Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

GHF2014 – PS32 – Local Food for All or How to Create Sustainability through Local Mobilization

Local Food for All or How to Create Sustainability through Local Mobilization
Dr. Claire Somerville
Visiting Lecturer, Interdisciplinary Programmes, the Graduate Institute of International and Development Studies, Switzerland
Mrs. Pam Warhurst
Founder and Chair, Incredible Edible Tordmorden, United Kingdom
Mr. Basile Barbey
Projact Manager, Equiterre, Switzerland
Dr. Mira Shiva
Navdanya Board & Health Advisor, India
Mr. John Kariuki Mwangi
Coordinator of Slow Food Kenya, Member of the Steering Board of the Slow Food Foundation for Biodiversity, Kenya

claire somervilleDr. Claire Somerville

Dr Somerville is an independent research consultant in health, development and technology working in collaboration with international organisations and industry/business partners. Previous appointments have been as Senior Social Scientist at the Technology Research for Independent Living (TRIL) Centre at Trinity College Dublin, Research Fellow at the Cente for Primary Care and Public Health at Barts and the London, Queen Mary University London, and lecturer at the University of Newcastle, Australia. She has a PhD from the University of Cambridge, and a Master's degree in Medical Anthropology from the School of Oriental and African Studies (SOAS).

PL05_Pam_WarhurstMrs. Pam Warhurst

Pam Warhurst is a British community leader, activist and environment worker best known for co-founding the community initiative, Incredible Edible, in Todmorden, West Yorkshire.

Pam studied Economics at the University of Manchester. She has previously served as a member of the Board of Natural England, where she was the lead non-executive board member working on the Countryside & Rights of Way Bill. She is a Fellow of the Royal Society of Arts & Manufacturing, and chairs Pennine Prospects, a regeneration company for the South Pennines, and Incredible Edible Todmorden, a local food partnership. Pam has also been Deputy Chair and Acting Chair of the Countryside Agency, leader of Calderdale Council, a board member of Yorkshire Forward, and chair of the National Countryside Access Forum and Calderdale NHS Trust. Pam was awarded Commander of the Order of the British Empire award (CBE) in 2005 for services to the environment.

MiraShiva200x150Dr. Mira Shiva

Dr. Mira Shiva is a physician and health activist (MBBS, MD Medicine, Christian Medical College, Ludhiana, India). She has been working on issues related to public health, women’s health, reproductive health & gender concerns, women ecology & health, food & nutritional security, health rights rooted in social justice & gender justice.

She is the Coordinator, Initiative for Health & Equity in Society/Third World Network, Founder Member & Steering Committee member of Diverse Women for Diversity, Peoples’ Health Movement, Health Action International-Asia Pacific, South Asian Focal Point-International Peoples’ Health Council.

She is member working Group Regulation of Food & Drugs by Planning Commission for 12th 5 year plan.She was member Central Council for Health, and  Chairperson of the Consumer Education Taskforce on Safety of Food & Medicine, Ministry of Health. She has been Member Health Committee National Human Rights Commission, Member, Central Social Welfare Board, Member-Advisory Committee, Gender and Communication Programme for Vigyan Prasar-Department of Science and Technology.

She was Director-Women & Health, Rational Drug Policy Head Public Policy in VHAI, Founder Coordinator All India Drug Action Network. She is steering Committee Member of Indian alliance of Child Righs & National alliance for Maternal Health & Human Rights, Right To Food Campaign, Doctors for Food & Biosafety.

She was involved in relief work following the Bhopal gas Tragedy 1984, was member of Supreme Court of India and member of the Commission that  investigated the causes of a cholera outbreak trans Jamuna, part of Delhi in 1988.

John_KariukiMr. John Kariuki Mwangi

John Kariuki Mwangi is the coordinator of Slow Food activities in Kenya. He was born in 1987, in Molo, Kenya. His years of professional experience includes representing the Youth and Africa at Slow Food International, administration and coordination of development projects in sustainable agriculture, education and socio-cultural sector with the aim of preserving food biodiversity, sustainable food production systems and cultural identities of local communities. He earned his under graduate degree in gastronomic sciences at the University of Gastronomic Sciences in Pollenzo, Italy. John is currently pursuing his Master’s degree in sociology (Community Development and Project Management) at Egerton University, Kenya.

John served as a Slow Food International Vice President from 2007 to 2012. He is currently a member of Slow Food International councilor (representing East, Central and the Horn of Africa) and Slow Food Foundation for Biodiversity Board of Directors. He has actively participated in development of Slow Food Youth Network and Slow Food in Kenya. John has also written several articles that have been published on the Slow Food website, books and other magazines.

He considers studying at the University of Gastronomic Sciences and being involved in Slow Food activities as transformational. It has improved his understanding of the complexity of the world and the centrality of food to all cultures and has opened his eyes to the integral role that small-scale farmers play in feeding the world.

Basile Barbey_squareMr. Basile Barbey

Basile Barbey is a swiss geographer, currently working for the swiss NGO equiterre – Partenaire pour le développement durable since 2009.

equiterre is active in sustainable development and health promotion and Basile has worked on several projects in these two fields, such as sustainable neighbourhoods and public space accessibility.

Like many of his colleagues, Basile is now working on what we call in French “Potagers urbains” and that we can translate as urban vegetable gardens. These are spaces for people to garden ecologically close to their living place on small plots (generally from 5m2 to 30m2). equiterre believes this project is meaningful and an excellent example of sustainability principles applied to a project. Urban vegetable gardens bring indeed many benefits such as ecological gardening, social interaction and friendship building, open air physical activity, change in the eating habits and a way to save some money.


GHF2014 – LS02 – Evidence Informed Decision Making in Achieving UHC: the Role of Macro HTA

Evidence Informed Decision Making in Achieving UHC:
the Role of Macro HTA

Dr. Nick Drager
Honorary Professor, Senior Fellow, Global Health Programme, The Graduate Institute, Geneva
Mr. Adrian Griffin
Vice President, HTA Policy, Johnson & Johnson
Dr. Franz Pichler
Director, Global Public Policy, Eli Lilly and Company
Dr. John-Arne Røttingen
Norwegian Knowledge Centre for the Health Services
Dr. Eva Maria Ruiz de Castilla
Executive Director, Esperantra (NPO, Peru)

As a number of countries aspire to implement universal health coverage frameworks, many are looking at methods to best structure their health system to ensure citizens obtain the health services they need. Given cost constrained environments, many low and middle income countries have increasingly focused efforts on prioritization and determining value for investments in health. As such, a significant focus has turned towards the use of research evidence as a tool to support decision making. However, historically, this type of evidence has rarely been applied to support overall health system decision making. In the context of developed countries, a narrow interpretation has placed a significant emphasis on decisions related to coverage and reimbursement of healthcare technologies, such as medicines and diagnostics. 1 Healthcare technologies are only one of several inputs in the overall health system. The organization and delivery of a health care system is a complex matter, which requires a number of decisions regarding the resources necessary to ensure access to services, the mix of interventions required and the means to achieve optimal results.2 Limiting evidence based decision making to coverage decisions tends to obscure the potential role to apply to the overall health system as a whole, such as interventions that facilitate access, service delivery, and aim to improve quality of care.

Therefore, as countries embark towards universal health coverage, it is important that decisions related to coverage of health products and benefits packages are only one part of the discussion. Many low and middle income countries have extensive inefficiencies in their health systems, including issues related to service delivery, quality of care and treatment standards that transcend the need to focus specifically on coverage of health technologies to determine value for investments in health.

This session will explore the role of evidence informed decision making in achieving universal health coverage, looking specifically at the role of "macro" HTA as it is applied to overall health system efficiency and quality of care. This unique session will provide the audience with a view of different perspectives from various sectors in the healthcare space - patient, industry, academic and payer/NGO. Through live interaction, the audience will be able to participate and provide thought provoking questions/answers amongst the group to explore this innovative topic.


