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International Health

Health Systems Program

Gender analysis, the examination of gender power relations in a society and the norms, expectations and roles for different genders, is receiving more attention in the public health sector, but is often considered an afterthought within the research process. Instead of being an add-on, gender analysis in health systems research should be an integral component at every phase. Health systems are not gender neutral; if the goal is to create equitable and sustainable health solutions and health promotion interventions, then gender (and how gender interacts with other social stratifiers) needs to be considered when designing effective solutions.

Applying a gender lens means examining the role of gender within the different building blocks of health systems and how we can most effectively shape health systems policies, programs and services to benefit everyone. This includes studying how gender power relations play out within a health system and ensuring that we do not perpetuate different gender inequities in our research.

Dr. Rosemary Morgan, assistant scientist in the Health Systems Program of the Department of International Health, brings her experience working on the project, “Research in Gender and Ethics (RinGs): Building Stronger Health Systems” to the Program. The project, funded by the UK Department for International Development (DFID), seeks to galvanize gender analysis within health systems research by providing resources for and building the capacity of health systems research to conduct gender analysis. In addition, Dr. Morgan has been working with students within the Johns Hopkins Bloomberg School of Public Health (JHSPH) to explore the role of gender within different areas of the health system.

Dr. Morgan advised Poonam Daryani, a recent graduate of the MPH program at JHSPH, to conduct an intersectional gender analysis of the Zika response in Brazil. Through her analysis, Poonam explored how the distribution of power based on gender interacted with other social stratifiers, such as race and class, to create different vulnerabilities to Zika infection during the epidemic.

Findings showed that the national response, with its focus on household-level vector control efforts, did not consider the complex sociocultural and economic barriers facing women in Brazil. Failure to account for differential power relations and the resulting gender inequities in Brazil may have limited the effectiveness of the national response in curbing transmission of the virus. Moreover, the inadequacies of the national response were felt largest by poor black and brown Brazilian women, who are largely concentrated in the peripheries of urban centers as well as the North and Northeast regions of the country and who experience disproportionate and compounding barriers to achieving positive health outcomes.

The gender analysis inspired Poonam to pursue the highly competitive Johns Hopkins-Pulitzer Center Fellowship for Global Health Reporting, through which Poonam traveled to the northeast of Brazil to explore the long-term consequences of Zika on those who care for and raise children with congenital Zika syndrome.

Health responses can be strengthened with a greater awareness of gender relations in a given society’s health system. Ideal responses examine and question gender inequities in order to achieve health goals and advance gender justice. It is necessary to apply a gender lens to all health issues so that we can build policies, structures and procedures at an institutional level that create a healthy society for everyone. 

The Program welcomed over 45 students from 10 countries

The Health Systems Program of the Department of International Health recently wrapped our 2017 Health Systems Summer Institute at the Johns Hopkins Bloomberg School of Public Health, a short-term program designed for part-time students or early- to mid-career professionals who want to further their career in public health. The Institute, directed by Health Systems senior scientist, Dr. George Pariyo, is designed to provide students an entire academic term’s worth of instruction in a condensed period of time. 

During the Summer Institute, participants have the opportunity to learn a variety of health systems skills and concepts that will help them measure the burden of disease and monitor and evaluate global health programs. Courses covered areas such as primary health care, gender analysis, technology innovation for global health, hospital and trauma surveillance, and summary measures of population health.

This year, the Institute increased the number of course offerings from seven to 11 in order to accommodate for the growing number of program areas. New courses included Introduction to Gender Analysis within Health Systems Research, Monitoring and Evaluation of Health Systems Strengthening, Designing Transformative Innovation for Global Health, and Managing District Health Systems. The majority of health systems courses focus on low- and middle-income countries, but the skills are universal.

The number of international students attending the Institute increased this year: as the Program amplifies its presence around the world, we hope to build a strong base of global students who can apply the principles of health systems in their home country. One such student, Khin Pa Pa Naing from the Ministry of Health (MoH) in Laos, chose to attend the Institute so she could gain skills and knowledge from the Monitoring and Evaluation course for her daily routine working with the MoH.   

It provided very in-depth thinking about the current situation of resource limitation, availability and allocation for the public health sector and medical care in developing countries, and how we as public health professionals could improve this situation,” stated Khin Pa Pa. In addition to Ms. Naing, we welcomed students from Canada, Nigeria, South Africa, Japan, Kenya, Vietnam, Thailand and Bangladesh.  

The Institute is also working to foster the growing number of part-time MPH students coming from all regions of the country, seeking to fulfill their 20% requirement of attending on-campus courses. We provided four lunchtime networking sessions, and hope to continue to expand our social offerings next year.  

As we seek to enhance the Health Systems Summer Institute in future years to incorporate more students coming from all areas of the public health sector, we will continue to expand and diversify our course offerings. We thank all students who made the second year of our Summer Institute a great success!

In April 2017, researchers from the Health Systems Program traveled to East Africa to launch data collection for a study under Project SOAR (Supporting Operational AIDS Research). Dr. Sara Bennett, professor, Dr. Daniela Rodriguez, assistant scientist, Jess Wilhelm, PhD student, and Mary Qiu, senior research program coordinator, went to Kenya and Uganda to examine the health systems impact in regions of both countries that are transitioning their HIV/AIDS programs to government support as part of Phase III of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)’s sustained control of the AIDS epidemic.

Project SOAR is a five-year program funded by the United States Agency for International Development (USAID) and led by the Population Council that conducts HIV and AIDS operational research. The evaluation of the Geographic Pivot is a specific component of the project, led by Dr. Bennett.

