The Health Systems Program is proud to announce that three students successfully passed their doctoral thesis exams in March. Youngji Jo, Mariana Socal and Veena Sriram presented their research from Bangladesh, Brazil and India.

Youngji’s dissertation, Cost-Effectiveness and Scalability of an mHealth Intervention to Improve Pregnancy Surveillance and Care Seeking in Rural Bangladesh, focused on how digital health can be used to improve maternal and newborn health. Proven health interventions could save millions of lives, but coverage of these interventions in low- and middle-income countries (LMICs) is low. Mobile health (mHealth) has shown a potential impact for improving knowledge, service delivery and intended health outcomes, but little evidence exists on its value for money or affordability in developing countries. Youngji examined the mCARE program in rural Bangladesh, which was designed to increase service utilization during pregnancy using SMS and home visit reminders to pregnant women from an established group of community workers. Her research found that the program, implemented from 2011 – 2015, was highly cost-effective and had a marginal budget impact in the country, based on her forecasting model scenarios. With her research, Youngji hopes to guide policy and program decision-making in Bangladesh and provide evidence for globally investing in healthcare innovations.

Mariana's dissertation, Polypharmacy in Older Adults: A Multi-Level Analysis of Trends and Determinants in Sao Paulo, Brazil, examined the occurrence of polypharmacy, an emerging public health problem where individuals utilize too many prescription drugs. Mariana found that a large proportion of older adults in Sao Paulo are exposed to polypharmacy, and that most of them are at an increased risk of adverse effects from the drugs they are taking. Through an examination of the health systems factors associated with polypharmacy, Mariana found that lower availability of doctors in the public health system and higher presence of private pharmacies and hospitals in a geographic area were associated with a higher likelihood of polypharmacy among persons living in that area, regardless of health conditions and socio-demographic characteristics. With her findings, Mariana hopes to bring to light that polypharmacy among older adults should be a public health concern in Sao Paulo, and that increasing the number of doctors in the public health system and focusing on integrating healthcare could potentially be policy options used to mitigate polypharmacy in the Sao Paulo context.  

Veena’s dissertation, The Evolution of Emergency Medicine as a Medical Specialty in India: A Policy Analysis, examined the power dynamics in play in the specialization of medical services in LMICs, using emergency medicine in India as a case study. Her research centered on the dual concepts of equitable access to health care and how medical specialties are regulated in India. Developed in response to a lack of emphasis in health systems research on governance and regulation, her study examined how new medical specialties emerge in India and how regulatory institutions within a country decide whether to include a specialty or not. Veena aimed to interrogate the idea of ‘specialization’ as a solution to service delivery problems, such as weak emergency care, and understand how stakeholders perceive the impact of specialization on health systems and equitable access to care. The role of power is not well understood in health systems research, and with her work, Veena hopes to contribute to the knowledge gap around this topic.

Congratulations to all three students for championing their research in Health Systems as they embark on the next step in their journey as public health leaders.