Strengthening systems to improve global health

A West African Ebola outbreak that killed more than 11,300 people has helped inspire two courses that aim to minimise the impact of such epidemics globally.

Developed by the Nossal Institute for Global Health and UNICEF, the newest course is free and promotes a big picture approach to help prevent and deal with major health crises.

When the first Ebola case was detected in Guinea in December 2013, weak surveillance systems and poor public health infrastructure allowed it to spread to neighbouring Liberia and Sierra Leone.

Between 2014 and 2016, it reached seven more countries, largely due to unprecedented infiltration of crowded urban areas.

Action from national and global health authorities finally helped contain the outbreak in mid-2016 after more than 28,600 cases and 11,325 deaths.

New course designed

That year, UNICEF asked the Nossal Institute for Global Health to develop a health systems strengthening (HSS) course for its staff.

UNICEF wanted to improve its capacity to work with partners to strengthen whole health systems and address the vulnerabilities which the Ebola crisis starkly demonstrated.

Research has since shown that the collapse of weak health systems during the Ebola epidemic also led to more deaths from other diseases.

Even without a crisis like Ebola, health systems around the world need to better respond to ‘slow moving’ epidemics such as cancer and heart disease and give people better access to quality health services.

UNICEF wanted the course to enable staff to better understand health systems, and the complex relationships between their many components.

Now in its third year, the blended learning course has 12 online modules and a further two are completed over a two-week intensive course in Melbourne. To date, 200 UNICEF staff from more than 70 countries have completed the course, with a further 200 enrolled in 2019.

In a recent evaluation conducted by Associate Professor Lucio Naccarella of the University of Melbourne’s Centre for Health Policy, participants rated the course as excellent, with well-structured content relevant to global needs.


Picture: One of the UNICEF cohorts in Melbourne for their two-week intensive course.

MOOC developed

Following its success, Nossal Institute researchers and UNICEF adapted the program into a Health Systems Strengthening MOOC (Massive Open Online Course) to open this up beyond UNICEF staff.

The first course will run through FutureLearn from 8 July and is open to anyone with an interest in health systems – particularly those working in low- and middle-income countries.

This may include health administrators, policy makers, doctors, nurses and others who work to shape health systems.

The eight-week course, which takes about two-three hours a week, uses interactive materials, engaging videos and quizzes to cover key elements of the UNICEF staff course.

It explores the complexity of health systems in low to middle income countries and applies systems thinking to better understand this complexity.

Participants critique major health system frameworks, analyse inequities and interrogate the evidence for HSS approaches.

Strengthening health systems

The idea is to learn how to strengthen systems through action in policy, finance, supply chain management, information systems, care quality, human resources, leadership, governance and private sector engagement.

Nossal Institute’s Maternal, Sexual and Reproductive Health Unit Head Dr Alison Morgan oversaw the development of the UNICEF staff course and Dr Matt Reeve, also in her unit, led the MOOC adaptation.

Both courses also involved collaboration between senior Nossal academics and counterparts from Harvard University, the Public Health Foundation of India, senior UNICEF staff and practitioners from Indonesia, India, Nepal and Malawi, to name a few.

Dr Morgan, who collaborated with UNICEF’s Dr Claudia Vivas Torrealba, says the course is primarily aimed at government, bilateral and multilateral agencies, and NGO health professionals and will help them see their programs in a larger context.

She says the big picture approach allows participants to appraise health systems and apply complex adaptive systems thinking in local, regional, national and global contexts in a fast-changing world.

“What you often see is that people are very passionate about a particular problem or an opportunity they see,” she says.

“An NGO might get some funding to start a program to address child nutrition, for example. This course helps ensure health planners think of the ramifications or think of the system effects of any change that they bring in.”

“It’s also got wider appeal than just health, so people working in fields such as water and sanitation, or anything to do with reducing inequities in any community, might find it relevant.”

Open to all

Anyone with internet access on computers, tablets or mobile phones can join the course. There are no prerequisites, but it is in English. UNICEF will fund certificate costs.

Before it was even advertised, hundreds of participants had registered from 81 countries including Kenya, Ethiopia, Nigeria, Myanmar, Pakistan and high-income countries such as Australia.

Dr Morgan, whose background is in maternal health, hopes the MOOC will save lives by improving how health systems function.

For example, she says strong health systems that are accessible and providing quality care would prevent most of the 300,000 maternal deaths recorded globally each year.

They could also have reduced the number of deaths in the recent Ebola epidemic.

“Because the health system was weak, Ebola spread very quickly,” Dr Morgan says. “There was little trust in the health systems.”

Link to the MOOC:

Nossal Health Systems Strengthening MOCC