HEALTH ECONOMICS, VOL.

5: 473-478 (1996)
STUDENT CORNER

The student comer publishes contributions on all
aspects of education and training in health econ-
omics and related disciplines. The content of the
section will develop over time but initially it will
cover three main areas:
- A digest of information.
- Short peer-reviewed papers whose content is
pedagogical rather than reporting original
research.
- Major commissioned surveys of key areas of
the literature written for the benefit of students
of health economics.
For more information, or to discuss possible
contributions, please contact Andrew Jones (tel:
44-1904-433766, fax: 44-1904-433759, e-mail:
amjl@york.ac.uk). Please submit announcements
and contributions to: Health Economics, Student
Comer, Centre for Health Economics, University
of York, York, YO1 5DD, U.K.

CAPACITY BUILDING IN HEALTH ECONOMICS

OPPORTUNITIES FOR TRAINING IN DEVELOPING
COUNTRIES
SARAH JAMES AND CATRIONA WADDINGTON
Institute for Health Sector Development, London

SUMMARY
This paper provides an overview of the opportunities available for training in health economics in the regions of
Africa, Asia and Latin America, following a WHO forum on Capacify Building in Health Economics held in
Geneva in December 1995. It describes in brief the training opportunities available throughout Asia, Africa and
Latin America. It then gives a detailed resume of courses available for students and professionals at Chulanlongkorn
University, Thailand, the University of Cape Town, South Africa and the University of the West Indies, Trinidad. It
also describes the international and regional networks which have developed and now provide further opportunities
for training.
The final section of this paper looks to the future and suggests that although continued financial and academic
support will be needed from the countries of the North, the development of regional capacities in health economics
should be as much as possible through regional resources, and regional strategies should be a priority.

The world’s skills in health economics have short lived and they perpetuate technical depen-
been overwhelmingly based in industrialised dence on outside sources.
countries with most developing countries employ- In the last decade, however, training and
ing knowledge from overseas. All too often the research capacities in health economics have been
contributions made are inappropriate, costly and developed in the South. Countries such as Thai-
land, Mexico, Philippines and Kenya are
beginning to take a leading role in advisory work,
Sarah James, Institute for Health Sector Development, 27 Old and other countries have begun to develop initia-
Street, London EClV 9HL UK
tives and programmes in the field. The number of

