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International Health

Health Systems Program

Bill & Melinda Gates Foundation Summer Internship: Health Systems Program Student Experiences

Three students from the Health Systems Program in the Department of International Health, along with one student from the School-wide MPH/MBA dual degree program at the Johns Hopkins Bloomberg School of Public Health (JHSPH), had the opportunity to intern at the Bill & Melinda Gates Foundation in Seattle, Washington this past summer. Through the Bill & Melinda Gates graduate internship program, designed for masters and doctoral students from partnering universities in the United States, students had the opportunity to travel internationally to work on specific projects and a range of public health issues, including vaccine development and delivery, digital health, water and sanitation and health financing. Brief excerpts of their experiences are included below:

Sudip Bhandari, third-year PhD candidate, Health Systems Program at the Johns Hopkins Bloomberg School of Public Health

Sudip Bhandari

Sudip interned with the Vaccine Development and Surveillance team as a research consultant on the Routine Child Contact Optimization (ROCCO) project. The project aims to optimize the World Health Organization’s routine immunization program, Expanded Program for Immunization (EPI). In this role, Sudip identified gaps where further research is needed to support a change of the EPI vaccine schedule. Sudip also helped to identify opportunities to incorporate new vaccines, nutritional interventions, and maternal, newborn and child health programs in an optimized schedule. With a small team from across the foundation, he traveled to London and organized a day-long convention, bringing together vaccine experts, immunologists and service delivery professionals to validate the research gaps, discuss the feasibility of a schedule change, and identify research areas for potential funding. Going forward, he plans to continue his research on vaccine delivery, exploring the feasibility and cost-effectiveness of multiple vaccine schedules. 

Karam Chohan, second-year MSPH candidate, Health Systems Program at the Johns Hopkins Bloomberg School of Public Health

Karam Chohan

Karam supported strategy, planning and management initiatives for the Office of the CIO. Karam was primarily responsible for developing a dashboard and scorecard for the CIO, in collaboration with IT and security directors, program managers and staff. The scorecard will aid in decision-making and the assessment of services that support the foundation’s internal and external operations. Through this project, Karam fostered interest in a new measurement and mapping initiative to better serve teams within operations and programs. Karam also advised the Financial, Planning and Analysis team on the development of a cost analysis and framework that will inform future investments for global HIV vaccine clinical trials. Throughout his internship, Karam was able to learn about new initiatives, organizational challenges and program strategies across the foundation and the global development community, which have informed his ideas for future research. 

Genevieve Kelly, second-year MPH and MBA student at Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Carey Business School

Genevieve Kelly

Genevieve interned with the Water, Sanitation and Hygiene team, where she managed the development of the City Sanitation Equity Dashboard, a model for evaluating sanitation investments in terms of their financial viability, equity of coverage, and effectiveness to safely remove waste from the environment. With Lusaka as the first case study, Genevieve traveled to Zambia to work with the grantee on the project, COWI A/S, a Danish engineering firm, where she learned how to strike the right balance between designing a model that is user-friendly and can function with varying levels of data quality, while also being complex enough to provide relevant, reliable insights into a city’s planned investments. Genevieve hopes to continue working in the sanitation field, now with a deeper appreciation of how private foundations can drive policy changes.

Ruth Young, second-year PhD student, Health Systems program at Johns Hopkins Bloomberg School of Public Health

Ruth interned for the Financial Services for the Poor (FSP) team. The FSP team works with governments and private-sector partners to improve access to financial services for the world’s poorest. Financial inclusion reduces poverty and inequality, which are risk factors for poor health. Ruth reviewed a wide range of literature exploring various aspects of corruption, including how to measure corruption, types and effects, and how governments, organizations and communities fight corruption. “I learned what it means to be part of such a mission-driven supportive organization, how to build collaborative relationships over time, and how admitting mistakes and your own misgivings can be helpful. I loved working in a diverse and international team and intern cohort. I learned new things every day with the team who were welcoming, friendly and insightful,” says Ruth on her experience with the FSP. Going forward, Ruth hopes to continue doing interdisciplinary research as part of her doctoral work.