Nick Drager M.D., Ph.D
Honorary Professor, Senior Fellow, Global Health Programme, The Graduate Institute, Geneva

Former Director of the Department of Ethics, Equity, Trade and Human Rights and Senior Adviser in the Strategy Unit, Office of the Director-General at the World Health Organization- now is Honorary Professor, Global Health Policy, London School of Hygiene & Tropical Medicine; Professor of Practice, Public Policy and Global Health Diplomacy, McGill University; Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa; Adjunct Research Professor, Norman Paterson School of International Affairs, Ottawa; and Senior Fellow, Global Health Programme, The Graduate Institute, Geneva.

  • Work focuses on current and emerging issues related to global health, in the areas of global health security/diplomacy/governance, foreign policy and international trade and health including intellectual property and health.
  • Extensive experience working with senior officials in over 100 countries and major multilateral and bilateral development agencies in health policy development, health sector analysis, strategic planning and resource mobilization and allocation decisions and in providing strategic advice on health development negotiations and in conflict resolution.
  • Deep experience in global health diplomacy and high-level negotiations on international health security and development issues.
  • Represented WHO, serves as chair, keynote speaker at major international events and conferences; lectures and teaches at Universities in Europe, North America and Asia.
  • Editor/author of books, papers and editorials in the area of global health; global health diplomacy; trade and health including IP; foreign policy and health. Has an M.D. from McGill University and a Ph.D. in Economics from Hautes Etudes Internationales, (the Graduate Institute) University of Geneva.


AdrianGriffinAdrian Griffin
Vice President, HTA Policy, Johnson & Johnson

Adrian Griffin is Vice President, HTA & Market Access Policy at Johnson & Johnson.  He has been involved in the fields of health economics, outcomes research, and reimbursement policy within the healthcare industry for 16 years, with experience across the pharmaceutical, medical device, and diagnostic sectors.

Mr Griffin graduated in Medicinal Chemistry from University College London, obtained a post-graduate teaching qualification from Oxford University, and spent several years teaching chemistry before joining the UK’s Medical Research Council.  He then received his MSc in Health Economics at City University, London, before joining the healthcare industry.  Mr Griffin has held positions at GlaxoSmithKline, Pharmacia, and most recently Johnson & Johnson, where he has been since 2003.

In addition to undertaking outcomes research from the industry perspective, Mr Griffin has also served as a ‘decision-maker’, on the NICE Technology Appraisal Committee, where he has been a committee member for 10 years.  Mr Griffin is also active in numerous multi-stakeholder forums where key issues of HTA and access policy are debated and shaped, such as the HTAi Policy Forum, and initiatives that have brought regulators and HTA agencies together with companies, thus improving transparency and appreciation of different stakeholder perspectives.

Mr Griffin has contributed to several UK industry-government task-force and working groups, aimed at developing policy and processes to improve equitable access and uptake for patients to new innovations.

Within Europe, Mr Griffin has engaged through Company and Industry Association activities with EUnetHTA, with the aim of ensuring that what comes out of HTA collaboration across Europe is fit for purpose, with the ultimate aim of improving healthcare for patients.

Mr Griffin is currently on the Board of Directors of ISPOR, (the International Society for Pharmacoeconomics and Outcomes Research), and continues in his position as a member of the NICE Technology Appraisals Committee


Franz_Pichler2Franz Pichler, PhD
Director, Global Public Policy, Eli Lilly and Company

Franz Pichler has been Director, Global Public Policy at Eli Lilly and Company since 2012. This role encompasses development of external policy positions; provision of strategic advice; and external engagement around policy-related issues. A key focus of the role relates to the European environment, in particular with regards to Health Technology Assessment (HTA) and market access. He represents Lilly on the EuropaBio HTA and Market Access Group and the EFPIA HTA Task Force Steering Committee. He participates in the EUnetHTA Stakeholder Advisory Groups related to relative effectiveness assessment and methodological guidelines development. He is co-chair of the Medicines Adaptive Pathways to Patients initiative and is a participant of the Innovative Medicines Initiative (IMI) project ‘Incorporating real-life clinical data into drug development’ (GetREAL). He was a founding member of the HTAi interest sub group on HTA-Regulatory Interactions which he currently chairs. Franz joined Lilly after serving as the manager of the HTA Programme at the Centre for Innovation in Regulatory Science (CIRS) – a non-profit, independent medicines policy and research think tank. Prior to joining CIRS, Franz worked for over 10 years in molecular biology with specialties in functional genomics, population genetics and bioinformatics. He obtained his BSC in biology and PhD in population genetics at the University of Auckland in 1997 and 2002 respectively.


John_Arne_Rottingen_squareDr. John-Arne Røttingen
Norwegian Knowledge Centre for the Health Services

John-Arne Røttingen is Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health; Professor of Health Policy at the Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo; Visiting Professor at the Department of Global Health and Population, Harvard School of Public Health; and Institute Visiting Scholar at the Harvard Global Health Institute.

He is Associate Fellow at the Centre on Global Health Security, Chatham House; research associate of the European Observatory on Health Systems and Policies; Chair of the Board of the Alliance for Health Policy and Systems Research; member of the Scientific Oversight Group of the Institute for Health Metrics and Evaluation, University of Washington, Seattle; and member of the International Advisory Committee for the Global Burden of Disease study.

He has been Director General of the Norwegian Knowledge Centre for the Health Services; Oxford Scholar at Wadham College; and Fulbright Fellow at Harvard Kennedy School.

He received his MD and PhD from the University of Oslo, an MSc from Oxford University and an MPA from Harvard University.


EvaMaria_Ruiz_de_CastillaEva Maria Ruiz de Castilla, PhD
Executive Director, Esperantra (NPO, Peru)

Dr. Eva Maria Ruiz de Castilla is a co-founder and since 2006 Executive Director of ESPERANTRA, a not-for-profit cancer and chronic disease patient advocacy organization in Lima, Peru. Her work at Esperantra is to improve the quality of life of patients with chronic conditions, health promotion, and to advance the recognition of the rights of patients to achieve access to timely diagnosis, treatment, and follow-up care. She has been instrumental in a number of national initiatives focused on cancer, including the government’s Plan Esperanza launched in 2012 to provide basic cancer care coverage for the poorest and most vulnerable Peruvians.

In addition to her work with Esperantra, Dr Ruiz de Castilla consults part-time for various Peruvian ministries, including Health, Social Development, Housing, Women, and Water-Sanitation to help design and coordinate the country’s public-sector social assistance programs. From 2011 to 2012, Dr Ruiz de Castilla was Director General of the Peruvian Ministry of Health’s (MINSA) International Coordination office and before that served as MINSA’s Director General of Health Prevention and Promotion. She has in-depth experience working with donor country agencies and multilateral organizations such as the World Bank.

As a Board Member of the International Alliance of Patients’ Organizations (IAPO) since 2010, Dr Ruiz de Castilla has been a global leader in patient-based organizational capacity building and has led various workshops on patient empowerment and networking. Her experience and involvement with building the capacity of civil society organizations focused on cancer in Peru earned her the American Cancer Society’s “Excelencia Latina 2009” Award. In 2011, Dr Ruiz de Castilla was named a Global Cancer Ambassador by the American Cancer Society, and was invited by the World Health Organization to participate as a civil society representative during the UN High-Level Meeting on non-communicable diseases (NCDs).

Dr Ruiz de Castilla’s academic credentials include degrees in Industrial Engineering and a PhD in Economic Development at the EHESS in Paris, France, and in Political Science at the Sorbonne University Paris 1. In Europe, she consulted for the United Nations on food and agriculture issues for the southern common market (MERCOSUR). Dr Ruiz de Castilla has authored a number of publications and papers on social development, health, and citizen engagement, and has been invited to speak at more than 200 national and international congresses.