CCC 1057-9230/96/050473-06
0 1996 by John Wiley & Sons, Ltd.
474 STUDENT CORNER
short courses and undergraduate and postgraduate public health and economics (as part of a graduate
courses are growing steadily. or postgraduate course). Comprehensive courses in
The purpose of this paper is to describe the health economics are also being offered in Argent-
availability and nature of some of the training ina, Brazil, Colombia and Mexico.
opportunities available in developing countries, In Asia, university training is offered in health
although it is not intended to be comprehensive. It economics in India, Indonesia, Philippines and
will, however, suggest sources of further informa- Thailand. There are also short courses available
tion and also areas in the field where further action which are designed for senior management and
might be needed. senior health professionals. China has a well-
developed training and research network and is
particularly interested at present in sharing experi-
WHAT IS AVAILABLE? ences with countries that have recently abandoned
a centrally-planned communist health system.
In the last decade, developed countries have In direct contrast to the favourable outlook in
moved beyond providing quick fix visits of health Latin America and Asia, supply in Africa and
economists and have been involved in helping to particularly French speaking Africa, is lagging
develop the indigenous training capacities of the behind. There are, however, local and regional
South in an effort to redress the deficit mentioned courses available, in health economics and health
above. They have provided both direct and indirect services management. At present they are aimed
financial and academic support, for example, by primarily at health professionals. The main institu-
providing fellowships for training in the North, tions operating these courses include the Centre
organising training courses for policy makers, Africain d’etudes SuperiCures en Gestion
distributing training materials, supporting (CESAG), in Senegal, the Department of Public
exchange and collaboration of national experts in Health in Nairobi and the National Research
health economics in the South and supporting Institute of Public Health (INRSP) in Mali. More
training and research institutions in the South. recently, the Health Economics Unit at the Univer-
Networks for training, research and information sity of Cape Town (South Africa) has initiated a
exchange have also been developed. Health Economics Masters Programme for
As a result, the resources available for training economists.
in aspects of health economics and thus the capac- Each of the regional areas mentioned above has
ities of many countries in the South to provide directed their training courses at a range of groups
relevant economic advice ‘in-country’ has grown including health professionals, managers and
in the last decade. students, and each of these groups will require
The following paragraphs give a general over- different skills and tools in health economics: the
view of what is available, and indicate where specific content of the training courses mentioned
further information can be found. They also pro- will obviously be specific to who and what they
vide details of three courses which are to some are trying to teach. The following sections give a
extent representative of those available throughout more detailed description of the priorities which
their regions. It is based on conclusions reached have been focused on at three regional centres.
during an International Forum on Capacity Build-
ing in Health Economics, held at WHO in Geneva
Asia
in December 1995. The aim of this meeting was to
consolidate what had already been achieved in this Chulanlongkorn University, Bangkok, Thailand.
area, and to plan a strategy for the future. The Centre for Health Economics at Chulanlongk-
om University, Thailand (CHE) is one particularly
worthy of note. It was established in 1990 after a
A REGIONAL OVERVIEW decade of research and educational activity in the
field of health economics. The faculty of econ-
In Latin America, opportunities to gain a good omics had already, for example, developed an
grounding in the skills of health economics are international reputation in research on cost
wide ranging: for example, courses are offered analysis and financing of tropical disease control
in public and private universities in Brazil, programmes, especially malaria.
Argentina, Chile, Colombia, Cuba and Mexico in The centre now offers a one year international
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postgraduate degree course with thesis in health
economics and has done since 1993-a course
which drew 12 students in 1995-6 from back-
grounds as diverse as computer sciences,
pharmacy, entomology and nursing, and which
included students from Bangladesh, China, Benin,
Indonesia, Myanmar, Sri Lanka, Tanzania, Thai-
land and Vietnam.
The centre has also organised six one month
courses in health economics, which are aimed at
researchers or health administrators/managers who
have specific issues that they wish to pursue in
detail.
In the future, it is hoped that the centre will
develop further as a regional centre for training
and research in health economics, particularly in
health care financing, economic evaluation of
disease control, promotion of rational drug use,
hospital studies, and an information network for
disease control policy.
The centre has also carried out research in a
number of fields of health economics, such as
malaria, leprosy, AIDS, health care systems, and
social impacts. More recently it has embarked on
multi-country research programmes involving
regional collaborations-in, for example, health
care financing of malaria control programmes, and
the development of a regional information network
encompassing economic, health and diseases
databases in Southeast Asia and China.
It also has international links with the Swiss
Tropical Institute, Basel, the London School of
Hygiene and Tropical Medicine, the Liverpool
School of Tropical Medicine, the Centre for
Human Resources, Hanoi, the Chinese Academy
of Preventive Medicine, Beijing, the Malaria
Research Unit at the University of Colombo, Sri
Lanka, the Department of Medical Research,
