. The learning-through-doing around teaching practice and course development also provided an excellent grounding in course development that has stood me in good stead.

As course organiser I particularly enjoyed getting to know the many students who did HPPF. Such a rich group of people and such a diversity of experience! Given quite large class sizes, I never felt that I was fully able to keep in touch with those who took the developed country stream. But I did try to keep in touch with those doing the course part-time, as well as those from the developing country stream. It’s still always

good to get news of ex-HPPFers. I also still continue to listen to CDs on the CD Walkman given to me as a present by the last student cohort I saw through – so thanks again!

Other features of my years as course organiser that stand out for me were the luxury of an offi ce of my own for two days a week in LSE (compared to shared offi ce space in LSHTM), the regular exercise of walking between the two schools, the enormous support and shared camaraderie of the course secretaries, Janice Harrison and Tricia Foley, in both schools, the excitement of the year the fi rst democratic South African elections were held (1994) and the associated diffi culty of studying for some in the class, and the warm collegiality of Anne Mills, Jenny Roberts and others at LSHTM as well as Julian Le Grand, John Carrier and colleagues at LSE.

I took over as course organiser from Anne in 1992, fully aware of the legacy of the course and having just completed my own PhD. I handed over as course organiser to Franco Sassi and Hilary Goodman in 1995, enriched by the experience and the people, and en route for South Africa – where I have been ever since. Here I continue to have contact with African ex-HPPFers and have continued to encourage others to take the course, as an excellent grounding for a career in health management or research.

Although I cannot be physically present in London for this year’s celebrations, I will certainly be there in spirit – remembering a period that was a central building block for my professional life.

‘I well remember the embarrassing moment when I was asked a question at the end of a lecture on drug policy: I not only had no clue of an appropriate answer but well knew that there were at least 3-4 people in the room with the depth of experience of drug policy that meant that they should have been giving the lecture!’

From Planning to PolicyLucy Gilson

18

Students have joined HPPF from many countries in all continents. The map in these pages shows the nationalities of those whose details we were still able to track down. The mix of countries has changed significantly over time, as shown by the two pie charts covering the first and the last ten years of the programme.

Student nationalities

1

1

1

12

9

1

1

26

70

153

3

3

6

1

16

24

1

7

1

1

13

2 25

7

3

1

11

2

8

11

1

7

2 8

2 3

2

1986-1996 1996-2006

Australia and New Zealand

Central and South AmericaRest of Europe

Asia

UKAfrica

North America

19

Australia and New Zealand

Central and South America

North America

Rest of EuropeAsia

UK

Africa

4

5

4

1

1111

1

2

1

1

3

1

1

2

3

1

1

17

1

10

2

1

3

71

9

15

1

4

12 12

11

1

4

3

12

116

2

6

1

3

4

1

1

2

2

9

2

1

1

2

3

1

3

1

8 3

Rob Anderson (HPPF ’98)For me, HPPF provided a number of things, which, in one way or another, have infl uenced my research career. Firstly, the course on economic evaluation brought out my latent geekish tendencies (i.e. a love of decision modelling) such that almost nine years later I still spend way too much time fi ddling with cost-effectiveness models and running endless ‘what if’ health policy scenarios. As a consequence and perhaps bizarrely, I now fi nd myself in a job with the words ‘health economist’ in the title. Secondly, HPPF further strengthened my commitment to policy-relevance in everything I do, and examination of the translation of research fi ndings into policy has become a recurring aspect of my work. It is no gimmick that so many HPPF courses have the words ‘...for policy-making’ in their title. Thirdly, HPPF allowed me to further indulge in my ‘hobby’ of international comparative health systems analysis, perhaps culminating in my decision in 2001 to live and study in Australia for four years (okay, so the sunshine and easygoing lifestyle helped). There’s nothing better for refl ecting on your own health system with fresh eyes than immersing yourself (and having babies!) in a different one. Asking why we do things differently here versus there, and trying to measure what difference it makes, still forms a central theme to much of my work. Finally, of course, the MSc put me in touch with a great bunch of people from all over the world who are similarly impassioned about understanding how health systems work, how health services can be evaluated and changed, and how ultimately we might create health policies that make a positive difference to people’s health. You can see me crabbing at Dittisham on Dart Estuary in the picture.

Silvana Castaldi (HPPF ’89)In the 1980s it was not usual for Italian students to study abroad. A friend told me about HPPF and I immediately decided to study in London. I fl ew from Novara, near Milano, to reach London with merely a knowledge of formal English – phrases such as ‘Where is the station?’ and ‘This is my pencil.’ Once in London, however, nobody asked me anything about stations or pencils.