GHF2014 – PL05 – Integrating Health, Wellbeing and Sustainability

Dr. Carlos Dora
Department of Public Health and Environment, World Health Organization, Switzerland
H.E. Ambassador Michael Gerber 
Ambassador and Special Representative for Global Sustainable Development Post-2015, Swiss Agency for Development and Cooperation (SDC), Switzerland
Mrs. Pam Warhurst 
Founder and Chair, Incredible Edible Tordmorden, United Kingdom
Mrs. Meenakshi Raman
Third World Network, Malaysia
Mr. Rick Bell
Executive Director, American Institute of Architects New York Chapter, Center for Architecture, United States
Discuss how to better integrate the three dimensions of sustainable development and embed health into the post 2015 new development agenda.
The Millennium Declaration adopted by the heads of State at the Millennium Summit in 2000 has constituted the dominant development paradigm and organizing framework of the last decade. The Millenium Development Goals have substantially contributed to focus development co-operation efforts, strengthened the accountability requirement and mobilized support. With the Millennium Development Goals scheduled to come to an end in 2015, the international community is now taking stock of the substantial advances made as well as the unevenness and gaps in achievement. As we approach the 2015 deadline, unrelenting efforts are required to accelerate progress across all the goals but debates and global consultations about what will replace the MDGs have already taken place. In June  2012, on  the  occasion of the Rio+20 Conference on  Sustainable Development, another mandate  with  similar  aspirations  was  born:  the  Sustainable  Development  Goals  (SDGs). Whilst the MDGs primarily focused on social issues such as poverty, hunger, health and education in developing countries, SDGs will seek to strike a balance between all three dimensions of sustainable development, namely the economic, environmental and the social, and will be applicable for all countries.Health as a component of social progress is a key aspect of the debates, and is being framed as a precondition for, an outcome and a possible indicator of sustainable development.The position health might take into this new framework is still subject to various narrative exercises and a lot of uncertainty still remains of what will be the next development framework by 2015.Moving away from global statements and declarations, the session will convey a diverse panel of actors involved in development, urban planning and community mobilization to discuss the enabling environment needed at a global and local level to build healthier societies and preserve our environment.Some of the questions to be discussed include:

  • What kind of systemic global reforms would be required to secure an accommodating international environment for sustainable development in both developed and developing countries?
  • How can health serve as an indicator to measure sustainable development policies progress, achievement and impact?
  • How can local communities, people’s movements and citizens contribute in shaping healthier and more inclusive societies/cities?
  • How can urban design influence behavioral changes and promote healthy living?

Carlos Dora_squareDr. Carlos Dora

Carlos Dora, is a coordinator at the WHO HQ Public Health and Environment Department, leading work on health impacts of sector policies (energy, transport, housing and extractive industry), health impact assessment and co-benefits from green economy/climate change policies. He previously worked at the London School of Hygiene and Tropical Medicine (LSHTM), at the WHO Regional Office for Europe, at the World Bank, and with primary care systems in Brazil after practicing medicine. He serves in many science and policy committees, has an MSc and PhD from the LSHTM.  His publications cover health impact of sector and sustainable development policies, HIA and health risk communication.


Michael Gerber Jan. 2013H.E. Ambassador Michael Gerber

Perspective: Switzerland’s position on the new Sustainable Development Framework

Member of the Swiss Agency for Development and Cooperation (SDC), Mr Gerber was the Head of the SDC Analysis and Policy Section before being appointed Special Representative for Global Sustainable Development Post-2015 by the Federal Council with the rank of ambassador. In this position, he has been given the task of formulating Switzerland’s position on a Framework for Sustainable Development Post-2015 . Ambassador Gerber is also representing Switzerland in the Open Working Group on SDGs (Switzerland shares with France and Germany).


PL05_Pam_WarhurstMrs. Pam Warhurst

Perspective: How to empower ordinary people to take control of their communities through active civic engagement.

Pam Warhurst is a British community leader, activist and environment worker best known for co-founding the community initiative, Incredible Edible, in Todmorden, West Yorkshire.

Pam studied Economics at the University of Manchester. She has previously served as a member of the Board of Natural England, where she was the lead non-executive board member working on the Countryside & Rights of Way Bill. She is a Fellow of the Royal Society of Arts & Manufacturing, and chairs Pennine Prospects, a regeneration company for the South Pennines, and Incredible Edible Todmorden, a local food partnership. Pam has also been Deputy Chair and Acting Chair of the Countryside Agency, leader of Calderdale Council, a board member of Yorkshire Forward, and chair of the National Countryside Access Forum and Calderdale NHS Trust. Pam was awarded Commander of the Order of the British Empire award (CBE) in 2005 for services to the environment.

PL05_Meenakshi_Raman_squareMrs. Meenakshi Raman

Perspective: How to tackle the growing environment crises factoring international equity in the equation?

Mrs Raman is Legal Advisor and Senior Researcher at Third World Network (TWN) and is based in Geneva. She is also a Member of the Board of Friends of the Earth International and Honorary Secretary to Friends of the Earth Malaysia (Sahabat Alam). As Legal Advisor to the Consumers’ Association of Penang in Malaysia, she currently heads its Community Mobilization Section, which works with farmers and fisher folk. She has served as Chair of Friends of the Earth International (2004-2008), an international organization with 77 member groups. At Third World Network, Meenakshi currently coordinates the Climate Change Programme and has actively been involved in the intergovernmental climate negotiations, from Bali to Cancun. She has been monitoring and reporting on the negotiations and providing analysis and support both to developing country governments as well as to civil society participants. Upon graduation in 1982, Meenakshi and a colleague set up the first public interest law firm in Malaysia, which launched her legal practice assisting consumers. In the past 25 years, she has represented the organizations she works with at numerous conferences and presented papers on issues ranging from environmental and consumer protection, to climate change, agriculture and fisheries, and globalization and trade.

PS25_Rick Bell_squareMr. Rick Bell

I became an architect because of the inspirational oratory of professors including Vincent Scully and the physical example of buildings seen while attempting, at the age of 19, to hitchhike from Paris to Dakar. As an architect I've had three careers, first in the private sector, then at a public agency, and, most recently, in the not-for-profit domain. As a private architect, I mostly designed schools and libraries in a NYC-based firm that also did hotel projects worldwide. In the public sector, I served as chief architect and assistant commissioner of New York City’s public works department, responsible for 700 projects annually. And for the last twelve years I’ve led the New York Chapter of the American Institute of Architects and created its storefront Center for Architecture.

GHF2014 – PS27 – Health as an Indicator of Sustainable Development: How Health Can Contribute to and Benefit from Sustainable Policies

Health as an Indicator of Sustainable Development: How Health Can Contribute to and Benefit from Sustainable Policies
Dr. Carlos Dora
Department of Public Health and Environment, World Health Organization, Switzerland
Prof. Ilona Kickbush
Director, Global Health Programme, The Graduate Institute of International and Development Studies, Switzerland
Health as an Indicator of Sustainable Development: How Health Can Contribute to and Benefit from Sustainable Policies
Ms. Natalie Mrak
Student, Masters of Development Studies, The Graduate Institute for International and Development Studies, Switzerland
Mr. Callum Brindley
Student, Masters of Development Studies, The Graduate Institute for International and Development Studies, Switzerland
Dr. Ralph Chapman, Environmental Studies Director, Victoria University, Wellington, New Zealand
Dr. Philippa Howden-Chapman, Professor of Public Health, University of Otago, and Director of the New Zealand Centre for Sustainable Cities, New Zealand
This session will begin with a comprehensive overview of the expansive literature, encompassing more than 20 years, on how health indicators can serve as measures of sustainable development and the presentation of a tool that has been developed which essentially combines all of this literature on indicators into one space. This will then set the stage for discussion on how this literature can essentially be placed into action. The session will entail perspectives from local, national and global levels as well as academic circles in order to provide a more comprehensive overview of the progress that has been made in incorporating health into sustainable development objectives as well as the challenges and the bottlenecks which still remain. The aim is to stimulate creative thinking and discussion around innovative ways through which health can become more embedded in the sustainable development agenda.This discussion is crucial particularly as the post-2015 development agenda talks continue. While the first set of Millennium Development Goals (MDGs) were a momentous endeavor to tackle crucial issues affecting the most vulnerable, they did not provide a comprehensive and integrated approach to tackling these challenges. Health was a dominant theme in the first set of MDGs, composing 3 of 8 goals but as 2015 approaches it is apparent that these goals do not comprehensively address the major health challenges of the 21st century for both developed and developing countries alike. While barriers to overcoming communicable diseases, maternal and child health still exist, issues such as tropical diseases (NTDs) and non-communicable diseases (NCDs) are posing challenges to existing approaches to health. A horizontal integrative approach is crucial to overcoming these new health challenges. For instance, good water and sanitation could prevent the infection from the majority of  NTDs while changes in daily routines, such as the substitution of motor transport for public or active transport, could reduce the incidence of NCDs.While recent literature has called for the inclusion of health in the post-2015 sustainable development agenda, there has not been a substantial discussion on how it could fit into this agenda and what exactly this health goal would look like as well as its feasibility at all levels of government from global to national to local.

