Geneva Health Forum Archive

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

GHF2014 – PS34 – Malaria Integration in the Post-MDG Agenda

14:00
15:30
PS34 THURSDAY, 17 APRIL 2014 ROOM: MOTTA
ICON_Fishbowl
Malaria Integration in the Post-MDG Agenda
MODERATOR:
Dr. Susanna Hausmann Muela
Senior Health Advisor, Swiss Agency for Development and Cooperation, Switzerland
SPEAKERS:
Dr. Roset Bahmanyar
Global Programme Head, Malaria and Leprocy, Novartis Foundation for Sustainable Development, Switzerland
Dr. Silvia Ferazzi
Technical Officer, Roll Back Malaria Partnership, Switzerland
Ambassador Laurence Ishengoma
Special High Level Adviser to the Minister for Lands, Housing and Human Settlements Development, United Republic of Tanzania
Dr. Flora L. Kessy
Ifakara Health Institute and Novartis Foundation, Tanzania
Dr. Jacques Mader
Regional Health Advisor, Swiss Agency for Development and Cooperation
Dr. Kaspar Wyss
Head of Unit, Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Switzerland
OUTLINE:
This session will encourage dialogue on how the global malaria community can integrate with non-health sectors to help eliminate malaria and pave the way for sustainable development. It will offer unique opportunity to discuss effective strategies to integrate with the non-health sector to ultimately free the world of malaria.
View Session Invitation Here
PROFILES:

PS34_Susanna_Hausmann_MuelaDr. Susanna Hausmann Muela

Trained as an epidemiologist and medical anthropologist, Susanna has been working over the past 20 years in Global and Public Health. She has done field work on health-seeking behaviour and social science aspects of malaria and neglected diseases.  She has published on vulnerability and access to care. Before joining SDC in 2012, she was a lecturer and senior researcher at Autonomous University of Guerrero in Mexico, where she was involved in a Dengue community engagement project. From 2003-2010, she was Deputy CEO of UBS Optimus Foundation, responsible for its Global Health Research grant strategy.  As a Founding Member of Partners of Applied Social Sciences (PASS) International, Susanna has been teaching Medical Anthropology Applied to Public Health in Antwerp and Glasgow.

Photo: Marion NitschDr. Roset Bahmanyar

Edith Roset Bahmanyar is Global Program Head, Malaria and Leprosy, at the Novartis Foundation for Sustainable Development, working with partners on projects aiming at elimination of these diseases. Edith holds a Diploma and a Doctorate in Medicine from the University of Geneva, Switzerland, with a Board Certification in obstetrics and gynecology. Edith also has a Degree in Tropical Medicine and Hygiene from the Prince Leopold II Institute of Tropical Medicine & Hygiene, Antwerp, Belgium, and a Master in Public Health from the Harvard School of Public Health, Harvard University, MA, USA. Prior to joining the Novartis Foundation in March 2014, Edith was Senior Medical Epidemiologist at GlaxoSmithKline Vaccines, working on large multi country studies in Africa to support the RTS,S/AS malaria vaccine development, and provided epidemiological expertise for other disease areas such as Tuberculosis, HIV, and Neglected Tropical Diseases.  Previously, Edith provided technical expertise to Ministries of Health to scale up HIV programs in sub-Saharan Africa, including in Tanzania with Centers for Diseases Control, and in Lesotho with the Elizabeth Glaser Pediatric AIDS Foundation and SolidarMed.

Silvia_FerazziDr. Silvia Ferazzi

Silvia Ferazzi has been working for some 20 years in humanitarian affairs and development in the UN and WHO and in public-private partnerships.  She started her career as a social policy researcher and activist with a primary interest in health, poverty and gender. Her academic and journalistic work resulted in some 20 publications in Italian and international journals and books. Between 2006 and 2010, she led fundraising activities at the Global Fund to Fight AIDS, Tuberculosis and Malaria and at the Global alliance for Improved Nutrition.

Laurence_IshengomaAmbassador Laurence Ishengoma

Ambassador Laurence Ishengoma is currently the Advisor of the Minister on matters related to water, sanitation, human settlement and environment. Previously, from 1976 to 1984, he held various management positions in the Tanzanian Government. In 1985, he was appointed Trade Counsellor in the Tanzanian Embassy in Tokyo, which subsequently launched his diplomatic career. Between 2005 and 2010, he worked for UN-HABITAT as Special Advisor, inter alia, for the Lake Victoria Water and Sanitation Programme and the Lake Tanganyika Water, Sanitation and Environment Programme, which had a major impact on the health programmes in the region. He represented the organisation in various regional group consultations, including with the Economic Communities of EAC, SADC, and COMESA.