In 1988, only two Italian students were in the HPPF MSc – one focused on developing countries and myself focused on developed countries. Language was not a problem, but learning to navigate the English university teaching system proved to be a big challenge. Choosing courses was very diffi cult, and nothing resembled the Italian structure of seminars and tutorial that I was used to.

During the fi rst term, I chose a course titled ‘The Gift Relationship,’ offered by the department of Social Anthropology. At the time, I thought, ‘We are in autumn and this will be the perfect method for drawing up my list of Christmas presents.’ The course was not exactly

what I had expected. Instead, I found myself studying anthropologists’ points of view about the relationship between human beings. ‘The Gift Relationship’ has nothing to do with Christmas; instead it is the starting point of a very nice essay about blood donors.

I do not wish to remember now the hours and hours I spent in the library (that still I consider the best in the world) studying many marvellous topics I had never before encountered. It was a year spent studying only what I loved and still love. Yet, there is another place in LSE that I grew to love so much. At the Shaw library, I began to appreciate drinking tea, reading with classical music, and sleeping surrounded by the sound of the rain. It is perhaps these memories that I cherish the most from my experience as an HPPF MSc student.

Øystein Evjen Olsen (HPPF ’98)The blackness of the night is intense on your eyes in the Tanzanian bush. Equally intense is the job of managing and directing Haydom Lutheran Hospital, a rural 400 bed hospital with basically all referral functions, situated more than 300 kilometres from the nearest town, Arusha. With more than 11,000 inpatients, 80,000 outpatients, 3,300 deliveries, 75,000 children, and 25,000 mothers seen through the outreach Reproductive and Child Health Services alone, and more than 350 patients on ART, 65 villages in the HIV outreach services, 22,000 blood slides, and 470 staff, we keep our days occupied as challenges continue to come at us. Basically all possible challenges and theoretical topics studied at LSHTM and LSE are present in their often dramatic realities. Policy, planning, and fi nancing challenges are present every day and every hour. Turning vertical interventions into horizontal services, managing priority setting processes, and improving cost effi ciency are essential to keeping the hospital alive. But perhaps most importantly, HPPF taught me the lingo necessary to please development partners, ministries, and donors. Translating the daily routines and activities into a language understood by all is a major challenge. My colleagues at the hospital know what to do and why they are doing it; their struggle has been to tell this to the rest of the world. Why is it so diffi cult for policy makers and development thinkers to understand that they, my colleagues, share their vision and objectives? This is probably where I matter the most, as I humbly watch my colleagues operate on complicated brain tumours, treat multiresistant infections, deal with HIV positive patients, and see children dying of pneumonia and malnutrition. Knowing how it all can come together into creating understandable and meaningful processes for sustainability, equity, effi ciency, quality, and trust – I am forever grateful for what I learned in London.

20

21

Working at the National Institute for Health and Clinical Excellence (NICE) is an exciting experience and quite a privilege! NICE as an organisation is often in the news – although not always depicted the way we would want it – and has international standing in the fi eld of health technology assessment. A privilege because NICE is a national agency that issues guidance to the NHS in England and Wales on a number of challenging subjects. About 200 people are working for NICE in two locations: London and Manchester. NICE has perhaps attracted most attention over its appraisals of pharmaceuticals, but this ‘arms-length body’ is responsible for many other activities associated with enhancing the quality of healthcare and preventing ill health.

Over the years we have managed to get quite a contingent of HPPF alumni interested in working for NICE. As of this month, there are fi ve of us: Kate Burslem, Helen Chung and Ebenezer Tetteh (HPPF ‘05), Meindert Boysen (HPPF ‘03) and Francis Ruiz (HPPF ‘01). We are all working within the Technology Appraisals programme as part of an ever expanding team of Health Technology Analysts (currently 10). With the involvement of our stakeholders, we set the boundaries (scope) of each technology appraisal, support the development of independent academic reports on the clinical and cost-effectiveness of

HPPF @ NICE

health technologies, critically assess the evidence submissions provided by the manufacturers, and write national guidance based on our standing Committee’s discussions on the technology in question.

NICE is an ideal place to put in practice the knowledge and skills (eg, the principles of cost-effectiveness analysis) we acquired while studying on HPPF. The MSc gave us insights into the operation of health care systems across the world, and especially the NHS in the UK. Working at NICE brings into sharp relief the tension between a cash constrained system and the demands of patients and others. The Appraisals team and NICE more widely, are comprised of individuals with a variety of backgrounds. Consequently we learn from each others expertise in areas such as epidemiology, systematic reviewing and clinical medicine. This helps to make NICE the dynamic and exciting place it is. Have a look at www.nice.org.uk if you want to know more about the Institute and what we do.