Carlos Dora_squareDr. Carlos Dora

Carlos Dora, is a coordinator at the WHO HQ Public Health and Environment Department, leading work on health impacts of sector policies (energy, transport, housing and extractive industry), health impact assessment and co-benefits from green economy/climate change policies. He previously worked at the London School of Hygiene and Tropical Medicine (LSHTM), at the WHO Regional Office for Europe, at the World Bank, and with primary care systems in Brazil after practicing medicine. He serves in many science and policy committees, has an MSc and PhD from the LSHTM.  His publications cover health impact of sector and sustainable development policies, HIA and health risk communication.

Ilona KickbushProf. Ilona Kickbush

Ilona Kickbusch is the Director of the Global Health Programme at the Graduate Institute of International and Development Studies, Geneva. She advises organisations, government agencies and the private sector on policies and strategies to promote health at the national, European and international level. She has published widely and is a member of a number of advisory boards in both the academic and the health policy arena. She has received many awards and served as the Adelaide Thinker in Residence at the invitation of the Premier of South Australia. She has recently launched a think-tank initiative “Global Health Europe: A Platform for European Engagement in Global Health” and the “Consortium for Global Health Diplomacy”.

Her key areas of interest are global health governance, global health diplomacy, health in all policies, the health society and health literacy. She has had a distinguished career with the World Health Organization, at both the regional and global level, where she initiated the Ottawa Charter for Health Promotion and a range of “settings projects” including Healthy Cities. From 1998 – 2003 she joined Yale University as the head of the global health division, where she contributed to shaping the field of global health and headed a major Fulbright programme. She is a political scientist with a PhD from the University of Konstanz, Germany.

PS27_Natalie_MrakMs. Natalie Mrak

Natalie   Mrak is a Global  Health  Project Coordinator with the Access to Health (A2H) team. In  parallel, she is also pursuing a Master´s in Development Studies, with a concentration on Human, Financial and Economic Development, at the Graduate Institute for International and  Development Studies (IHEID).  At  the  Institute,  she  is  focusing  on  global health issues. including  health  and  sustainable  development  as  well  as  the role of emerging  economies  in  global  health  governance and diplomacy. While in Geneva,   Natalie   has   interned  for  Otsuka  Pharmaceuticals  in  their communications  division  and in the community mobilization unit at UNAIDS. Prior  to  her  arrival in Geneva, Natalie worked at UNICEF headquarters in New York for 4 years as the Executive Assistant to the Chief of the HIV and AIDS  programme. In addition, she has a Master´s in International Relations from  the  City College of the City University of New York (CCNY) where she focused  on  gender  and  development  issues  in  Eastern  Europe. Natalie received  her  Bachelor´s  degree  from Kenyon College where she received a dual degree in History, with honors distinction, and Spanish Studies as well as Magna Cum Laude and Phi Beta Kappa honors.

PS27_Callum_BrindleyMr. Callum Brindley

Callum Brindley is studying a Masters of Development Studies at the Graduate Institute for International and Development Studies in Geneva. He is also a part-time researcher with the Global Health Programme and has co-authored two WHO publications on Health in All Policies and health in the post-2015 development agenda. Prior to his post-graduate studies, Callum worked for three years with the Australian Agency for International Development.

Ralph Chapman (aug06) VUW photoDr. Ralph Chapman

Ralph directs the Graduate Programme in Environmental Studies at Victoria University. An environmental economist, he’s worked on energy, transport, urban design and climate change. He’s also worked with the New Zealand Ministry for the Environment, the NZ Treasury; the British Treasury in Whitehall; the OECD, in the Beehive, and as a negotiator for New Zealand of the Kyoto Protocol. Ralph has a first in engineering, a Masters in public policy, and a PhD in economics.

GHF2014 – PL01 – Integrated Care, Empowered People

Dr. Nick Goodwin
PhD, Chief Executive Officer, International Foundation for Integrated Care, United Kingdom
Mrs. Alice Njoroge
Managing Director, Eastern Deanery AIDS & Relief Program, Kenya
Dr. Joachim Stumberg
Associate Professor of General Practice, Department of General Practice, The Newcastle University, Australia
Mr. Bertrand Levrat
Chief Executive Officer, Geneva University Hospitals, Switzerland
Prof. Nicolas Fernandez
Assistant Professor, Center for Pedagogy Applied to Health Sciences (CPASS), Faculty of Medicine, University of Montréal, Canada
This plenary debate seeks to define the meaning and logic of ‘integrated care’ from the service users’ perspective. In particular, the panel will examine what it means to deliver more ‘patient-centered and co-ordinated care’ to people and communities and why this should be seen as an important design principle for health care systems.
Integrated care is a term that has come into common usage, yet people struggle to agree with what integrated care means and particularly how it can be applied. At its most basic, integrated care is a simple idea – combining different parts of the care system in order to optimize care and treatment to people where fragmentations in care have led to a negative impact on their care experiences and outcomes. Integrated care, therefore, is by definition ‘people centered’ since its core principle is to better co-ordinate care around people’s needs.The principles of integrated care from the person’s perspective therefore should:

  • seek to combines a range of care strategies that involve users and communities in the design of care programmes ;
  • create partnerships between people and professionals so that there is ‘co-production’ of health ;
  • support people to have the autonomy to make their own choices over care and treatment option ;
  • ensure that care is well co-ordinated around people’s needs by a team of care providers who communicate with each other to achieve more integrated service provision ; and
  • enable people to feel self-empowered.

Some of the questions to be discussed by the panel in this plenary include:

  • What do we mean by integrated care?
  • Is there a difference between the goals of integrated care from the person’s perspective compared with a systems perspective?
  • Why should integrated care be regarded as an important design principle for the future of health care systems?
  • What do we mean by person-centered care?
  • What are the benefits to be gained from better involving and empowering people and communities?
  • How can people and communities be better involved and empowered in making decisions about how care should be provided to them?

How can the ability of people to self-manage their own health be encouraged?


Nick_Goodwin1Dr Nick Goodwin, PhD

CEO, International Foundation for Integrated Care

Nick is a social scientist, academic and policy analyst with a specialist interest in investigating the organisation and management of primary, community and integrated care. Nick is co-Founder and CEO of the International Foundation for Integrated Care (IFIC), a not-for-profit membership-based foundation dedicated to improving the science knowledge and application of integrate care across the World ( and is Editor-in-Chief of its scientific periodical the International Journal of Integrated Care ( Nick also works as a Senior Associate at The King’s Fund, London supporting its programme of research and analysis for improving and integrating care to older people and those with long-term conditions (LTCs).

In addition to his role in leading and developing the various work programmes at IFIC, Nick continues to be very active in research, development and support for integrated care at both a political and practical level. Nick’s current portfolio of work includes UK, US and European-based research and development studies examining the impact and deployment of integrated care to people with complex and long-term health problems.  Nick continues to work with the UK government to support its policies on integrated care, including the evaluation of its Health and Social Care Integration Pioneer Programme and the Commission on Whole-Person Care. Nick’s international commitments include the EU FP7 Project INTEGRATE ( and the European Innovation Partnership on Active and Healthy Ageing. Nick is working with the World Health Organisation to support the development of a Global Strategy to develop person-centred and integrated care, and is on the Expert Advisory Team to WHO Regional Office for Europe’s Framework for Action Towards Coordinated/Integrated Health Services Delivery (CIHSD).


