Peter Hansen, PhD ’08, Health Systems
Head of Monitoring & Evaluation
The GAVI Alliance
Dr. Peter Hansen earned his PhD from the Department’s Health Systems Program in 2008. As a doctoral student he helped develop, test, and implement a national monitoring and evaluation tool for the Afghan health system—the Balanced Scorecard. Now, as the Head of Monitoring & Evaluation (M&E) at the GAVI Alliance, he leads a major global health organization’s evaluation efforts that contribute to improved programming and health systems across the world.
Public Health in China
Hansen decided to pursue a career in public health while working in China for an NGO called the China Foundation. With a master’s degree in East Asian Studies, Hansen wanted to apply his knowledge of the region in a way that had the most potential to improve people’s lives. In his role with the Foundation, he began to see how public health could achieve this aim. As a program officer, he participated in an interagency committee chaired by the Chinese Ministry of Health to coordinate efforts for the nationwide introduction of the Hepatitis B vaccine. This initiative generated Hansen’s interest in the intersection between vaccines and health systems. During this period, he concluded that in order to maximize his impact in this field, he needed more training.
Based on its eminent and diverse faculty, Hopkins and the Department of International Health became the clear choice for his doctorate work. And, he reflects, “I was drawn to health systems because it seemed to be the place I could have the biggest impact: Sustained benefits come from strong systems.” Working in China highlighted how critical it is to work within existing systems when introducing a new intervention, such as a vaccine.
Afghanistan’s National Health System
While he originally intended to return to China for his doctoral work, the Department’s partnership with the government of Afghanistan presented an ideal opportunity that he couldn’t pass up. In 2004, the health system was in disarray and needed to be rebuilt from the ground up. To be able to help shape and improve such a large and complex health system was one of the major reasons for pursuing his doctorate.
Hansen spent a good part of 2004 traveling around the country with survey teams. He was fortunate to see much of the country and interact with communities at a time when security conditions were passable; a short while later conditions deteriorated, making travel through much of the country no longer feasible. In 2005, Hansen returned to Afghanistan full time to work for the next three years as the Department’s country director for Afghanistan.
Hansen remembers most fondly the Afghan people’s resolve to rebuild their country:
"Families within the village would bring the research team tea and invite us to stay for dinner and spend the night in their homes before moving to the next village. Similarly, we had a great experience with our counterparts within the Ministry of Public Health. They are deeply committed to creating a better future and they are very active in their pursuit of learning and innovation. A real highlight of our time there was the sense of camaraderie in working toward a common purpose."
Then and now, the Department’s team in Afghanistan enjoys an unusual level of access to high-level policy makers. The results of the Balanced Scorecard are used by the government not only as a measurement tool, but as an active means of managing health services.
On top of testing and refining the Balanced Scorecard, the Department’s team in the country conducted a number of related research studies. One of these was a health financing pilot study that looked at the effect of user fees on a number of outcomes, including quality, utilization and community and health worker perceptions. The study’s findings informed the government’s decision to abolish fees at the point of delivery.
Hansen offered a note of thanks to several of his Hopkins professors, including David Peters, Gilbert Burnham and Mathu Santosham, for making his experience in the country so valuable. Hansen completed his thesis from Afghanistan in 2007, and returned to Baltimore for his defense, formally receiving his degree in 2008.
During his tenure as country director, he was able to host the late Professor Carl Taylor, who was also working in the country. Hansen and his team celebrated Taylor’s 90th and 91st birthdays with him. “Carl was inspirational and his visits to our house are some of my fondest.”
Leading M&E at GAVI
In late 2008, Hansen joined the GAVI Alliance as head of M&E. GAVI is a global health partnership, which includes the World Bank, WHO, UNICEF and others, and is currently active in 72 countries. Its mission is to save children’s lives and protect people’s health by increasing access to immunization in poor countries.
Research translated to policy and programming
To help illustrate the benefits of evaluation, Hansen was happy to share several examples of how work in monitoring and evaluation has contributed to policy changes. The Alliance uses performance-based financing for its immunization support, which means, among other things, that additional funding is linked to the number of vaccinations administered. Through monitoring and evaluation, GAVI has learned a number of lessons about the program that it is using to inform the development of the next generation of its performance-based financing programs. Changes include
- ensuring that incentives are cascaded down to lower levels of the system to reach actors whose behaviors are critical in influencing immunization outcomes
- aligning incentives with gains in equity, and
- enhancing the independent verification of results.
In addition, Hansen and his colleagues are developing a monitoring and evaluation framework and strategy for GAVI for the 2011-2015 period. The cornerstone of this strategy is the implementation of a forward-looking system that links routine programme monitoring, targeted studies and full country evaluations that are designed at baseline and conducted prospectively. This strategy recognizes the limitations of standard models of evaluation that compare intervention to non-intervention areas, which can overlook other efforts within the same study locations. GAVI is now working on ways of integrating their evaluations with governments and other organizations to better capture the complexity of country situations. Instead of creating a completely new system, this approach builds on a country’s existing system and works with other national players to capture more information than possible with stand-alone evaluations.
Advice to Students
Hansen thinks that his training by the Department prepared him well, and that the Afghanistan project was a great example of how the size and diversity of the Department offer students unique training and work opportunities. He urges students to go beyond their course work:
“Get involved, particularly in country settings. That’s where the action is.”
He jokes that while the School offers all its students great opportunities, not everyone will be as fortunate as he was to meet a future spouse in the Department. Fellow Health Systems graduate, Kavitha Viswanathan, PhD, and he met as students and now live together in Geneva. “At Hopkins I received a great education and found a great job and a great wife. I got more than my money’s worth. I hope Kavitha would agree.”
--Brandon Howard, September 2010