Learn more about the Bill & Melinda Gates Foundation graduate internship program, and view more information on the graduate degree programs offered by the Health Systems Program.

HSR2018

The Fifth Global Symposium on Health Systems Research, hosted by Health Systems Global, brings together players from across the globe to discuss key issues in the field of health systems and policy research and practice. Thousands of representatives from global health and development non-profit and private sector organizations, academia and professional society organizations convened in Liverpool in October for the Symposium. In addition to sharing knowledge and fostering discussions on strengthening health systems, the Symposium also serves as a forum to drive policy and action on pressing global health issues.

This year’s theme, Advancing Health Systems for All in the SDG Era, draws upon the Alma-Ata vision of health for all, with the Symposium occurring one week before world health leaders returned to Kazakhstan for a renewed global commitment to primary health care on Alma-Ata’s 40th anniversary.

The Health Systems Program was represented by faculty and students in 33 sessions spanning the conference sub-themes of multisectoral action, engaging the private sector, leaving no one behind, and community health. Students from the Program, in particular, were a great source of drivers for change and advocated for implementation of policies and research that drive equity and protect the most vulnerable. Brief excerpts of the Program’s student experience are included below:

Jaya Gupta, PhD, ‘18Jaya Gupta Poster

Jaya is a recent doctoral graduate from the Health Systems Program. Her dissertation consisted of a systematic literature review synthesizing evidence on approaches to motivate health workers in low- and middle-income countries. She presented her dissertation research in a poster presentation at the Symposium.

Thoughts on the conference: “The Global Symposium on Health Systems Research was a week of learning, conversation and debate. The symposium encouraged us, as researchers, to examine our practices and question whether sufficient consideration has been made of those traditionally marginalized. This rich dialogue was complemented with practical sessions on study design, frameworks, and methods to become more inclusive researchers.”

Ankita Meghani, PhD studentAnkita Meghani

Ankita is a PhD student and part of the team at Johns Hopkins Bloomberg School of Public Health working on the Data for Health Initiative (D4HI), a Bloomberg Philanthropies project aimed at improving public health data so that governments are equipped with the tools and systems to collect and use data to prioritize health challenges. Ankita presented a poster on behalf of D4HI, sharing research on how best to use mobile phone surveys to collect population data in Bangladesh and Tanzania. The surveys were used to measure non-communicable disease risk factors. 

Thoughts on the conference: “Attending HSR 2018 was a great experience – several sessions brought together the voices and perspectives of different actors, such as researchers, program implementers, and policymakers from across the world. These sessions provided a platform for rich discussions and incorporated the important views of those closest to the on-the-ground realities. As a doctoral student, HSR 2018 was a great way to make new connections with fellow students and researchers, and learn about interesting work happening across different dimensions of health systems in diverse settings.”  

Jess Wilhelm, PhD student

Jess is a PhD student in the Health Systems Program whose research focus is on the effects of transition from donor-funded HIV programs on health facilities in Uganda. The panel he was a part of focused on the financial transition of aid programs, specifically how to sustain health gains when funding is transferred from donor to domestic. Jess presented empirical findings on the impact of transition of PEPFAR support for both private for-profit and not-for-profit facilities in Uganda. The robust audience discussion that followed touched on issues related to health governance, transition, and the needs for, and limitations of, transition planning.

Thoughts on the conference: “The scale of HSR provides students an opportunity to learn at varying ‘altitudes’, ranging from the 30,000 ft. views in the plenary sessions to the ‘in the weeds’ perspective through methodological workshops. It is a ‘choose your own adventure’ experience, so students attending HSR should arrive already knowing what they want to gain from the conference.”

Nukhba Zia, PhD studentNukhba Zia

Nukhba is a doctoral student with the Johns Hopkins International Injury Research Unit (JH-IIRU). Her poster, Inclusive health Systems: Incorporating individuals with disability into plans for achieving the Sustainable Development Goals, touched on the “leaving no one behind” sub-theme and focused on understanding access-related issues that individuals with disabilities face within their environment.

