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International Health

Advancing Global Health Systems Research

International Conferences and Recent Publications Showcase Department’s Leadership in a Growing Field

As the international commitment builds to expand health coverage and improve services in low- and middle-income countries, health systems research is becoming increasingly important. The Department has been a leader in this field for years. And as the field has grown, the Health Systems Program faculty have spearheaded new efforts and initiatives to keep the Department on the cutting-edge, in both the worlds of academics and practice. Recent publications and two important international events help to highlight this leadership role, especially in three research areas:

  1. Innovation in Service Delivery
  2. Complex Adaptive System Modeling
  3. Informal Providers and Private Markets

The Second Annual Global Symposium on Health Systems Research

Over a dozen Department faculty and students traveled to Beijing this fall to present at the Global Symposium of Health Systems Research. (Complete list of Hopkins presentations). This year’s theme was "Inclusion and Innovation towards Universal Coverage." The conference brought together researchers, program managers, policymakers, and donors to advance health systems research and increase the use of evidence in public health decision-making in low- and middle-income countries. While IH presentations covered an array of topics, many of presentations helped to highlight some of the key areas Health Systems faculty are championing.


ANC Utilization in Kamuli District. From BMC:
International Health and Human Rights 2011 11(Suppl 1):
Blue line: intervention; red line: control.

Innovation in Service Delivery

Assistant Professor Asha George, presented on The MANIFEST Project (Maternal and Neonatal Implementation for Equitable Systems). This project follows up a successful taxi driver voucher program in Eastern Uganda implemented under the Hopkins-led Future Health Systems Consortium. The program provided vouchers for mothers to hire independent taxi drivers to take them to health clinics for antenatal visits. As the graph here shows, antenatal visits increased dramatically during the intervention in late 2009 and early 2010. But, once the program ended, visits returned to near normal levels.

In response to this, the MANIFEST Project’s mandate is to investigate challenges to supporting local action, ownership and sustainability in health delivery. Through participatory action research, the project is engaging with key stakeholders at district and community levels in Uganda to promote maternal and newborn care practices. Their research will feed into the development of a conceptual framework for measuring community capability and should provide insight into developing sustainable interventions that tap into existing community resources.


Key actors and their interactions in the lens of complex
adaptive systems. From: Social Science & Medicine (online),
Essential drugs policy in three rural counties in China:
What does a complexity lens add?

Complex Adaptive System Modeling

Over the last decade, Department faculty have advanced the use of complex adaptive systems to better understand health systems in developing countries. At the Beijing conference,

Professor David Peters moderated the session: Complex adaptive systems: Recent applications in health systems research. This session provided an overview of the current state of the art and provided an opportunity to present analysis of relevant lessons for the health sector. Professor David Bishai, who has a joint appointment in International Health, was one of the main session presenters. The title of his talk was, Modelling resource allocation policies: A systems dynamics simulation of trade-offs between curative and injury prevention.

Professors Peters and Bishai also recently published an article in Social Science & Medicine, entitled "Essential drugs policy in three rural counties in China: What does a complexity lens add?" The article provides a good illustration of a simplified model that shows how key players in a health system interact.

BookInformal Providers and Private Markets

The Bellagio Conference: Future Health Markets in December brought together a small group of experts to discuss changes in health markets. One of the main topics was how to utilize the increasing capacity of informal providers and private health markets, while at the same time improving and regulating quality. Professors Bennett, Bishai, and Peters contributed their expertise along with other academics, policy-makers, entrepreneurs, and funders. A complete meeting report with recommendations for how markets can better serve the needs of the poor in low- and middle-income countries is now available on line.

In a related effort, a new book co-edited by Professor Peters was released earlier this year as part of the Pathway to Sustainability Series, entitled "Transforming Health Markets in Asia and Africa: Improving quality and access for the poor." The book documents the problems associated with unregulated health markets and presents innovative approaches to address these issues. In addition to Peters’ Introduction and Conclusion, several Hopkins faculty and alumni authored chapters:

Drug Detailers and the Pharmaceutical Market in Bangladesh. Assistant Scientist M. Hafizur Rahman and Smisha Agarwal

Evidence of the Effects of Market-Based Innovations and International Initiatives to Improve the Performance of Private Providers.  Claire Champion, DrPH ‘11, Gerald Bloom and Professor David Peters

The Economics of Social Franchising for Health in Low and Middle Income Countries. Professor David Bishai and Claire Champion, DrPH ‘11

Teaching Health Systems Research

The field of health systems research is still in its early stages of development. Not surprisingly, methods and approaches for teaching it continue to evolve. During the Beijing conference, Professor David Peters chaired a session entitled "Teaching health policy and systems research: current approaches and challenges." Faculty from institutions across the globe presented their experiences and discussed issues around developing key competencies and learning objectives. Assistant Professor Asha George represented Hopkins faculty, and other participants included instructors from the Karolinska Institutet, London School of Hygiene and Tropical Medicine, Makerere University College of Health Sciences, Peking University, and University of Cape Town.

The session was one of the most popular, with about 200 people in attendance. One of the session highlights was the video feedback from students who took the new Hopkins course: Health Systems Research and Evaluation in Developing Countries. Assistant Professor George and Assistant Scientist Shivam Gupta developed and taught the course last year, and will be co-instructors again in the 4th term of 2013. Several students from the DrPH, PhD and MSPH programs recorded their experiences from the course. Their comments and suggestions are available on the Department’s YouTube channel.

Continued Leadership in the Field

While the next Global Symposium on Health Systems Research is not for another 2 years, Hopkins faculty will remain actively engaged in this exciting research community. One example is the election of Associate Professor Sara Bennett as the first Vice Chair of the Board for Health Systems Global. As the first international membership organization fully dedicated to promoting health systems research and knowledge translation, it will play an important role in setting the global research agenda. The group evolved from a working group formed during the first Global Symposium in 2010. Its goals are to strengthen and coalesce the international community of health systems research, facilitate debate on key health systems research issues, and advocate for increased health systems research funding and utilization. As part of the group’s mandate, it will also be in charge of organizing the next Health Systems Research Symposium in 2014.