Nicolas_FernandezProfessor Nicolas Fernandez

Nicolas Fernandez is Professor of the Faculty of Educational Sciences of the Université du Québec à Montréal (UQAM) and Associate Professor at the Center for Applied Pedagogy in the Health Sciences (CAPHS) of the Faculty of Medicine at the Université de Montréal. Recipient of a transplanted kidney in 2008, Nicolas learned to manage his dialysis treatments, both peritoneal and hemodialysis, over a period of eight years. This life transforming experience, combined with his academic career in educational research and teaching, allowed Nicolas to develop unique insights into self-management of chronic illness as well as into development of patient self-efficacy. His doctoral thesis was completed in large part during treatment sessions in the dialysis unit of his local hospital.

Nicolas has published in the field of higher education and cognitive science as well as in the field of group development and collaboration. Since 2010, Nicolas has been active in the Direction of Collaboration and Patient Partnership of the CAPHS and contributes regularly to initiatives aimed at integrating patient perspective into training of health professionals and organizational change in clinical settings.

A quote from Prof. Fernandez:

‘The transformative power of illness hinges on the answer to a simple question: can I live with it or not? If the answer is no, then you are nearer to death. If the answer is yes, you are not farther from death, but a lot closer to life.’ 


Joachim_SturmbergDr. Joachim Sturmberg is Conjoint A/Prof of General Practice in the Department of General Practice, The Newcastle University, Newcastle, Australia. He graduated from Lübeck Medical School, Germany, where I also completed his PhD. Since 1989 he works in an urban group practice on the NSW Central Coast, with a particular interest in the ongoing patient-centred care of patients with chronic disease and the elderly. In 1994 he started to pursue systems and complexity research with an inquiry into the effects of continuity of care on the care processes and outcomes. Since then, his research has expanded and includes the areas of understanding the complex notion of health, health care and healthcare reform, showing that health is an interconnected multi-dimensional construct encompassing somatic, psychological, social and semiotic or sense-making domains, that health care has to embrace the patient’s understanding of her health as the basis for effective and efficient care, and that an effective and efficient healthcare system ought to put the patient at the centre. He has published extensively on these topics. He is joint chief editor of the Handbook of Systems and Complexity in Health, and joint chief editor of the Forum on Systems and Complexity in Medicine and Healthcare which appears in the Journal of Evaluation in Clinical Practice. Together with Carmel Martin and Jim Price he chairs the Complexity Special Interest Group (SIG) in the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians WONCA.


23.07.2013_Bertrand Levrat, 23.07.2013_Bertrand LevratMr. Bertrand Levrat

Chief Executive Officer , Geneva University Hospitals, Switzerland

Bertrand Levrat is an « engaged humanist ». Lawer by training, he has successively worked for seven years at the International Committee of the Red Cross on field missions as delegate, chief of under-delegation, legal advisor for Asia and Latin America and representative of the ICRC at the United Nations in New York.

Since returning to Geneva in 2001, he has continued to be committed to helping vulnerable persons during three years as deputy director for social affairs.  He was in charge of policies for the disabled and substance dependence.

In 2004, he became Director General of the Hospice General, a Geneva institution with 1000 collaborators in charge of socially dependent persons and asylum seekers. During nine years he entirely reformed this institution.  Under his leadership, the Hospice Général recovered long term financial  balance and rigorous management, but what is essential to him is something else: “Most important to me was to make collaborators proud to work there”.

Appointed new Director General of the Geneva University Hospitals (HUG) in June 2013, he intends to respond to the challenges that face him as head of this major institution.


Alice_NjorogeMrs Alice Njoroge, Managing Director, Eastern Deanery AIDS & Relief Program, Kenya

Alice Njoroge is a Nurse Leader working in resource limited settings.  She is very passionate about high quality care for clients. To accomplish this she has learned over the years to be innovative and at the same time being very sensitive to proper utilization of resources allocated for various activities. She always strives to maintain high standards of care, as well as stretches available resources as far as possible.