Kessey Profile PhotoDr. Flora L. Kessy

Flora Lucas Kessy, a Senior Lecturer in Development Studies at Mzumbe University, Morogoro Tanzania holds a PhD in Agricultural and Consumer Economics with a major in Family and Consumer Economics and a minor in Women and Gender in Global Perspective from University of Illinois at Urbana Champaign, USA. Dr. Kessy has researched and published on issues related to income and non-income poverty, social sectors development and good governance. In particular, she has researched on poverty reduction strategies in Eastern and Southern Africa, poverty escape routes, covariate and idiosyncratic shocks affecting households in Tanzania and social protection. In the area of governance, she is involved in public expenditure studies for the health sector and water sector and the use of evidence for actions to improve maternal and newborn health.

She has provided services to the Government of Tanzania including leading the team that drafted the second cluster (quality of life and social wellbeing) of the National Strategy for Growth and Reduction of poverty (MKUKUTA). She has also provided consultancy services to national and international organizations on on-social-economic development and project evaluation including the World Bank, Swiss Development Cooperation (SDC), UNFPA, UNICEF, DfID and Gatsby Charitable Foundation among others.

Her major community development intervention is the implementation of the access project which aimed at improving access to effective malaria treatment in two districts in Southern Tanzania using interventions designed to increase household resources for accessing health care and improving quality of health care at health facilities. She has also participated in implementing Water, Hygiene and Sanitation (WASH) action research for people living with HV and AIDS.

Wyss Profile PhotoDr. Kaspar Wyss

Kaspar Wyss is a Public Health Specialist, Associate Professor (PD) and Deputy Head of Department at the Swiss Centre for International Health, Swiss Tropical and Public Health Institute.  Kaspar Wyss has strong management and leadership experience and is in charge of a team of 15 staff focusing on health systems development primarily in low- and middle income countries. Activities relate to both research and health system monitoring and performance assessment and he directs a number of research and implementation projects in Africa, Eastern Europe, and Asia. He has further extensive consultancy experiences for a broad range of clients. For the University of Basel (MSc and medical students) and for other courses including the Swiss Inter-University Master of Public Health Program he teaches on health systems.

 

 

Dr. Steven van de Vijver

PS06_VijverDr. Steven van de Vijver

Senior Research Officer, African Population and Health Research Center, Kenya

During his studies he worked in Ethiopia, India, Australia and the United States and published articles on this in various magazines.

After specializing as a tropical doctor he worked for Doctors without Borders in the Democratic Republic of Congo. There he discovered the need for care of chronic diseases, and specifically cardiovascular diseases, in low resource countries. In order to obtain this expertise he went back to The Netherlands to finish his specialization in Family Medicine and Masters in International Health in order to focus on primary health care in slums. He obtained the position of Director of Urban Health, at the Amsterdam Institute of Global Health and Development (AIGHD) and moved with his family to Kenya to work on prevention of cardiovascular diseases in slums. Currently he works as a Senior Research Officer at the African Population Health Research Center (APHRC) on the SCALE UP project. The aim of the SCALE UP study is to design an effective and efficient intervention to prevent cardiovascular diseases in the slums of Nairobi that is sustainable and scalable to other settings in Sub Saharan Africa.

GHF2014 – PL02 – Integrated Health Systems in a Pluralistic and Fast Changing Environment

08:45
10:15
PL02 WEDNESDAY, 16 APRIL 2014 ROOM: 2 ICON_QA
INTEGRATED HEALTH SYSTEMS IN A PLURALISTIC AND FAST CHANGING ENVIRONMENT
MODERATOR:
Prof. Don de Savigny
Head, Health Systems Interventions Research Unit, Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Switzerland
PANEL:
Prof. Recep Akdağ
Former Minister of Health of Turkey between 2002 and 2013, Turkey
Mr. Jacques Mader
Regional Health Advisor, Swiss Agency for Development and Cooperation, Switzerland
Prof. Manoris Meshack
Team Leader, Health Promotion System Strengthening Project in Dodoma, Tanzania
Dr. David B. Evans
Director, Department of Health Systems Financing, World Health Organization, Switzerland
AIM:
Discuss the drivers and enabling factors that determine health systems ‘ability to better integrate their critical functions.
OUTLINE:
The World Health Organization (WHO) defines health systems as all organizations, people, and actions whose primary intent is to promote, restore, or maintain health. An effective health system is a core institution, no less important than a fair justice system or democratic political system. Depending how they are designed and governed health systems can empower people thus alleviating suffering or further exclude them, deepening inequity and worsening the experience of poverty. Strong and equitable health systems contribute to the progress toward universal health coverage and sustainable development. In a context of profound demographic and epidemiological changes and highly pluralistic environments characterized by multiple public and private providers, the integration of the various activities, resources and actors that are shaping health systems remains a challenge.Drawing on the experiences three countries pursuing reforms to achieve universal health coverage (UHC) and the personal journeys of actors involved in health system development, this session will aim to discuss the contextual drivers and factors that are shaping health systems transformation towards universal health coverage.
PROFILES:

