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International Health

Health Systems Program

Date: Apr 2017

Four members of the Health Systems Program and Department of International Health at the Johns Hopkins Bloomberg School of Public Health (JHSPH) attended Bloomberg Philanthropies Data for Health Initiative (D4H) partner’s meeting in New York City, New York in April 2017. Drs. Adnan Hyder, Dustin Gibson, Alain Labrique and George Pariyo were in attendance, as well as Joe Ali from the Johns Hopkins Berman Institute of Bioethics.

D4H seeks to help government officials and public health leaders make informed decisions on health care priorities by collecting public health data. The Initiative seeks to improve civil registration and vital statistics (CRVS) systems, explore ways to expand current non-communicable disease (NCD) surveillance efforts, and provide training on data analysis and use to governments in low- and middle-income countries (LMICs).

JHSPH is a partner organization that is leading the research and development (R&D) component of the non-communicable disease (NCD) arm of the Initiative. Researchers at JHSPH are evaluating the viability of mobile phone surveys to gather NCD risk factor information. Read more on JHSPH’s work with mobile phone surveys for Data for Health.

The partner’s meeting was held April 4 – 5, 2017. The objectives of the meeting were to discuss future opportunities to strengthen global health data, highlight successes in each arm of the Initiative, and review critical work completed in the first two years of funding. Dr. Gibson gave a presentation entitled, Early Findings from Formative Research on Use of Mobile Phones for NCD Risk Factor Data Collection. His presentation addressed research on the potential for mobile phone surveys to collect data on NCD risk factors such as tobacco use, unhealthy data, physical inactivity, and harmful use of alcohol.

The Health Systems Program is focused on achieving accessible, cost-effective health care and healthy outcomes across the lifespan for families, communities and nations. In the past decade, the Program has conducted projects in over 50 countries, with particular expertise in South Asia and sub-Saharan Africa, where the greatest number of people continue to struggle with deep poverty and unmet health needs.

The Health Systems Program announced four winners of the 2017 Health Systems awards for doctoral research in April 2017. The awards were given to Sudip Bhandari, Douglas Glandon, Jose Gutierrez and Ankita Meghani.

Sudip won for his qualitative research project, which focused on evaluating the national and local context against which the contracting-out model has been implemented in Nepal, especially after the earthquakes in 2015. Contracting-out refers to the process in which essential public services, such as healthcare, are delivered through third party non-state actors. Contracting-out is common in post-conflict and fragile situations where institutional capacity for service provision might be compromised. While there are advantages to contracting-out, including facilitation of state-building, it is also vulnerable to fiduciary, political, and technical risks like bypassing of government and undermining long-term recovery. With his project, Sudip hopes to provide avenues for developing a framework and set of indicators in order to evaluate the effects of policy decisions on contracting-out in the Nepalese context.

Douglas’ research examines 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. While the government has achieved widespread geographical coverage, multiple evaluations have highlighted substantial gaps in implementation and limited impact on child nutritional status and development outcomes. These shortfalls have prompted calls for strategic review of the initiative, including the approach to collaboration. Douglas’ dissertation aims to develop a village-level collaboration scorecard, measure associations with service coverage, and identify key local governance factors affecting the nature and extent of collaboration between the frontline workers from these two ministries.

Jose received the award for his proposed research on a comparative analysis of Guatemala and El Salvador’s post-conflict health reforms. In the aftermath of decades-long civil war, both countries sought to expand primary healthcare coverage among the poor, however, their contrasting strategies set them on divergent trajectories. By situating their experiences within their post-conflict political economies, Jose will explore questions such as how the structure of political institutions influences the degree of accountability to marginalized groups, how elite capture of fiscal policy reform constrains health system resources, and specifically in Guatemala, how health policies embody the social exclusion of the indigenous population. The study ultimately aims to generate lessons for policymakers and researchers seeking to make sense of the policy process and working towards Universal Health Coverage.

Ankita’s research focuses 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. Given the rising burden of NCDs, Uganda has been looking at various mechanisms to scale up NCD prevention and treatment services to reach communities, and training CHWs to provide basic NCD services and manage care is one possible approach. Understanding policymakers’ perspectives on this proposed policy could help identify contextual factors as well as barriers and opportunities that could influence the policy formulation and implementation for scaling up NCD services. Results from this research will aim to highlight areas that may need further examination, as the country moves towards expanding access to NCD care.

Congratulations to all four recipients of the Health Systems Doctoral Research Award for their work in international health systems research. 

The annual Consortium of Universities for Global Health (CUGH) conference kicks off this weekend with the theme, “Healthy People, Healthy Ecosystems.” Key sessions from the conference highlight the relationship between climate change and health, social determinants of health, how to promote healthy outcomes in conflict-afflicted areas, and the burden of non-communicable diseases in low-income countries.

Johns Hopkins University is co-hosting the 2017 conference, along with Makerere University in Uganda. The Health Systems Program in the Department of International Health at Johns Hopkins Bloomberg School of Public Health will have two plenary panel sessions held on Sunday, April 9: Non-Communicable Diseases (NCDs) in Low- and Middle-Income Countries (LMICs) with Dr. Adnan Hyder, and Humanitarian Emergencies with Dr. Paul Spiegel.

Department Chair, Dr. David Peters, will also be a featured speaker in a pre-conference satellite session on Thursday, April 6, entitled Putting Quality on the Global Health Agenda. Register here.

Deaths from NCDs are rising rapidly worldwide, especially in developing countries who often lack the necessary resources and experience to respond adequately to this growing burden. Many health systems in LMICs are already struggling with poverty and unmet health needs from infectious diseases; NCDs - such as cancer, diabetes and heart disease – exacerbate an already fragile health system. In addition, addressing injury-related deaths often results in a challenge to convince governments that injuries are a health care issue.

Dr. Hyder, Professor and Director of the Health Systems Program, will present “Beyond Epidemiology of Injuries,” and will address the public health threat that deaths from injuries pose in LMICs. He will also discuss evidence-based strategies used to effect policy change and prevent injury-related deaths.

Participants will be invited to share their experiences and suggestions on responding to the growing challenge of NCDs and deaths from injuries. At the end of the session, participants will be able to understand the emerging epidemic of NCDs in LMICs, particularly in Sub-Saharan Africa; understand the value of and how to utilize established infectious disease care platforms for NCD care and prevention; and understand successful approaches and challenges to curbing injuries. The session will be held from 10:15 a.m. – 11:45 a.m.

Later that afternoon, Dr. Paul Spiegel will moderate a panel session on humanitarian emergencies. Dr. Spiegel is Director of the Center for Humanitarian Health, hosted by the Health Systems Program and Department of International Health. The session, held from 2:30 p.m. – 4 p.m., will address the current global challenge of humanitarian emergencies and displacement of millions, and discuss ways to adapt health care responses for the future.

The CUGH conference is held from April 7 – 9, 2017 in Washington, DC. For more information on sessions, as well as the rest of the conference agenda, click here