The ESTHER European Alliance: a decade of hospital partnerships assessed

Author(s) MEZGER Nathalie1.
Affiliation(s) 1Service de Medecine Tropicale et Humnanitaire, Hôpital Cantonal Universitaire de Genève, Genève, Switzerland.
Country - ies of focus Switzerland
Relevant to the conference tracks Health Systems
Summary To evaluate a decade of activities, better define the current environment and its future, the ESTHER European Alliance, an initiative based on hospital/institutional partnerships with low resources countries, requested an external, qualitative assessment. Results showed that added value of these partnerships and of the EEA were well perceived. EEA seems in line with the current development cooperation landscape, helping to tackle the health human resources crisis and adapted to face the new health challenges. Nevertheless to better contribute and improve, there was a need to better demonstrate EEA's contribution to the health system strengthening and review its strategy.
Background The ESTHER Alliance (Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau - EEA), a French initiative composed currently by 12 European member states (France, Italy, Luxembourg, Spain Germany, Austria, Belgium, Portugal, Greece, Norway, Switzerland, Ireland) and 1 observer (UK), was launched in 2002 to strengthen, through hospital partnerships, the capacities of low income countries to face the HIV/AIDS emergency and related diseases. Each ESTHER national entity is different from each other, but all signed a ministerial declaration of engagement to develop the initiative and are linked by a joint charter of principles.
In 2012 the Alliance members were active in 41 countries and involved in a wide range of training activities including collaboration with civil society organisations. As the last 10 years has seen a change in the worlds health needs and cooperation landscapes, ESTHER evolved and broadened its scope, scale and type of activities to include other health priorities that contribute to meet the Millennium Development Goals 4-5-6 and strengthen health systems to improve health outcomes.
In 2013, an external study was ordered by the Alliance to qualitatively assess the achievements and challenges faced by the EEA over its decade of existence.
Objectives This external qualitative evaluation of the ESTHER initiative, at European and country implementation level, aimed to capture the EEA’s achievements and challenges, draw lessons and clarify the EEA position in the current, evolving, development cooperation and health landscape in order to better define its future. This work was made on request of the EEA.
It focused on identifying the added value of the institutional partnerships for health, on identifying and analyzing the added value that the Alliance brings as a European platform for development cooperation in health, identifying commonalities and challenges for Alliance member bilateral partnership programs, evaluating contributions that partners have made to Health Systems Strengthening (HSS) and presenting future option to move forward.
Methodology Capacity Development International won the EEA international tender after each ESTHER national entity ranked the different candidate’s proposals for this qualitative evaluation.
Two investigators ran it. In all stages of the assessment they included the priority countries that have an active bilateral program (France, Germany, Spain, Italy, Norway and Ireland). Switzerland, Luxembourg, Greece and UK were involved in the first stage of this evaluation. Belgium, Portugal and Austria did not participate.
An extensive review of documents and literature provided by the EEA secretariat, the national coordinating bodies and the technical implementing partners, was performed. It was completed by an international literature review guided by key informants related to development cooperation, health partnerships, capacity development, human resources for health and health system strengthening.
The first stage of interviews focused on the ESTHER model, its achievement, its added value, the challenge and future. They reached the EEA secretariat, 10 northern governments, 13 national coordinating bodies and 2 experts working in the institutional partnerships.
Best practice demonstrating projects were selected by the interviewed national coordinating bodies to be included for the second type of interviews, which focused on the added value of hospital partnerships. Enablers, challenges, lessons learned and contribution to health system strengthening were reviewed. Nine northern implementing partners, 11 southern implementing partners and 3 southern government representatives were interviewed.
Results were analyzed at 4 different levels (added value of institutional partnerships for health, EEA level, National Secretariat level and partnership/project (case studies and lessons learned)) using the OECD/DAC framework (relevance, efficiency, effectiveness, sustainability) to draw out the main themes. Results were synthesised in the perspective of current thinking and EEA objectives and guidelines. Case studies concretely illustrated the evaluation, highlighted innovations, lessons learned and challenges in contributing to HSS.
Limitations were due to the limited time and geographical constraints. Data objective verification was beyond the scope of the study. Best practice projects were selected by the national secretariat and may be subject to bias. Descriptions were dependent on the completeness of information provided.
Results The added value of institutional partnerships (IP) for health based on capacity building and sustainable improvement was clearly perceived. Benefits were: institutional strengthening, responsiveness to needs, ownership, long term building of trust and capacity, peer to peer multidisciplinary exchanges, solidarity, innovation, ability to fund unusual interventions for development cooperation, opportunities to learn how to manage in deprived conditions and cultural sensitivity. IP was felt to go well beyond traditional assistance which is centered on short term filling of capacity gaps and was considered to be a complement to the classical development cooperation.
If hospitals, often neglected in the development, should remain central to ESTHER, inclusion of other organizations or levels was valued.
Concerns expressed the IP potential contribution to the aid fragmentation/proliferation, unintended harms, the creation of pockets of excellence and their real capacity to strengthen the health system.
Recognition, objectification, better definition of the EEA contribution to the HSS were felt to be improved, as the conceptualization of the IP added value to the gaining of knowledge, evidence and ease and the conceptualisation of costs.
The EEA added value was recognized (networking, information sharing), but much of its potential is not fully realized (joint projects, joint working, coordination).
Political mandate and release of resources not straightforward. Weight given to EEA validation and mandate varies. Political commitment was sometimes seen as a mere weight to back-up “ESTHER”, an IP quality brand. Consequently the quest for external funds becomes vital. This would be eased by a better demonstration of the EEA added value beyond members’ programs. The ESTHER diversity, a wealthy fishpond cemented by valuable charter of principles, makes knowledge generation and joint work challenging. If key, knowledge management will have to be balanced as resources are restricted.
In the changing global health agenda ESTHER seems well adapted to address issues such as the non-communicable diseases or the horizontal and integrated approaches. By building capacity, contributing to medical education and continued professional development EEA clearly addresses the human resource crisis.
There is momentum to revisit the EEA vision, strategy and objectives to better adapt to the on-going changes in economy, health and development cooperation.
Conclusion This qualitative study outlines that the EEA, which is based among others on institutional/hospital partnerships, capacity building, local ownership, is needs driven, has long term involvement, respects the Paris Declaration (enshrined in its shared charter of principles), is well aligned with the current thinking and best practices in development cooperation for health. It especially helps in tackling the health human resources crisis.
These principles and ESTHER multidisciplinary identity are clearly of value in the post MDG landscape. Initially focused on the HIV/AIDS crisis, a thematic which was already broadened to include the MDG4-5-6, the EEA has the potential to evolve and contribute to the new emergent health themes.
Added values of IP and of the EEA are well perceived by members, even if it is felt that there is still unveiled potential. The perceived addition of the work in partnerships over other forms of technical cooperation and of the EEA is nevertheless difficult to measure and demonstrate. Creation of enabling, inspiring environments by partnerships does not fully guarantee results. Approaches that address knowledge and capacity gaps through empowerment, leadership by the beneficiary and use of country systems are quite recent and lack rigorous evaluation material to assess their impact. Therefore, efforts should be made to develop material and evaluate processes and projects, but in a light and bearable manner. This could contribute to developing evidence on how to make a quality partnership that brings added value, a matter in which the Alliance could play a role.
Worldwide, little agreement exists on the effective strategy to strengthen the health system, one of the ultimate EEA goals. Operational research could help to clarify how partnership work can contribute to HSS at different levels. The EEA projects/programs diversity is a rich field to work on. This will require the Alliance members to better define and share a common understanding of the HSS.
This knowledge generation would serve EEA to better demonstrate its impact/contribution and increase donors and key stakeholders’ interest. Balance between operational research, monitoring/evaluation and service delivery will have to be found, especially when resources are scarce.
To take advantage of this momentum, clarification and re-definition of the Alliance strategy and structural improvement seem to be needed. A motivating challenge !

Strengthening the competencies and skills of nurses in mental health: Experiences from Bosnia and Herzegovina

Author(s) Selma Kukic1, Zvjezdana Stjepanovic2.
Affiliation(s) Mental health, Mental health Project in BH, Sarajevo, Bosnia and Herzegovina, Mental Health, Mental Health Project in BH, Banja Luka, Bosnia and Herzegovina.
Country - ies of focus Bosnia and Herzegovina
Relevant to the conference tracks Health Workforce
Summary The mental health reform in BiH was launched in 1996 focusing on community-based care and so far has made significant progress in the development of a large network of community mental health centers. In the centers multidisciplinary teams operate, however nurses are the largest and least skilled professional category of professionals and have the highest fluctuation rate within health system. The reform project in BiH (Mental Health Project in Bosnia and Herzegovina) is focused on the informal education of nursing staff with the objective of professional development, empowering and providing networking as a first steps toward a systematic re-profiling of nurses in mental health.
What challenges does your project address and why is it of importance? In 2008/09 the survey "Situation analysis and assessment of community-based mental health services in Bosnia-Herzegovina“ (Mental Health in SEE Project 2009) was undertaken. The findings of the 2008/09 survey were used as the baseline for the Mental Health Project in BiH to monitor changes and improvements made with the project's support. A self-assessment of the middle-level nursing staff in this survey revealed that the staff believed they were under-trained. 46% of nurses believed they had not received enough training to work in a mental health centre, and the MHC team members believed that the work of the nursing staff was not recognised by other health professionals and that there were prejudices caused by vaguely defined job descriptions for the nursing staff working in a MHC team. A new concept of nursing, as well as the empowerment of nurses within the system of community mental health, requires well trained nurses, whose knowledge is closely linked to psychological, sociological, philosophical, educational, medical and expert training. This would improve the ability of nurses to assume new tasks. This can be achieved through formal education, non-formal education, continuing professional education, as well as initiative and creativity in the field of nursing.
How have you addressed these challenges? Do you see a solution? The adequate re-profiling of nurses in mental health is optimally achieved through formal education. This project presented informal education as the first step to a systematic aproach. Education has garnered excellent results in terms of narrowing the gap of professional training, but the benefits of education are more reflected in the development of contacts, exchange of experiences and formal networking of these professional groups that did not previously exist in the form of professional associations. The results indicate that associated advocacy for the development of nursing legislation on education and employment in mental health is required.
How do you know whether you have made a difference? The results of the performance evaluation of the Conducted Educations suggested key improvements in the work of this professional group. 96 % of respondents felt that the education contributed to providing quality services to patients and their families through individual or team work. Particular emphasis was upon the acquisition and use of new knowledge, skills and techniques in work (88%), the rights and obligations of medical professionals and patients (66%) and combating the stigma of mentally ill patients in society (32%). 90 % of respondents observed changes in the area of respect for the professional attitudes of mental health nurses by other team members. Particular emphasis was on the experience exchanges among colleagues (65%), the level of self- confidence in the process of presenting opinions to their superiors (64%) and an additional level of competence to work within a multidisciplinary team (53%). With continous collaboration with mental health staff in MHCs there is greater viability for the initiatives taken by nurses to process their difficulties in work.
Have you or the project mobilized others and if so, who, why and how? The key project holders and implementers were the Ministries of Health, and their key responsibility was to make the entire process a success by ensuring the participation of nursing stuff and relevant experts and key stakeholders in the implementation of activities, as well as to provide further support to the continuing education of nursing staff.
When your donor funding runs out how will your idea continue to live? Sustainability is ensured through cooperation with other projects whose main goal is to work on legislation that would provide a legal framework for the employment of nurses in mental health, including formal education, by providing needed information and support.

Impact of Voucher Scheme: Delivery Care Services in Rural Bangladesh.