Don de Savigny_squareProf. Don de Savigny

Professor de Savigny is an epidemiologist and public health specialist and currently Head of the Health Systems Research Unit in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, University of Basel.  He has extensive experience in conducting and facilitating health research in developing countries and has lived and worked for many years in Africa.  He chairs or is a member of a number of WHO, RBM, Global Fund, and TDR advisory committees and networks such as COHRED, the Health Metrics Network and the INDEPTH Network.  His current research focuses on interventions to strengthen health systems in developing countries, and on the health system effects of Global Health Initiatives for scaling up access.

 

RecepAkdagSquareProf. Recep Akdağ, Turkey

Recep Akdag was born in Erzurum, Turkey in 1960. As a pediatrician, he has been holding a professor title from the Ataturk University School of Medicine since 1999. During his career as a medical specialist and academician, he had been involved in a number of administrative tasks. Between 1994 and 1998, he worked as the Deputy Chief Medical Director, Chairman of the Procurement Commission and Deputy Editor of the Medical Bulletin in the Research Hospital of the Medical Faculty of Ataturk University. He also co-founded the Biotechnology Research Center of the University and served as the Deputy Head of the Center from 1997 to 2000. (Read more...)

 

jacques Mader_squareMr. Jacques Mader

Jacques Mader has several decades of multifaceted experience of the health sector in various positions. He’s always been more of a practitioner than a theoretician, more of a (critical) user than a producer of research results. Over the years and thanks to his practice in a great variety of contexts he has become increasingly pragmatic. He strives to use his expertise to promote equity in the access to health resources as well as a broader approach on the determinants of health.

 

Prof. Manoris Meshack

Manoris Meshack was a Team leader of a component of Tanzania Essential Health Project in Developing a community based approach for rehabilitation for Health facilities for Morogoro and Rufiji; after successful completion of the two regions was tasked to roll out the plan to the whole country. Trained District teams and village teams of the same districts and supervised the implementation which was very successful both by constructing the facilities, developing a sustainable maintenance system and reduction of costs. Thereafter Lead a multidisciplinary team for developing, training and implementation  a countrywide approach on community infrastructure rehabilitation in the process rolling out of the approach, to the whole country on the same approach.

From 2001 he was founder member for initiating Tanzania network for Community Health Funds and was the first Secretary General of the Network until he retired in 2006.

He also acted as consultant in Dar es salaam Urban Health Project; he acted as facilitator in Lake Victoria Basin Development program and operated in East African contest.

Manoris Meshack has been Deputy Vice Chancellor Planning and Finance latter promoted to Vice Chancellor Academics. He was appointed to start a New University and acted for one 1year as Project leader before he was appointed to the post of Vice Chancellor until the completion of his term. From 06/2011 to date Manoris Meshack has been employed  as a Team leader of Health Promotion System Strengthening project in Dodoma.

 

David_evansDr. David B. Evans

David B. Evans, Director of the Department of Health Systems Financing in the Cluster on Health Systems and Services at WHO, has a PhD in economics and worked as an academic and consultant in Australia and Singapore before joining WHO in 1990. His work has covered the social and economic aspects of tropical disease control, the assessment of health system performance and the generation, analysis and use of evidence for health policy. His current responsibility is the development of effective, efficient and equitable health financing systems, through technical support to countries, generation and use of evidence, capacity strengthening and partnership with other development agencies and initiatives. He was the lead author for the World Health Report 2010 (Health Systems Financing: the Path to Universal Coverage).