Bernd Appelt

Thomas Kirsch-Woik

Nina Siegert

Burkard Kömm

22

The Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH is an international cooperation enterprise with worldwide operations. It provides viable, forward-looking solutions for political, economic, ecological and social development in a globalised world. GTZ promotes complex reforms and change processes, often working under diffi cult conditions. Its corporate objective is to improve people’s living conditions on a sustainable basis. GTZ’s services span a wide range of activity areas, from economic development and employment promotion, through governance and democracy, health and basic education to environmental protection, resource conservation, agricul ture, fi shing and nutrition. In all the activity areas GTZ helps to enhance the capabilities of individuals and organisations. GTZ’s core interventions and advisory services in the health sector focus on health system development, health sector reforms (including fi nancing and decentralisation), social equity and orientation within the services towards the poor, quality management and human resource management, sexual and reproductive health, control of infectious diseases (particularly HIV/AIDS), health promotion and urban health.

Since graduation from HPPF Nina Siegert (HPPF ‘03) has been working as health-fi nancing consultant for the GTZ Health Financing Component in Tanzania. Within the German supported Health Sector Programme, she gives direct support to the government’s health sector reform process with a main focus on strengthening the social health insurance system. This includes direct support to the organisation and management of Community Health Insurances at district level and the National Health Insurance Fund at national level. Thomas Kirsch-Woik (HPPF ‘00) holds a position as senior health consultant giving policy advice mainly to the leadership of the German Federal Ministry of Economic Cooperation and Development in Berlin on HIV/AIDS and Health Issues. He worked for many years as senior manager on health system development (and later HIV/AIDS) at GTZ head offi ce in Eschborn, Germany with special interest on contracting, health fi nancing, community participation and health sector reform. He spent more than six years in developing countries, mainly in Madagascar advising and supporting a District and Reproductive Health Project. Ole Doetinchem (HPPF ‘02) worked at GTZ in the area of international cooperation and health insurance. During his three years at GTZ, Ole’s work focus shifted from advocacy towards predominantly technical work on health insurance in developing countries. He left GTZ in 2005 to take up a post at WHO. Bernd Appelt (HPPF ‘00) currently works for GTZ as a technical advisor at the Health Sector Reform and Research Unit of the Department of Health of the

Government of the North-West Frontier Province in Pakistan on decentralization, hospital autonomy, quality management and health fi nancing with particular emphasis of introducing social health insurance. After having worked for the last ten years with GTZ in Islamic countries in Africa and Asia he has developed a special interest of looking at health reform processes from an Islamic perspective. He has started his career in 1987 as a clinician in a district hospital in Zimbabwe. He sees the key to the solution to the poor health situation in many developing countries not only in the health sector, but also rather in the general and especially fi nance politics and policies of a state. The HPPF course has equipped him with the knowledge to better understand the relationships between health, politics, power and fi nancial systems. Burkard Kömm (HPPF ‘01) has been working from August 2001 until August 2004 as the CEO of a regional health insurance in the South East of Nigeria. His task was to reform an existing health scheme owned by a catholic congregation and to expand it regionally as well as to develop a proposal for a national approach to the question of health care fi nancing in the vast sector of Faith Based health care providers in Nigeria. Since October 2004 Burkard is working in Nairobi as a technical advisor in a GTZ/Government of Kenya project on health care fi nancing and global fi nancial support in health. His task is to provide support for the development of effective linkages between national fi nancing mechanisms in health and global fi nancial support.

HPPF @ GTZ

Angela Burnett (HPPF ’96)I am a GP at the Sanctuary Practice in Hackney, East London, which was originally established to provide a dedicated service for asylum seekers and refugees and which now caters for a wider practice population. I have also worked at the Medical Foundation for the Care of Victims of Torture since 1994. I provide training on the health care of refugees and torture survivors and have assisted in the development of health services throughout the UK. Previously I worked in Zambia, providing health care for people affected by HIV/AIDS and their families and researching collaboration between traditional healers and formal health workers. I also worked in Macedonia evaluating a professional development programme for doctors and with Oxfam in Ethiopia, with people affected by drought and famine. With RETAS (Refugee Education and Training Advisory Service) I provided mentoring support for refugee doctors, in order to assist them to work in the UK. I regularly write on the health of refugees and survivors of torture, including a series in the British Medical Journal, several book chapters, guidelines and a resource pack for health workers. I have a two year old daughter, Lili, and like singing, dancing and long cycle rides. You can see me in the centre of the picture as I receive the NHS ‘Outstanding Achiever of the Year’ award as a primary care professional in 2004.