Author(s) Forhana Noor1, Ubaidur Rob2.
Affiliation(s) 1Reproductive Health, Population Council, Dhaka, Bangladesh, 2Reproductive Health, Population Council, Dhaka, Bangladesh.
Country - ies of focus Bangladesh
Relevant to the conference tracks Women and Children
Summary This paper examined the impact of the intervention of a demand-side financing scheme on the utilization of services as well as out-of-pocket expenses incurred by women for availing of delivery care services. A quasi-experimental research design was conducted for this study. Findings reveal that there was a significant (p<0.0001) increase in the utilization of delivery care at public facilities in the intervention areas compared to the control areas. The average out-of-pocket cost or money required for a normal or caesarean delivery decreased over thirty percent over the time period. Demand-side financing had a positive effect on both utilization and cost.
Background In rural Bangladesh, around 71% of births take place at home. Home delivery is preferred as it is associated with low cost and delivery care at facilities are only considered for emergency obstetric care (EmOC). Bangladesh is predominantly a rural, low income country with a vast majority of its people living in poverty. The utilization of skilled attendants at delivery was almost three times less in rural areas compared to urban areas and also it is seven times less among the poorest (9%) compared to the richer (63%) households. Borrowing, using household savings, and financial assistance from relatives were also found to be important sources in paying for the delivery care.
In the health sector of Bangladesh, the primary source of finance is out of pocket (OOP) expenditure and it is primarily spent in the private sector. Here 64% of total health care expenditure is paid by individuals and the rest by the government. In many situations, OOP payments for health care can cause households to incur catastrophic expenditures, which in turn can push them into poverty. Bangladesh has one of the highest rates of catastrophic illnesses which drives 3.8% of the population into poverty every year.
Objectives To address this equity issue, the Government of Bangladesh piloted a demand-side financing (DSF) scheme (popularly known as the maternal health voucher program) in 21 upazilas (sub-districts) from 2006 and expanded to 33 upazilas in 2007. The selected poor women under DSF scheme receive a package of essential maternal health care services, as well as treatment of pregnancy and delivery related complications. This program also provides supply side financing to service providers. This program has been expanded to another 11 upazilas in 2010. Population Council, with funding from the Bill and Melinda Gates Foundation, has been evaluating the impact of voucher programs in five countries including Bangladesh. As part of evaluation activities, Population Council conducted a baseline survey in 2010 and a follow-up survey in 2012 in new 11 DSF (intervention) and 11 non DSF areas (control). This article used information from the baseline and follow-up survey to examine the impact of this intervention on utilization as well as out-of-pocket expenses incurred by women for availing delivery care services at facility.
Methodology A quasi-experimental research design with pre and post studies in intervention and control areas was conducted to evaluate the impact of demand side financing vouchers on maternal health care services. The assignment to the intervention was non random. A baseline survey was conducted in 2010 with a follow-up survey in 2012. The study was conducted in 22 sub-districts where 11 sub-districts were selected as intervention areas where demand-side financing scheme was implemented. The other 11 sub-districts were selected as control areas where the demand-side financing scheme was not implemented. To draw a sample population, the national facility-based births figure was considered for baseline and follow-up survey and a total of 3300 women with 1650 experimental subjects and 1650 control subjects were selected. From each sub district, three of nine unions and three villages from each union were selected through probability proportional to size and finally, from each selected village, required numbers of respondents were interviewed. Women from 18-49 years of age were interviewed who had given birth in the previous 12 months from the starting date of data collection. Respondents’ socio-economic and demographic characteristics as well as service utilization and cost of each service were collected by using a structured questionnaire. Following the same sampling procedure, we interviewed the same numbers of respondents in the follow-up survey.
Out-of-Pocket Expenses: To examine the expenditure pattern, women were requested to report expenses on card/registration fees, consultation fees, laboratory examination, medicine, round trip transportation and any other associated costs to avail maternity care services. These expenses have been divided into three broad categories: medical cost at the facility, medical cost outside the facility, and transportation cost. “Medical cost at the facility” or internal medical cost includes card/ registration fee, consultation fee (unofficial), laboratory charges, drug cost (unofficial), tips to support staff for expediting services, and attendant expenditures for staying at the facility. Expenditures to purchase drugs and get laboratory services from the other private sector are considered as “medical cost outside the facility” and the actual cost women pay to transport providers is calculated as “transportation cost”.
Results Information on the utilization of delivery presented in Table 1 indicates an increase in the proportion of the deliveries that occurred at the facility from 19 percent in 2010 to 31 percent in 2012 in the intervention areas with the control sites experiencing almost the same increase. Use of public-sector facilities for delivery services increased in intervention sites while control sites experienced greater increase in using the private sector. It has emerged from the 2010 & 2012 expenditure pattern that all delivery services involved OOP payments and the average volume of expenditure is higher in control than in intervention. Findings illustrated  the average cost of different OOP expenses for receiving normal delivery services from public health facility. Cost incurred outside the facility (purchasing drugs and laboratory services) is the largest component (about half) of OOP expenditure for normal and cesarean delivery services in both areas. For that reason total average cost for normal delivery decreased a little bit in control areas also. Commonly, transportation cost increased in both intervention and control for normal or cesarean delivery.In the intervention group there has been a decline in the OOP cost for cesarean delivery that women incurred as medical cost both inside and outside the facility while an increase was reported for control. Reduction in both internal and external cost implies a positive impact of demand side financing benefits on women in receiving cesarean deliveries. With a mixed pattern of expenditure, the differences in OOP expenses between intervention and control that women incurred in 2012 cannot be explained with the effect of the DSF program.In the intervention areas, the average OOP cost for receiving normal delivery service reduced by 44% (from $40 to $22), and money required for a caesarean delivery decreased by 30% (from $115 to $80). Comparisons within public and private and voucher non-voucher has been made only in DSF upazillas.  For the women external medical costs at private facilities were double compared to public facilities. Internal medical cost was four times higher at private facilities than at public facilities. In a two-year period, this expense remained same for public facilities while it increased three times for private facilities. Again, voucher clients spent much less money than non-voucher clients.
Conclusion The recent shift in program development has taken place from being supply-side driven to being demand-side driven which improves the situation of non-accessibility of poor pregnant mother to the health facility. Findings reveal that there was a significant increase in the utilization of delivery care at the facility but it was also observed that the use of public-sector facilities for delivery services increased in only intervention sites while control sites experienced greater increase in the use of the private sector. The demand-side incentive package for the poor covers essential costs for maternal health care services and related to transportation cost also, while other costs like the purchase of additional medicine, unofficial provider fees and incidental costs incurred at facility are not covered under the program. Therefore, in DSF upazillas, there is no woman who did not incur any cost to utilize delivery services. Findings suggest the average volume of expenditure in receiving normal or cesarean deliveries is higher in control than in intervention areas. So, cost implies a positive impact of DSF benefits on women and this leads to the conclusion that DSF may have contributed to lower OOP payments. These findings necessitate the allocation of resources to subsidize the cost women incur to purchase medicine and undergo laboratory services that are not available in government facilities. Increased transportation expenses strongly justifies the need to increase the existing amount of financial assistance the government provides to poor clients. Without making normal delivery fully subsidized, it will be difficult to increase the institutional delivery rate  as women still spends a large share of their family income for receiving normal delivery services.Besides this, implementing programs at the upazila hospital alone cannot raise the rate of delivery in rural areas. Additionally, for optimum utilization of the existing health structure in rural areas, other govt. facilities need to incorporate it. It was also observed that a large proportion of women are receiving services from private health facilities. Therefore, the national health financing strategies should engage the private health sector in a way that enables poor women to receive services from the private sector more easily. With the right types of interventions, maternal health-related MDG may not be very difficult to achieve in Bangladesh.

HIV Risk Perception among Injecting Drug Users in Egypt.

