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International Health

Health Systems Program

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 melissar@jhu.edu

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:

https://connect.johnshopkins.edu/hsr2017/

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

 

Please RSVP:

https://goo.gl/forms/Kfwj7NX9vm8myZvz1

Summary: 

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).

Presenters:

  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)

Today, May 23, 2017, marks Johns Hopkins Bloomberg School of Public Health’s Convocation Ceremony, with the school-wide celebration taking place tomorrow. At 3 p.m. today, graduates will take the stage at the Royal Farms Arena in Baltimore, MD, ready to begin their careers in the vast field of public health.

The Health Systems Program is honored to have many graduating students representing the Program in the Department of International Health in today’s ceremony. Thirty-five Health Systems students are officially receiving their degrees: three Master of Health Science (MHS) in Health Economics students, 25 Master of Science in Public Health (MSPH) students, and seven PhD students. The Program is delighted and congratulates all of them!

In March, the Program celebrated three students defending their thesis, and recently celebrated two more in May. Yuen Wai Hung, presented her dissertation, Understanding the Mental Health Consequences and Associated Risk Factors among Adult Injury Survivors in Kenya, and Julia Zhang also presented her dissertation, Rehabilitation of Occupational Injuries: Evaluation of a National Return-to-Work Program in Malaysia.

The Program also had the honor of awarding the 2017 Doctoral Research Award to four outstanding students for their international research. Sudip Bhandari received the award for his qualitative research project, which evaluated the national and local context against which the contracting-out model has been implemented in Nepal. Douglas Glandon’s research examined collaboration between frontline workers from the two Indian government ministries that have joint responsibility for delivering essential health and nutrition services to women and children in villages across the country. Jose Gutierrez received the award for his proposed research on a comparative analysis of Guatemala and El Salvador’s post-conflict health reforms, and Ankita Meghani won for her research on understanding the perspectives of policymakers and key stakeholders in Uganda on the integration of non-communicable disease (NCD) care into existing community health worker (CHW) roles.

The Program works in over 50 countries, and encourages students to seek diverse opportunities for learning and training all over the world. The hallmarks of our academic program are a rigorous focus on scientific methods, a multidisciplinary faculty, and training through real-world examples. It is especially rewarding to see students earn their degrees and contribute the discoveries made through their research.

Health Systems students have gone on to work for renowned global organizations such as the World Bank, the World Health Organization and the Centers for Disease Control. We always seek to train our graduates to design efficient systems and implement equitable strategies for delivering health care, especially in the most vulnerable and disadvantaged parts of the world.

We wish all graduating students a successful career in public health, and are looking forward to seeing great achievements made by Heath Systems students around the globe. Visit us for more information on our Program. 

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.