Yangon, Myanmar and the Health Economics Unit
at Dhaka, Bangladesh.
South Africa
The Health Economics Unit, Department of
Community Health, University of Cape Town,
South Africa. Due in part to its political position
during the apartheid era, health economics is a
relatively new discipline in South Africa. As
public sector resources for health care have
become more constrained in recent years, the
demand for health economics skills has increased.
The need for such skills is particularly acute at the
moment as the South African health sector is being
475
restructured under the Government of National
Unity.
In recognition of the need to develop health
economics, financing and planning capacity in
South Africa and other Anglophone African
countries, the Health Economics Unit (HEU) at
the University of Cape Town has developed a
number of training programmes in recent years.
Some of these programmes are being undertaken
in collaboration with other South African institu-
tions, particularly the Centre for Health Policy at
the University of the Witwatersrand. Collaborative
links with other universities in Africa are still
weak, again largely due to the previous political
position in South Africa. However, there is
increasing participation of academics from other
African countries in the various HEU training
programmes.
The HEU’s training activities were previously
largely directed at undergraduate and postgraduate
medical students and health personnel. In 1994, it
initiated a Postgraduate Diploma in Health Man-
agement (Economics and Financial Planning),
aimed at senior health service managers. This
works on an in-service training basis with students
applying what is learnt to the work situation.
Given the urgent need to develop senior health
service management capacity in South Africa in
line with the current health sector restructuring,
this Diploma is restricted to South African appli-
cants at present. Study blocks include: situation
and policy analysis/economic evaluation, health
planning and resource allocation, managing health
sector transformation, and monitoring and evaluat-
ing health sector change.
In 1995, the HEU offered an optional module on
health economics as part of the taught economics
masters programme at the University of Cape
Town. As from 1996, a full taught Masters pro-
gramme will be offered which specialises in Health
Economics, in collaboration with the School of
Economics at the University of Cape Town. The
entrance requirement for this course is a four year
honours qualification in health economics, and
participants are drawn from a range of Anglo-
phone African countries. The Masters comprises a
year of course work and a dissertation component.
Course participants may conduct their dissertation
research in their country of residence. The course
work includes the following modules:
0 Advanced microeconomics;
0 Advanced macroeconomics;
476 STUDENTCORNER
0 Econometrics and quantitative techniques in
The Caribbean
economics;
0 Introduction to health systems, health policy, The University of West Indies, St. Augustine,
epidemiology, and the sociology of medicine; Trinidad, West Indies. The Health Economics Unit
0 Mobilising resources for health care planning (HEU) at the University of the West Indies in the
and equity; Caribbean has set itself three goals-a database on
0 Demand and supply of health care; and economic aspects of health services in the Caribbean;
0 Theory and application of economic evaluation a compendium of health service costs; and expanded
in health care. under- and post-graduate training in health econ-
omics. Established in May 1995, it now has
In addition to the Postgraduate Diploma and
Economics Masters programme, the HEU also undergraduate courses in health economics as part of
the BSc. in Economics-and has trained 6 students
offers a three week short course in health econ-
in health economics at Masters level (Masters in
omics, financing and planning in collaboration
public health, in public sector management), cover-
with the Centre for Health Policy (University of
ing demand and supply for health, health financing
Witwatersrand) and the Public Health Programme
and economic evaluation methods to name just a few.
(University of Western Cape). This course is
The health economic programme at present collabor-
aimed primarily at mid-level managers within the
ates with Boston University, Aston University in the
public health sector and non-governmental agen-
UK and Monash University in Australia.
cies, as well as researchers who work closely with
It has also worked with Harvard University
health authorities. Once again, participants are
School of Public Health for workshops in health
drawn from a wide range of Anglophone African
financing for senior ministry of Health officials in
countries. Students registered for the Masters in the Caribbean-part of the USAID funded Eastern
Public Health at the University of the Western
Caribbean project.
Cape also attend this course. The objectives of this
Given the limited number of core staff at HEU,
course are: the unit is becoming more heavily involved in the
To provide an understanding of the basic REDEFS network which is mentioned elsewhere
economic concepts of relevance to the health in this paper, and this will provide the institutional
sector; strengthening which is needed to develop the unit
To provide an understanding of alternative further.
methods of financing and paying for health
services, and to develop skills for analysing
these alternatives within specific country INTERNATIONAL AND REGIONAL
contexts; NETWORKS
To develop skills in health sector planning, with
particular reference to budgeting and the allo- International and regional networks are a further
cation of resources for health care provision; resource for training: typically, a health economics
and network will bring together a large number of
To develop slulls in selecting and applying faculties of medicine, the resources of which can
appropriate tools of economic analysis to eval- be used to set up training and research schemes on
uate the inputs, processes and outcomes of economic aspects of the health service. These are
health services, projects and programmes. particularly useful where there are few staff at a