HIV/AIDS continues to be a significant burden on low- and middle-income countries, and funding for the epidemic has plateaued in recent years. PEPFAR’s geographic prioritization strategy focuses on intensifying support to regions where the HIV/AIDS burden is highest, and phasing support to the government in regions where the burden is less severe. The objective of this shift is to increase efficiency of available funds and to achieve the UNAIDS 90-90-90 goal of having 90% of all HIV+ individuals aware of their status, 90% all people diagnosed with HIV on sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy to have viral suppression, by 2020.

The Health Systems team is examining how the transition is being implemented and what the impact is on transitioned regions. Their research consists of a facility survey; document reviews from USAID and governments in Kenya and Uganda; and primary interviews with ministry of health employees, patients, and government officials in order to get a multi-perspective account of the impact of these changes.

As part of their effort to understand how health systems are affected by the change in support allocation, they are deploying a large-scale survey across the transitioned regions and are training in-country partners to conduct the survey. In addition to the survey, the in-country teams are conducting in-depth interviews with specific health facilities in Kenya and Uganda to get a more thorough understanding of the transition effects across all levels of health care, from delivery to how it is affecting business operations, such as human resources and available commodities.

The goal of the project is to help guide both donors and in-country government on how to implement programmatic transitions while limiting any adverse effects on how health systems function and care is delivered. Findings from the Program’s researchers will inform future efforts to manage HIV/AIDS investment and create a more targeted response to the epidemic. Read more about the programmatic transition process here


Assistant Professor Dr. Andreea Creanga joined the Health Systems Program in January 2016, holding a joint appointment with the Department of International Health and the Department of Gynecology and Obstetrics at the Johns Hopkins School of Medicine. Within the Program, Dr. Creanga serves as an Associate Director for the International Center for Maternal and Newborn Health and co-Coordinator of the Master of Science in Public Health (MSPH) degree program in Health Systems.  

Dr. Creanga obtained her M.D. degree from Carol Davila University of Medicine and Pharmacy in Bucharest, Romania in 2002, and her Ph.D. in Population and Reproductive Health from the Johns Hopkins Bloomberg School of Public Health in 2009.

She has dedicated her career to improving maternal and newborn health. As doctoral student and Research Assistant for the Bill and Melinda Gates Institute for Population and Reproductive Health, she worked on a wide range of topics including family planning, maternity care and obstetric fistula, mostly in sub-Saharan Africa. Immediately after graduating from Hopkins, Dr. Creanga began working for the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC), first as an Epidemic Intelligence Service Officer and then as Medical Epidemiologist and Senior Scientist over a period of six years.

While at the CDC, Dr. Creanga was instrumental in leading epidemiologic investigations in maternal and infant health and serving as a subject matter expert on maternal mortality, severe maternal morbidity, and perinatal illicit drug abuse. Notably, Dr. Creanga led the United States Pregnancy Mortality Surveillance System, and it was for this work that she received the 2013 Presidential Early Career Award for Scientists and Engineers, the highest honor bestowed by the United States government on outstanding scientists and engineers in the early stages of their independent research careers.

In her current academic position, Dr. Creanga is developing a research agenda around the quality of obstetric care, both domestically and internationally, and has active projects in India and the United States. In India, she works with CARE on a project funded by the Bill and Melinda Gates Foundation to evaluate various initiatives to improve maternal and newborn health care in the state of Bihar.  In the United States, Dr. Creanga has developed several projects examining severe maternal morbidity, aiming to reduce its burden by integrating clinical decision-making tools into electronic medical records at Johns Hopkins Medicine. She also continues her work with the CDC reviewing and characterizing maternal deaths in an effort to prevent future deaths.

Dr. Creanga is a Member of Maternal Mortality Review Committee in Maryland. Read more about her work in her faculty profile.

For more information, please contact Melissa Reed at

Webinar: "Health Systems Research Ethics: Special Issue Webinar"

When:  05/30/2017   8:30 AM - 9:30 AM

Time Zone:  (GMT-05:00) Eastern Time (US and Canada) 

Host: Professor Adnan Hyder (Johns Hopkins Bloomberg School of Public Health)

To join the webinar:

Log-in as a guest if unaffiliated with Johns Hopkins. 


Please RSVP:


Health systems research ethics is a relatively new and emerging field, with numerous normative and descriptive questions that have largely not been considered. It has been argued that the ethical issues arising in health systems research projects may be unique or nuanced relative to biomedical research.

To further build the field of health systems research ethics and promote scholarship in this area, a special issue of Developing World Bioethics was devoted to it in 2016. This webinar brings together the authors (Sassy Molyneux, Bridget Pratt, Hayley MacGregor, Gerry Bloom, and Abbas Rattani) of four papers published in that special issue as well as one of its co-editors (Adnan Hyder) to share their findings and work.

The webinar is one hour and will consist of an introduction, 4 short presentations by the authors discussing their papers, followed by a Q&A with the authors and a broader discussion on the ethics of health systems research moderated by Joe Ali (Berman Institute of Bioethics).


  1. Introduction: Professor Adnan Hyder, Johns Hopkins Berman Institute of Bioethics and Bloomberg School of Public Health; Guest Editor of Special Issue
  2. Health Systems Research Consortia and the Promotion of Health Equity in Low and Middle-Income Countries, Bridget Pratt, University of Melbourne (Australia)
  3. Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale, Hayley MacGregor and Gerry Bloom, Institute of Development Studies (UK)
  4. Research Involving Health Providers and Managers: Ethical Issues Faced by Researchers Conducting Diverse Health Policy and Systems Research in Kenya, Sassy Molyneux, KEMRI-Wellcome Trust Research Programme (Kenya)
  5. What Makes Health Systems Research in Developing Countries Ethical? Application of the Emanuel Framework for Clinical Research to Health Systems Research, Abbas Rattani, Meharry Medical College (USA)