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International Health

Health Systems Program

Keyword: health systems

Dr. Krishna D. Rao, assistant professor, joined the Health Systems Program in 2014, bringing expertise in health systems and health economics. He received his master’s degree at Cornell University in agriculture and resource economics and his PhD in health systems from the Program.

Prior to joining the Health Systems Program, Dr. Rao worked with the Public Health Foundation of India (PHFI), where he conducted research on health systems and taught health economics. Before coming to PHFI, Dr. Rao worked in Afghanistan as part of the Johns Hopkins team supporting their Ministry of Public Health (MoH) to evaluate models of community financing of health services. Dr. Rao started his career in public health at the World Bank, working on the delivery of child nutrition and health services in India. In 2016, Dr. Rao was selected as a practitioner resident fellow to the Rockefeller Foundation Bellagio Center Residency Program.

Dr. Rao’s research focuses on three major areas – human resources for health, health financing and evaluation. He is particularly concerned with issues around strengthening primary care and nutrition services, measuring quality of care, and reducing financial hardship faced by households due to health care payments. He teaches courses in health financing in low- and middle-income countries, and the role of health in economic development. Dr. Rao also co-leads the Program’s health systems seminars.

Dr. Rao is involved with a variety of research projects. One of Dr. Rao’s key projects includes evaluation of a large-scale mentoring program for nurses at primary health centers in the state of Bihar, India. The mentoring program is funded by the Gates Foundation and provides nurses with the knowledge and skills to improve their obstetric skills. This evaluation is being conducted in partnership with the Johns Hopkins School of Nursing.

Dr. Rao is also currently working on designing a conditional cash-transfer program for improving nutrition in young children in India. The study uses a discrete choice experiment to understand the preferences of mothers for program conditionalities and cash transfer amounts. Other key projects include mentoring researchers from eight different countries to help them improve their research skills, conducting a cost-effectiveness analysis of a nutrition program in Malawi, and a previous health financing project in Kyrgyzstan that examined how health financing issues affect delivery of services.

Going forward, Dr. Rao is interested in studying conditional and unconditional cash transfer programs, aging and what implications that has for health systems and the financing of health care, and how the management and institutional structures of health services affect health worker performance and quality of care. Read more about Dr. Rao’s work in his faculty profile

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!

Dear Colleagues and Friends,

It is my pleasure to welcome you to the Department of International Health’s Health Systems Program inaugural blog. Our Program’s goal is to enhance the capacity of communities to improve the health of their people, and we hope to share stories from around the world about our efforts. Our multidisciplinary faculty work in partnership with local governments, community leaders, ministries of health, community-based health and human service agencies, universities and research institutes to address health burdens that span a wide range of fields. From humanitarian relief, to mobile health technology, to addressing the burden of chronic conditions, to injury prevention, our intent is to promote sustainable and community-driven health care and health system interventions.

In light of many global changes, such as the transition from Millennium Development Goals to Sustainable Development Goals and the impending threat of global warming, we hope to join a very important conversation on the future of health systems and define what a cost-effective, equitable and resilient health system should look like. We will do this online, at conferences, and in person as we travel the globe.

I am excited about several items our Program has slated for this year: we launched our Facebook and Twitter accounts so that we can share with you and also hear what you have to say; we have released our first Annual Report for 2015; and most importantly, we welcomed our new Health Systems students into our MSPH, PhD and MHS in Health Economics degree programs. We look forward to sharing more exciting developments with you.


Adnan A. Hyder, MD, MPH, PhD

Director, Health Systems Program

Professor and Associate Chair, Department of International Health