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.