 

 

 

GHF2014 – PS21 – Political Analysis of Global Health Policy Making: A Recipe

16:00
17:30
PS21 WEDNESDAY, 16 APRIL 2014 ROOM: 2
WORKSHOP
Political Analysis of Global Health Policy Making: A Recipe
MODERATOR:
Prof. Ronald Labonté
Professor and Canada Research Chair, Institute of Population Health, University of Ottawa, Canada
SPEAKERS:
An Exploration of How Health is Positioned in Canadian Foreign Policy
Prof. Ronald Labonté
Professor and Canada Research Chair, Institute of Population Health, University of Ottawa, Canada
The Integration of Health into Foreign Policy: Health is Global
Dr. Michelle Gagnon
Vice President, Adjunct Professor, Norlien Foundation and University of Calgary, Canada
Ms. Miriam Faid
Visiting Professor, CAPES-Fiocruz/CDTS, Centre for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Brazil
Mr. Mohsin Ali
United Kingdom
Ms. Sarah Rostom
McMaster University, Hamliton, Ontario, Canada
OUTLINE:
PROFILES:

Ronald_LabontéProf. Ronald Labonté

Prof. Labonté is Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and Professor in the Faculty of Medicine, University of Ottawa. His current research interests include globalization as a ‘determinant of determinants’ (he chaired the Globalization Knowledge Network for the WHO Commission on Social Determinants of Health); ethics, human rights and global health development; global migration of health workers; revitalization of comprehensive primary health care; global health diplomacy.

He recently reviewed the various policy frames (security, development, global public goods, trade, human rights and ethical/moral reasoning) for health in foreign policy that inform global health diplomacy.

Gagnon PhotoDr. Michelle Gagnon

I began my career as a health professional and after working in a variety of health care settings pursued management studies and spent about a decade working for the Canadian Institutes of Health Research (CIHR). My work focused on health services and policy research and population and public health and in particular on how to support and promote the application of knowledge in policy and practice. Given I was working in a health research organization and was very interested in interdisciplinary knowledge and approaches to finding solutions to major health issues through research, I decided to pursue a doctorate in population health from the University of Ottawa. I focused on global health diplomacy and the integration of health into foreign policy under Professor Ronald Labonté. I am interested in policy relevant research and global health issues at the macro level such as governance and the role that actors from public, private and civil sectors play in the global health policy making process.

In addition to my academic and research interest, I continue to pursue an eclectic professional career aligned with my interests and experience in population health and knowledge translation. I am currently Vice President of a private foundation located in Alberta, Canada that Mobilizes knowledge about early childhood development and its link to lifelong health (lifecourse model), in particular addiction and mental health, by engaging with and brokering relationships across science, policy and practice.

Miriam.Faid_pictureMs. Miriam Faid

With parents coming from two countries that could probably not be any more different in terms of their socio-economic and political liberties and development stages – Norway and Eritrea - Miriam’s personal and professional perspective has always been shaped and guided by this particular background. Having grown up in Germany where she pursued her graduate studies in Political Sciences and with stints in Portugal, Brazil, Belgium and Norway, her more recent professional journey was significantly shaped by a 6-year long stay in Geneva, where she completed a master’s and PhD degree in International Studies. With Geneva being the world’s global health hub, there was no other way but to get involved academically and professionally in this complex but fascinating governance realm. With emerging countries taking up new identities, roles and responsibilities in global health, she is particularly interested in the Global South, most specifically on South-South health cooperation initiatives. Most recently she started a Visiting Professorship at the Centre for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro, Brazil. In this function, she identifies and initiates opportunities for cooperation between Fiocruz/CDTS and public, private and philanthropic institutions worldwide, aiming to promote scientific and technological development and innovation with a focus on neglected diseases.

PS21_Sarah_Roston_squareMs. Sarah Rostom

Sarah Rostom is currently interning at the World Health Organization in the Department of Service Delivery and Safety, focusing on the Safe Childbirth Checklist Collaboration initiative. She is also working part-time as a research associate for a project commissioned by the Canadian government on essential medicines procurement. Her research experiences and interests lie at the nexus of global health, law, and policy—which she hopes to continue as a lawyer, researcher and advocate in the future. Sarah holds a Bachelors of Arts & Science (Hons) from McMaster University in Hamilton, Ontario, Canada.

