Adapting CHEPSAA’s health policy analysis module for undergraduate teaching: experience from Singapore

CHEPSAA has a portfolio of three open access postgraduate health policy and systems courses. The first of these – Health Policy Analysis – was launched in 2007 and later became part of the CHEPSAA offering when its developers joined CHEPSAA. Dr Joanne Yoong of the National University of Singapore was one of the first to write to CHEPSAA to tell us that she was using the course materials. In this blog, Dr Yoong reflects on the work that she did to adapt the materials to her undergraduate course. This is interesting because most health policy and systems teaching takes place at postgraduate level. Her experience can therefore provide guidance to others interested in expanding their teaching in this direction.

In the academic year of 2013/4, I was asked to design and offer for the first time a module targeted specifically at undergraduate students of the Saw Swee Hock School of Public Health at the National University of Singapore (SSHSPH). The aim of the course, entitled “Systems and Policies for Improving Health”, was to provide an introduction to the topic, giving special attention to the health system in Singapore, as well as the experience of other countries in Asia.

As a new assistant professor and moreover a faculty member new to Singapore, this was a real challenge. While developing the curriculum and materials for this class, it became clear very quickly that there were few readily-available undergraduate textbooks or sample syllabi on health systems and policy suitable for undergraduates from varying disciplines with no background in public health or public policy, let alone materials with a focus on Asia as well as concrete guidance on making the class sufficiently interactive and introducing critical thinking. I therefore searched more broadly.

One of the key resources that I eventually used to put the class together was CHEPSAA’s Facilitators Guide for Health Policy Analysis. The CHEPSAA material provided the clearest topic guide and framework for teaching policy analysis that I could find, and was easily modifiable.

What were some challenges I encountered?

It was clear from the beginning that the materials would need to be adapted. The course was designed for postgraduates with professional experience to draw on in discussions, rather than undergraduates with no previous background. In addition, students’ real-world experience with diverse healthcare settings was limited – although Singapore is very small, most had not had the opportunity to travel internationally.

To manage this, I moved the policy analysis component to the second half of the semester and prefaced it in the first half with more didactic lectures on global health systems and the Singapore/South East Asian region to give students some necessary background. I also replaced suggested case study discussions that drew on professional experience with topics that the students could relate to based on experiences as patients or community members in their everyday settings (e.g. care delivery in government primary health centers, or ways to build community engagement in the design and implementation of Singapore’s universal health coverage reform).

The undergraduate class was also planned for a full semester, while the CHEPSAA course was an intensive week-long programme. As health policy formed the second half of the course, I structured the course topics in order to be delivered over the remaining series of weeks (reserving the final two weeks for group presentations). For the class as a whole, students were assessed using a mid-term examination (to assess conceptual and background understanding), two individual written assignments and a group project. For this last component, to encourage interaction and inter-disciplinary thinking, students were mixed deliberately into groups with varied expertise (life sciences majors, social science majors and arts majors) and jointly undertook a policy analysis (rather than individual exercises) on a topic of the group’s choosing.

The CHEPSAA guide provided a basic roadmap but I also drew on a variety of other open-source materials, articles from the popular media, online videos as well as other campus resources. To make global health-related issues more accessible and tangible, for instance, we scheduled a guest speaker from the non-profit sector in Cambodia. I also frequently turned to TED talks, which provided a wide variety of high-quality, free videos from excellent speakers,  starting from an excellent curated set that can be viewed here.

What did I learn?

Firstly, I learnt to think out of the box in seeking resources! Being able to draw on CHEPSAA was a tremendous help, although the setting and audience are at first glance very far removed from the initial target group. The corollary of this is that tailoring to the current local context is critical – no curriculum can be expected to be “plug-and-play”. Local context helped not just to promote better conceptual understanding but also helped to spark and sustain interest.

Using local examples for discussion allowed students the chance to reflect upon and investigate the issues discussed in class further in their own time. This also provided a natural way for students to realize on their own that they themselves are stakeholders in the health system, with their own rights and responsibilities. This was especially true for students new to the field of public health, or who were initially simply enrolled as a pre-requisite and needed a little extra motivation.

I also realized that in a multidisciplinary and multicultural setting with undergraduates, group work could be productive but also required careful moderation. In SPH2103, it was necessary to check on students’ understanding, to offer a range of activities to which different groups could contribute, and to guide students towards collaboration especially when different social or disciplinary norms existed (notably between life-science majors and social science majors), for instance by providing guidelines for group project writeups and presentation that required all members to contribute their own piece and be able to answer questions on the whole.

Regardless of the level of initial preparation, I learnt that one has to adapt as things evolve and learning needs become more apparent. In the case of SPH2103, it became clear that starting off with some of the more theoretical aspects of health systems research was too abstract for most of the class and relying on the (relatively dry) material I had planned for the initial weeks would not work. To avoid losing momentum, I revised my approach to include many more discussions. I also previewed the policy analysis activities earlier on than I had expected.

Finally, since 2013, CHEPSAA has created some terrific new resources on health systems and policy. If I were to do this again, I would also almost certainly use CHEPSAA’s Introduction to Health Policy and Systems Research as well as Introduction to Complex Health Systems to introduce the concept of complexity, an important theme that emerged recurrently but was never explicitly discussed in depth. For those making materials available, it is extremely helpful to indicate specific online sources that might complement the materials (as CHEPSAA does), particularly videos and other interactive media that help a course to come alive for students (and faculty!).

Looking back now, SPH2103 was very successful, both in terms of student learning and feedback. Today, I have passed on responsibility for this module to other colleagues, but continue to teach and to hear from past students who have gone on to work in the healthcare sector, in a range of fields (from public health research assistants to junior analysts at the Ministry of Health, and junior executives at local hospitals) who report being inspired by their first look at the “big picture” of health systems. Many thanks to individuals and institutions like CHEPSAA who make such open access resources available – I remain very grateful for my own learning experience and welcome future interaction with others who are working on developing their health policy and systems teaching at the undergraduate or postgraduate level.

Joanne Yoong, The National University of Singapore and the University of Southern California