health development institution and a networking
These issues are addressed with reference to capacity can provide a useful backup to help to
developing countries, particularly within the develop the institution.
African context. Examples include the International Health
A specialist course in health care financing and Policy Programme (IHPP), the International
health sector reform is currently under considera- Clinical Epidemiological Network (INCLEN), the
tion with other regional institutions. The Centre for African Economic Research Consortium (AERC)
Health Policy at the University of Witwatersrand is and the Inter-American Network on Health Econ-
also developing a range of short courses in the omics and Financing (REDEFS)
areas of health policy, health care financing and INCLEN, for example, covers clinical econ-
health economics. omics in its research training programme, with the
 STUDENT CORNER
aim of including more economics in medical
education and medical research. The World Bank/
IDE supported REDEFS network in Latin America
is intended as a means to link specialists working
in health economics and finance and to strengthen
information exchange on this subject area in the
Americas. Persons in related disciplines interested
in learning more about the discipline can also
participate. From March 1994-December 1995,
REDEFS has promoted the organisation of 17
courses and seminars in Argentina, Bolivia,
Colombia, Cuba, Jamaica, Mexico, Paraguay,
Peru, Trinidad and Tobago, and Uruguay.
Other networks include the China network for
the People’s Republic, and the WHO supported
Mahgreb health economics network (RESSMA).
THE FUTURE
What then, are the most important needs for
developing further the opportunities for training in
health economics that have already begun? What
are the best methods for fulfilling the needs which
still exist and which areas and people would be the
most effective to concentrate on?
Due to the resources available in some countries
in the South at present, technical support from the
North will still be necessary for some time, but it is
essential that this is not prescriptive and that local
resources are used as much as possible. Now that
training opportunities have become available
throughout regions in the South, the use of local
resources is feasible: the consensus of the inter-
nationally attended WHO Forum on Capacity
Building in Health Economics held in Geneva last
December was regional strategies should be a
priority and that institutions in developing countries
should be used to train people from other develop-
ing countries because they were more likely to be
able to provide relevant case studies and field visits.
If a shortage of skilled teaching and research s M
should occur, those in industrialised countries could
second their own SM (preferably for at least one
year) and offer flexible PhD programmes which
allowed students to conduct research in their own
country. It was suggested in contrast that UK insti-
tutions should develop more focused training inputs
(i.e. short courses).
WHO has been providing co-ordination over the
last decade and will continue to do so through,
for example, the Task Force on Health Econ-
omics, which issues regular publications. An ’ [on health economics]’ (2); ‘Identification of needs in
477
international directory of health economics courses
for 1996 is available2; a database on health econ-
omics consulting skills is being developed.
CONCLUSION
Progress has been made in developing training
opportunities in health economics in the last ten
years and this paper has provided an overview of the
main sources of training which are currently avail-
able throughout Latin America, Asia and Africa.
In Latin America and Asia, graduate pro-
grammes are now available at universities, and
institutions and regional networks have been
developed which offer shorter courses in various
areas of health economics. In Africa, the range of
courses is more limited although initiatives for
university training have already begun and local
and regional courses are also available in health
economics and health services management.
Regional and international networks have been
established, but so far, few countries have joined
them in this region. They are, however, a vital
resource in institutions where the number of
skilled staff who are available to carry out the
training programmes is limited.
International organisations and donors have
agreed that in the future regional strategies should
be developed which concentrate on developing
training institutions in regions of the developing
world using, as far as possible, the capacities
which have already been built up. WHO for
example, will continue its work in providing
readily available information on health economics
courses and will continue to support health econ-
omics training in Thailand, South Africa, Algeria
and Benin and it is likely that other international
actors will be encouraged to follow suit.
However, although supply is still a priority, the
demand for health economics is not guaranteed,
and programmes are needed to educate senior
decision makers in the value of health economics.
This should be organised in tandem with support
for increased training programmes.
REFERENCES
1. Publications include ‘Privatisation in health’ (7); ‘A
bibliography of WHO literature [on health
economics]’ (1); ‘A guide to selected WHO literature
478 STUDENT CORNER
health economics in developing countries’ (5); and Chulalongkorn University, Bangkok 10300,
‘Health economics: a WHO perspective’ (6). The Thailand.
publications can be accessed on e-mail at
hecon’l@who.ch. [7 is the privatisation document; for Dr. D. Mchtyre
other titles, insert the number given in brackets Director
above.] Health Economics Unit
2. Copies available from the Director, Division of University of Cape Town
Strengthening Health Services, WHO, 1211 Geneva Medical School
27, Switzerland. Fax: 00-41-22-791-0746. E-mail: Anzio Road
creesea@ who.ch. Observatory 7925, Cape Town
South Africa
CONTACT NAMES Professor K. T. Theodore
Co-ordinator
Dr. Kaemthong Indaratna Health Economics Unit
Director Department of Economics
Centre for Health Economics University of the West Indies St. Augustine,
Faculty of Economics Trinidad.