Monica Davoli and Geert Haghebaert (both HPPF ’97)Whenever we meet new acquaintances, we are asked where we are from (our accents still betray us). Unmistakably, when informed that one is from Brazil and the other is from Belgium, they suppose somehow we met in Brazil or another tropical destination. Every time our answer is prompt: No, we met in London while studying at LSE and LSHTM, actually! The resulting ‘Oooh!?’ consistently leads us to talk about our HPPF Master’s course – now ten years behind us – and the different paths in life that led us there. We were both able to enrich our previous experiences thanks to the course and its participants. We also admit that our lives changed signifi cantly when we fell in love in London. Indeed, we hardly can limit ourselves to a short and factual description of what is just about one year in our lives.

Perhaps it is not a day-to-day situation in which a Brazilian specialist in public administration working in the federal health ministry with World Bank funds joins life with a Belgian trained medical doctor working with NGOs in the

humanitarian sector. One of us – eager to strengthen knowledge about health and specifi c issues in the fi eld of health economics, and the other – desperately seeking to understand how to be more effective. Both of us feel much more comfortable these days though, thanks in part to the solid teachings of the HPPF course as well as the in-depth exchanges brought about by the different backgrounds of its participants.

Monica left the Federal Ministry in Brasilia to join Geert in Bosnia Herzegovina (quite an unexpected result of HPPF). We quickly moved on working, with both of us taking some spells as ‘spouse’ for some time when our children were born. Ever since our time in London, people look a bit surprised to hear our story of lives turned upside down. We always confi rm this is not due to, but rather thanks to, HPPF.

Ariel Frisancho (HPPF ’02)As a medical doctor with 12 years of experience working for various health and social development projects in Peru, taking HPPF helped me to improve my analytical skills and understanding of the underlying processes that cause health sector reforms to fail or succeed. I initially applied the new knowledge, especially what I learned through discussions in the European and Comparative Health Policy course, working at Health and Life Sciences Partnership, an international organization that provides technical assistance to health sector reform processes in 30 countries. I also became a lecturer in Health Policy on MSc courses for several Peruvian universities.

Since 2004, I have been the Project Manager of a DFID-funded Peruvian health rights program run by CARE. The project goal is ‘to improve the health of the poor and excluded population of Peru through the improvement of the relationship between Peruvian society and the state’. Through better relationships and improved interaction with state offi cers, citizens will become involved in the health policy design and implementation process. This project shows the importance of public participation as a principle that contributes to more inclusive social policies. It provides an analysis of conditions and factors that may infl uence the success of public participation for strengthening governance and rights engagement. Working with both health professionals and the public has been an enriching professional experience, and the knowledge that I gained through the Health Policy, Process, and Power as well as the Primary Health Care courses has been of paramount importance in this work. The project has been recognized as one of CARE International’s twelve innovative programs employing rights-based approaches.

23

24

The LSE Health Society has created a formal network of alumni in June 2006. Membership of the Health Alumni Network is open to past and current students of International Health Policy, Health Population & Society and Health Policy, Planning & Financing taught Masters Courses, as well as health teaching staff at both LSE and LSHTM. The aim of the Network is to provide a platform for global networking, focused career advice and alumni professional mentoring through a private database and a series of events. The database will be password protected for alumni and staff and abide by EU data protection legislation. It will be hosted by the LSE Health Society website and linked to LSE Health and Social Care to maintain good links and coordination with the relevant LSE and LSHTM academic departments.

LSE, Department of Social Policy

In the MSc International Health Policy, offered by LSE, gives students the opportunity to examine current and emerging health policy issues through the application of basic health policy and economic principles. The MSc International Health Policy (Health Economics) allows students to concentrate in more detail on options geared to health economics analysis. For both the Health Policy and Health Economics streams of the MSc, opportunities are provided for internships with major international and governmental organisations, companies or academic institutions as part of the overall student assessment. Professional destinations after graduation include consultancies, pharmaceutical companies, national health services, international organisations and government departments and agencies as well as employment in research or further study for a PhD.