GHF2014 – PS18 – Improving Health Information Systems for Better Decision Making

10:45
12:15
PS18 WEDNESDAY, 16 APRIL 2014 ROOM: LEMAN
ICON_Fishbowl
Improving Health Information Systems for Better Decision Making
MODERATOR:
Mr. Hazim Timimi
Data Manager, Tuberculosis Monitoring and Evaluation, World Health OrganizationSwitzerland
SPEAKERS:
Best Practices for Building an Integrated National Health Information System: Rwanda
Dr. Caricia Catalani
Senior Researcher, Innovative Support to Emergency, Disease, & Disaster (InSTEDD) & University of California, Berkeley, School of Public Health, United States
Prof. Don De Savigny
Head, Health Systems Interventions Research Unit, Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Switzerland
OUTLINE:
PROFILES:

PS18_Catalani_squareDr. Caricia Catalani

I am a researcher, focusing on digital innovations for health.  I started working in the health field at age 16, as a physician’s assistant in our family-run urgent care clinic in the rainy Pacific Northwest of the United States. Since then, I’ve worked in an emergency room in a tough neighborhood in New York City, a sex workers’ union in the Dominican Republic, devastated neighborhoods in New Orleans after hurricane Katrina, US government health departments across the coasts, a cigar factory in Cuba, one of the world’s biggest private health insurance companies, a women’s health advocacy powerhouse in Washington, DC, a milky-eyed shamanic healer’s hut on the border of Cameroon, a teen health and empowerment center in San Francisco low-income housing, and clinics with mud floors and tin roofs throughout the African continent.  These days, I spend most of my time as a research consultant to eHealth, mHealth, and digital innovation projects at ministries of health, hospitals, and non-governmental organizations around the world (especially in Rwanda, Cambodia, Kenya, India, Canada, and the USA). I am faculty at the University of California, Berkeley, where I teach courses on digital innovations for health.  Awesome comedy improv and freestyle rap give me a lot of joy.  I spend countless hours learning from my four-month old and three-year old daughters, as we grow up together in the San Francisco Bay Area.

Don de Savigny_squareProf. Don de Savigny

Professor de Savigny is an epidemiologist and public health specialist and currently Head of the Health Systems Research Unit in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, University of Basel.  He has extensive experience in conducting and facilitating health research in developing countries and has lived and worked for many years in Africa.  He chairs or is a member of a number of WHO, RBM, Global Fund, and TDR advisory committees and networks such as COHRED, the Health Metrics Network and the INDEPTH Network.  His current research focuses on interventions to strengthen health systems in developing countries, and on the health system effects of Global Health Initiatives for scaling up access.

GHF2014 – PS06 – Integrated Management of NCDs at the Primary Health Care Level : a World View

14:00
15:30
PS06 TUESDAY, 15 APRIL 2014 ROOM: MOTTA
ICON_Fishbowl
Integrated Management of NCDs at the Primary Health Care Level:
a World View

MODERATOR:
Dr. Nicholas Banatvala
Senior Adviser to the Assistant Director General, Noncommunicable Diseases and Mental Health, World Health Organization, Switzerland
SPEAKERS:
An Integrated Approach to Management of Diabetes and Hypertension in Western Kenya
Dr. Simon Manyara, Pharmacist, Academic Model Providing Access To Healthcare (AMPATH), Kenya
Introducing a Model of Cardiovascular Prevention in Slums of Nairobi
Dr. Steven van de Vijver, Senior Research Officer, African Population and Health Research Center, Kenya
Clinical Audit on Diabetes Care in UNRWA Health Centres
Dr. Yousef Shahin, Chief Disease Prevention and Control, Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
Identifying the Barriers to Care and Medicines for Diabetes and Hypertension: A pilot study in Lima-Peru
Mrs. Maria Kathia Cardenas, Investigator, CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Peru
OUTLINE:
PROFILES:

Nick Banatvala_squareDr. Nick Banatvala

Dr. Nick Banatvala is currently Senior Adviser to the Assistant Director General (Noncommunicable Diseases and Mental Health) at WHO in Geneva. Current responsibilities include leading development of a global coordination mechanism for the prevention and control of NCDs, spearheading a newly set up UN NCD Taskforce and leading WHO’s global training programme to build capacity on NCDs for senior policy makers in middle and low-income countries.

Prior to this, Nick was Head of Global Affairs at the Department of Health in England where he led the development and implementation of the UK Government's first-ever global health strategy, its strategy for working with WHO and DH’s bilateral engagement with emerging economies. (Read more)

PS06_ManyaraDr. Simon Manyara

Dr. Simon Manyara is a pharmacist working in Eldoret, western Kenya. He also studies Global Health (masters) at the University of Edinburgh, Scotland. His two key areas of interest are non communicable diseases and access to medicines. He works in rural western Kenya to provide care for patients with diabetes and hypertension using a model that combines both peer groups and microfinance. Additionally, he implements community revolving fund pharmacies which ensure accessible and affordable supplies of essential commodities in government facilities within the same catchment area.