Author(s) Doaa Oraby1
Affiliation(s) 1Self employed, Self employed, Cairo, Egypt.
Country - ies of focus Egypt
Relevant to the conference tracks Infectious Diseases
Summary Egypt has low HIV prevalence (below 0∙02 %) among the general population mostly attributed to conservative culture. In 2010, transmission through injecting drug use represented around 5∙1% of reported cases and the 2010 second round biological/behavioral surveillance survey (Bio-BSS) conducted in some governorates revealed concentrated epidemic among male injecting drug users. The aim of the current study was to assess HIV risk perception among IDUs; to what extent is that risk perception attributable to the nature of HIV, the characteristics of the IDUs population and cultural considerations in Egypt in addition to identifying possible interventions to mitigate HIV infections among IDUs.
Background Egypt has low HIV prevalence (below 0∙02 %) among the general population mostly attributed to conservative culture. In 2010, transmission through injecting drug use represented around 5∙1% of reported cases and the 2010 second round biological/behavioral surveillance survey (Bio-BSS) conducted in some governorates revealed concentrated epidemic among male injecting drug users (IDUs). IDUs face the risks of HIV through the sharing of contaminated needles and other drug paraphernalia, and engaging in unprotected sex sometimes occurring under the effect of, or in exchange for drugs. Additionally, because of their legal status, IDUs are put in prison, where clean needles are harder to find, thereby raising the threat of HIV. Through sharing injection equipment, IDUs are also at particular risk for acquiring hepatitis C virus (HCV). HCV is one of the major health threats and leading causes of death in Egypt. The 2008 Egyptian Demographic Health Survey tested a representative sample of both urban and rural populations in the entire country for HCV antibody and the overall prevalence positive for antibody to HCV was 14.7 %. The current harm reduction interventions do not tackle HCV and only focus on HIV.
Objectives The aim of the current study was to assess HIV risk perception among IDUs; to what extent is that risk perception attributable to the nature of HIV, the characteristics of the IDUs population and cultural considerations in Egypt in addition to identifying possible interventions to mitigate HIV infections among IDUs.
Methodology The assessment included in-depth interviews with 50 IDUs (45 males and 5 females, who were very hard to locate as they are poorly connected compared to male IDUs) who were reached using respondent driven sampling technique. The interviews were structured around the themes of HIV transmission, how IDUs perceive their own risk of contracting HIV and their knowledge of the protective role of safe sex and safe injection practices, in addition to exploring the barriers that keep them from abiding to safe sex and injection behaviors. The study was conducted late in 2012. Informed consent was obtained from all interviewees after explaining the purpose of the study, asking permission to record the interview and assuring voluntary participation and confidentiality. Analysis was based on grounded-theory.
Results For most interviewed IDUs were poor and unemployed, and getting high is their only escape from the hardships they face daily so they inject drugs. Some tried to quit but failed. The majority of the interviewed sample reported that they never perceived HIV as a threat because they do not deal with HIV patients, HIV is uncommon in their communities and they do not go to the countries famous for the high rate of HIV infection. This is contrary to HCV which they perceive as a high threat prevalent among themselves. None of the interviewed IDUs could list all the correct methods of HIV transmission; the majority stated sexual contact as the mode of transmission and some stated infected blood but none mentioned syringes apart from them leading to abscess if frequently used. Interviewed IDUs stated sharing needles, syringes or paraphernalia at least once in the 3 months preceding the interviews. Sharing needles, syringes and paraphernalia when probed was affirmed as a mode of transmission of HCV, yet they do not consider they have an alternative. IDUs clarified that although syringes are cheap and available in pharmacies yet they share syringes rather than buying new ones because IDUs fear being detained as carrying syringes, particularly if drug contaminated, is a sufficient excuse for arrest by policemen who easily identify IDUs. Male IDUs revealed that under the influence of drugs they engage in sexual relations sometimes with the same sex though they are heterosexuals while few female IDUs admitted that they exchanged sex for drugs. Both admitted that in such impromptu encounters, using condom never crosses their minds. All interviewed male IDUs knew about condoms, some use condoms when not under the influence of drugs but not on regular basis while others hate condoms because they reduce pleasure. On the other hand, female IDUs stated that using condoms is not their decision. None of the interviewed IDUs linked non-use/irregular use of condoms to the possibility of contracting HIV but did link non-use to urinary discharge, itching and other genital manifestations.
IDUs revealed that owing to the sensitivity and stigma of drug use in Egypt conservative culture they fear disclosing their sexual and drug injection practices. Hence, they resort to self-treatment rather than going to doctors in case of abscess development or sexually transmitted infections which are common ailments among IDUs. When probed, IDUs stated that if acceptance by service providers, in addition to maintained  confidentiality was guaranteed, they would access health services in the case of aliments.
Conclusion Approaches that address the perceived benefits of safe injecting and safe sex and barriers to behavioral change among IDUs are needed with regard to HIV. Listening to IDUs enabled better understanding of HIV-related knowledge and perceptions which may contribute to the innovation of HIV prevention interventions for IDUs that could also lead to benefits regarding HCV which is currently a public health priority in Egypt. Addressing HIV and HCV simultaneously through competent trained providers will increase IDUs acceptability and commitment to the delivered interventions.

Introducing Kangaroo Care in an urban district hospital of Bonassama – Cameroon.

Author(s) Danièle Kedy Koum1, Cristina Exhenry2, Riccardo Pfister3.
Affiliation(s) 1Paediatrics, District Hospital Bonassama, Douala, Cameroon, 2none, noen, Geneva, Switzerland, 3Neonatology and Intensive Care Services , Geneva University Hospitals, Geneva, Switzerland.
Country - ies of focus Cameroon
Relevant to the conference tracks Women and Children
Summary In sub-Saharan Africa neonatal mortality in LBWI (<2500g) is one of the highest worldwide. Kangaroo Care (KC) is an alternative to incubators recommended by the WHO. However, most published reports originate from central reference hospitals. In low-resource countries, a large proportion of LBWI remain at district level such that KC at this level seems an obvious necessity. We have successfully introduced KC in the urban district hospital of Cameroon. At one year, 30 LBWI were included. Mortality was 3%, considerably lower than previous years (14.5%). Parental acceptability was subject to social and financial circumstances that are potentially more easily solved at the district level.
Background In Douala, Cameroon's economic capital of 2 million people, some 20,000 of 100,000 new-borns are low birth weight infants (LBWI)
Objectives To implement Kangaroo Care in an urban district hospital in order to reduce neonatal mortality and morbidity in a low resource setting. An additional aim was to study the implementation of this method, anticipating an extension to other peripheral structures initially in the same district.
Methodology In July 2012, we launched a pilot project introducing Kangaroo Care in the urban district hospital Bonassama. It is a two year project approved by the ethics committee of the Ministry of Health of Cameroon and the University Hospitals of Geneva (HUG), with the following main steps: 1. Identifying local site management; 2. Obtaining support of the local health authorities and ethics committees (ownership); 3. Public and private funding; 4. Functional reorganization of the neonatal unit; 5. Staff training; 6. Patient recruitment; 8. Patient follow-up of until the age of 2 years; 9. Data analysis (particularly data referring to difficulties in introduction of Kangaroo Care).
Results The project is under the direction of a Cameroon physician trained at HUG. The site has been restored and reorganized with funding from the Ministry of Health of Cameroon, the political district authorities and HUG. Twelve staff members, mostly nurses, were trained in Kangaroo Care during one week. Recruitment of LBWI began 9/25/2012 with 30 LBWI included at one year. The mortality rate was 3%, considerably lower than the average of the previous two years (14.5%). The inclusion rate was 40% of potentially eligible patients. Parental refusal, often resulting in hospital dismissal against medical advice, was the main cause of non-inclusion.
Conclusion Kangaroo Care has been successfully introduced and is practiced in a district hospital with limited resources. Its decentralisation, closer to the families, is an advantage. However, many obstacles remain and require new strategies. The acceptability of Kangaroo Care, little known to the public, requires a community-based communication emphasizing its undeniable benefits. A unique hospital package and financing alternatives for the poorest could increase acceptability. Finally, maternal work, often vital for the family, requires early relocation of Kangaroo Care to the family household, with local support more readily available in the district.