Thoughts on the conference: ‘’The Fifth Global Symposium on Health Systems Research, or HSR2018, in Liverpool was my first time attending the symposium. It was a great opportunity to learn new methodologies and approaches in health systems research and meeting health systems and policy researchers from across the globe. I was intrigued by two main areas - knowledge translation and multi-sectoral collaborations - that the symposium placed great emphasis on. These are crucial elements of health systems research and are very relevant to injury and disability work that I am engaged in as part of JH-IIRU.”

Data for Health Update: Mobile Health Surveys in Tanzania

 

In early July, researchers from the Health Systems Program went to Tanzania to help conduct focus group sessions on the challenges and successes of using a SMS survey to assess non-communicable disease (NCD) risk factors within the country. Assistant scientist Dustin Gibson and research coordinator Hannah Selig went as part of the Data for Health Initiative (BD4HI), a project funded by Bloomberg Philanthropies which aims to help government officials and public health leaders make informed decisions on health care priorities by collecting public health data.

The Johns Hopkins Bloomberg School of Public Health (JHSPH) is a partner organization in BD4HI that is leading the research and development component of the NCD arm of the Initiative. Researchers in the Health Systems Program and Department of International Health at JHSPH are evaluating the viability and helping to optimize performance of mobile phone surveys to gather NCD risk factor information, such as tobacco and alcohol use, physical inactivity and unhealthy diet.

The goals of the focus group session were to learn how the participants interacted with a text message survey and gauge their comprehension of the question wording and intent, and to measure the logistical aspects of the survey, such as how long it took participants to complete and if they struggled to understand the questions. The focus group sessions were a collaborative effort with JHSPH partner organization, Ifakara Health Institute (IHI), who conducted and analyzed the data from the focus group sessions and will be leading survey efforts in Tanzania.

The SMS survey included 15 questions aimed at assessing major NCD risk factors and touched upon topics such as reducing salt intake in one’s diet, blood pressure screening, and tobacco and alcohol use. JHSPH and IHI used international technology providers Viamo to implement the survey, and Datavision, a Dar-es-Salaam-based call center and recording studio for the audio files (where the questions are recorded in Swahili).

The focus group sessions revealed challenges such as more difficulty for older participants to read the questions and complete, and a longer length of time overall to finish the survey. Following the focus group sessions, IHI researchers made adjustments for the length in time by having participants input a number instead of a worded response and made the questions easier to respond to.

The focus group sessions were a key step in the process to collect risk factor information, as now the JHSPH group will move on to the next phase, which is implementing the survey to approximately 1,500 respondents. Incentives in varying amounts will be provided to all participants. This phase will provide essential data on the presence of NCD risk factors in Tanzania, the viability of collecting surveillance data using mobile technology, and will help inform policy decisions for country health officials. 

Going forward, the JHSPH research team will conduct comparable surveys in additional countries that have partnered with the Data for Health Initiative, such as Bangladesh, Colombia and Uganda.

For more information on using mobile health surveys to collect NCD data, read the Special Issue published in the Journal of Medical Internet Research.

 

Building Bioethics Capacity: The Johns Hopkins Fogarty African Bioethics Consortium

 

The need for enhanced capacity in international research ethics and global bioethics is important, especially in low- and middle-income countries where there are huge leaps in health systems research but not as much parallel work on ethical implications. The Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) aims to improve bioethics capacity development for institutions within Africa.

FABTP is an in-depth bioethics training program that is funded by the National Institutes of Health Fogarty International Center and directed by Drs. Adnan Hyder and Nancy Kass. The program includes bioethics training at Johns Hopkins University, independent research in the recipient’s home country, and a scholarly exchange at a different FABC member institution in Africa.

Gershom Chongwe from the University of Zambia and Dan Kaye from Makerere University were the 2018 FABTP recipients. During their stay in Baltimore from January-May they took courses in the Department of International Health at Johns Hopkins Bloomberg School of Public Health (JHSPH) and the Johns Hopkins Berman Institute of Bioethics. In May they went home to collect data and will return in August to continue their courses and analyze the data.