The MSc Health, Population and Society, also offered by LSE, provides state-of-the-art training for population and health issues, both substantive and policy related. In the last 50 years the improvements in health have been dramatic in both developed and developing societies. As a result the average life expectancy of human populations has increased rapidly. Western societies are being faced with an ageing population, in a new demographic regime of low mortality and low fertility. While some developing societies in Asia and Latin America are following this experience, most of Sub-Saharan Africa is experiencing a mortality crisis as a result of the escalating HIV/AIDS epidemic. This MSc addresses the implications of health and mortality trends for health policy making and the broader economy, adopting a multidisciplinary perspective.

LSHTM, Department of Public Health Policy

The MSc Public Health, offered by LSHTM, covers the whole breadth of public health and allows students to follow a general stream of study (Public Health stream), which focuses mainly on high- and middle-income countries, or to concentrate on one of four other streams (Environment and Health stream; Health Promotion stream; Health Services Management stream; Health Services Research stream). Students on this degree will be able to select teaching modules from a variety of areas such as Epidemiology, Health Economics, Social Research, Health Services, Health Policy, Health Promotion.

The MSc Public Health in Developing Countries, also offered by LSHTM, aims to equip students with skills to analyse public health problems in developing countries and design and evaluate actions to improve public health. It combines the research and teaching strengths of the School’s academic departments and considers issues related to health, development and the provision of health services from a broad multidisciplinary perspective. Students are expected to have been involved in the planning or implementation of health programmes in developing countries, in teaching or in research. Every year the course attracts experienced health professionals from around the world.

In addition to the degrees offered within the Department of Public Health Policy, other MSc courses at the School may be relevant to students with a public health interest including: MSc Public Health Nutrition, MSc Epidemiology, MSc Control of Infectious Diseases among many others.

As part of the network’s activities, an annual Health Alumni Reunion Conference in London is planned as well as a high level speaker series organised by the LSE Health Society. We aspire to expand the network’s function to organisation of regional reunions and events with the support of enthusiastic local volunteers.

To get involved and for further details on the Alumni Network please contact either: Samia Saad, LSE Health Society Alumni Network Offi cer (MSc IHP 2005/2006); or Leon von Brasch, LSE Health Society ChairmanMSc HPPF 2005/2006. Please address your queries to the email address: health.society@lse.ac.uk

LSE Health Society Launches Alumni Network

Other Graduate Programmes offered by LSE and LSHTM

After the establishment of a joint degree in Health Policy, Planning and Financing in 1986, both LSE and LSHTM have expanded their offer of taught programmes in the field of health policy. Here is a brief description of the main programmes available at the two Schools, more information and application forms for these and for HPPF can be found on the respective Web sites (www.lse.ac.uk and www.lshtm.ac.uk).

2005

-06

2001

-02

2003

-04

2004

-05

1997

-98

1996

-97

Design: LSE Design Unit www.lse.ac.uk/designunit

Photography: LSHTM and LSE

The London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine are part of the University of London. LSE is a charity and is incorporated in England as a company limited by guarantee under the Companies Acts (Reg No 70527).

The Schools seeks to ensure that people are treated equitably, regardless of age, disability, race, nationality, ethnic or national origin, gender, religion, sexual orientation or personal circumstances.

Every effort has been made to ensure that the information contained herein is accurate at the time of going to print (June 2006), excludes errors of fact and avoids ambiguity or overstatement, but the text is issued errors and omissions excepted. No part of this document forms part of any contract with any person and the Schools and shall not be read or taken as such.

This information can be made availablein alternative formats, on request. Please contact: mschppf@lshtm.ac.uk

Department of Public Health and PolicyLondon School of Hygiene and Tropical Medicinewww.lshtm.ac.uk/php/ Tel: +44 (0)20 7927 2432Fax: +44 (0)20 7436 3611

Department of Social PolicyThe London School of Economics and Political Sciencewww.lse.ac.uk/collections/socialPolicy/ Tel.: +44 (0)20 7955 6169Fax: +44 (0)20 7955 7415

LSHTM Alumni Associationwww.lshtm.ac.uk/alumni/ Email: alumni@lshtm.ac.ukTel: +44 (0)20 7927 2644

LSE Offi ce of Development and Alumni Relationswww.lse.ac.uk/alumni/ Email: alumni@lse.ac.ukTel: +44 (0)20 7955 7361

LSHTM Registry50 Bedford SquareLondon WC1B 3DPEmail: registry@lshtm.ac.uk Tel: +44 (0)20 7299 4646Fax: +44 (0)20 7323 0638

LSE Graduate AdmissionsTower 2, Houghton StreetLondon WC2A 2AESee website for onlineenquiries (www.lse.ac.uk)Tel: +44 (0)20 7955 7160Fax: +44 (0)20 7955 6137