Dr. Chongwe has a background in medicine and public health at the University of Zambia, specifically focusing on adaptive trial designs, an emerging field of epidemiology sometimes seen as controversial because of the ethical issues surrounding it. Adaptive trial designs allow for greater flexibility and efficiency by incorporating modifications during the trial based on the data. An increase in the use of adaptive trial designs has caused a debate about whether the trials offer any significant methodological advantage compared to traditional randomized trials, as well as whether they are ethically justified.

Dr. Chongwe’s aim while studying at JHSPH is to use applied skills from the coursework to frame the right questions and clarify the ethical issues surrounding adaptive trial designs. Also an instructor at the University of Zambia, Dr. Chongwe teaches his students how to conduct clinical trials and wants to apply the insights gained through his bioethics research while in Baltimore to his lessons back home in Zambia.

Dr. Kaye is a member of the Institutional Review Board (IRB) in Uganda and is taking training that will help him improve his performance in looking up literature and analyzing and interpreting data with a focus on ethical issues, literature review, communicating findings and the informed consent process. Dr. Kaye aims to focus on the ethical questions surrounding randomized control trials (RCTs), as they are not up to standard in his home country of Uganda.

Dr. Kaye’s courses provide insight on how one can ensure an ethical conduct of research and how to avoid research misconduct. This will help him to understand the different ways in which ethical principles are applied to research and how the context of emergency care informs the consent process for RCTs, and also demonstrates the different ways ethical issues are contextualized and analyzed.

"The Fogarty African Bioethics Training Program is an excellent opportunity to foster a new cohort of researchers in bioethics research from countries where it is needed most," states director Dr. Adnan Hyder.

The coursework, research and fieldwork facilitated by FABTP will help both fellows contribute to standards and procedures back home in Uganda and Zambia, and will allow them both to lead others through instruction and mentorship. 

Health Systems Leadership: Promoting Health Equity and Effecting Change

Dr. Krishna Rao, assistant professor in the Health Systems Program of the Department of International Health, was recently featured in the Johns Hopkins Bloomberg School of Public Health magazine in an interview with Barbara Bush, co-founder of Global Health Corps. Dr. Rao’s discussion with Barbara touched upon health equity and humility, and how to exemplify these traits in a leadership capacity. The Health Systems Program delved further into the idea of health equity as a key ingredient of effective health systems leadership by asking Dr. Rao a few questions.

1. Identifying leaders and change agents: as a teacher, how do you identify leaders and potential change agents? What are some more important qualities in a leader when it comes to promoting health equity?

In some students leadership qualities are apparent – they take charge of things naturally, don’t shy from expressing opinions and take ownership of any job given to them. There are other students who demonstrate their leadership in a quiet way – they are more watchful and reserved but are clear about what they think and how to get the job done. In both cases, I think they like taking ownership and putting in more effort than normally expected.

2. You have a lot of experience in working in human resources for health – what are some lessons you have learned about how leaders can effect change at the systems level?

Health systems are hard to change. Yet, I think, a health system is ultimately as good as the people who make it function. Particularly because all health services are ultimately delivered by people. You can take a well-designed system but incompetent people can make it ineffectual. On the other hand, there are numerous examples of individuals who have done remarkable things working in broken health systems. I have come across so many health workers – doctors, nurses, community workers, managers – who for little money and working with poor infrastructure, manage to do so much so that others can benefit from their services. So I think investing in health workers and keeping them enthusiastic about their work is as critical as the particular way a health system is organized. 

3. For researchers such as yourself, you mentioned that you can write as many papers as you want but nothing might really happen unless there are people who can see the importance of what you do – how can researchers position themselves as change agents and make sure their work is more likely to be implemented in the field?

There is an important line between being an academic and being an activist. Researchers have traditionally seen themselves as producers of knowledge, while ‘changing the world’ has been in the domain of social and political activists. More recently, you see researchers also becoming activists. In some cases it’s because the science itself is being disputed by the politically powerful like in the case of climate change. So I think there is an increasing sense that researchers should not be passive about their research and expect that it will find a voice on its own. They need to actively make it known and promote it via social media, public debates, and even demonstrations. 

For more information on Dr. Rao’s research interests and profile, read his interview with Barbara Bush, as well as his faculty feature