PS06_VijverDr. Steven van de Vijver

During his studies he worked in Ethiopia, India, Australia and the United States and published articles on this in various magazines. After specializing as a tropical doctor he worked for Doctors without Borders in the Democratic Republic of Congo. There he discovered the need for care of chronic diseases, and specifically cardiovascular diseases, in low resource countries. In order to obtain this expertise he went back to The Netherlands to finish his specialization in Family Medicine and Masters in International Health in order to focus on primary health care in slums. He obtained the position of Director of Urban Health, at the Amsterdam Institute of Global Health and Development (AIGHD) and moved with his family to Kenya to work on prevention of cardiovascular diseases in slums. Currently he works as a Senior Research Officer at the African Population Health Research Center (APHRC) on the SCALE UP project. The aim of the SCALE UP study is to design an effective and efficient intervention to prevent cardiovascular diseases in the slums of Nairobi that is sustainable and scalable to other settings in Sub Saharan Africa.

PS06_Yousef_Shahin_squareDr. Yousef Shahin

After graduating in Medicine and General Surgery at Zaprozyha Medical University in the Former USSR in 1985, he joined Jordan University of Science and Technology where he completed Master degree in Public Health in 1995.

Joined UNRWA in 1992 as Medical Officer in charge of health centers till 2005, when he was promoted to a senior position at UNRWA headquarters. He has more than 8 years’ experience in disease prevention and control programme, and responsible for the development, monitoring and evaluation of the UNRWA’s progrmme for disease prevention and control by preparing technical instructions, clinical guidelines, periodic assessment and supervision of related activities.

Dr. Shahin was designated to World Health Organization/ Eastern Mediterranean Region from July-December 2011 as Technical Officer on non- communicable diseases.

He has publications in medical journals including the Lancet on different health topics mainly diabetes care among Palestine Refugees. Participated in many international conferences and workshops addressing public health related topics.

PS06_Maria Kathia CardenasMrs. Maria Kathia Cardenas

Mrs. Cardenas is a Peruvian investigator at CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia (UPCH) based in Lima. She graduated from Economics and studied a Master in Epidemiological Research at UPCH through a Fellowship supported by The National Heart, Lung and Blood Institute.

Prior to her move to CRONICAS, she worked in areas devoted to Economic Evaluation of Projects and Public Policy in Social Development at two larger economic and development Think Tanks in Peru: Centro de Investigación de la Universidad del Pacífico and Instituto de Estudios Peruanos. Her area of main interest is Health economics applied to chronic diseases. Her desire and main motivation is to help improving the quality of people's lives of Peruvian population through better health status, especially of the most deprived.

Exploring Primary Care: System Dynamics in USA and Romania.

Author(s) Andrada Tomoaia-Cotisel1, Karl Blanchet2, Zaid Chalabi3, Samuel Allen 4, Victor Olsavsky 5, Cassandra Butu6, Michael Magill7, Bernd Rechel8
Affiliation(s) 1Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Cluj-Napoca, United States, 2Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom, 3Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom, 4Utah Medical Education Council, Utah Medical Education Council, Salt Lake City, United States, 5WHO Country Office Romania, WHO Country Office Romania, Bucharest, Romania, 6WHO Country Office Romania, WHO Country Office Romania, Bucharest, Romania, 7Department of Family & Preventive Medicine, University of Utah, Salt Lake City, United States, 8Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
Country - ies of focus Romania, United States
Relevant to the conference tracks Health Systems
Summary Policy-makers are better able to identify and implement effective health system strengthening (HSS) efforts when they have an accurate understanding of the dynamic, emergent behavior of the system they are attempting to strengthen. Achieving such an understanding is difficult. Yet, without it, decisions can easily result in unintended consequences or policy resistance. This paper describes system dynamics methodologies employed in the context of a HSS effort in Utah, USA and explores ways of applying them in LMICs, based on a case study in Romania. We present differences in data needs, availability and quality; and discuss how methods can be modified in view of these constraints.
Background Policy-makers are better able to identify and implement effective health system strengthening (HSS) efforts when they have an accurate understanding of the dynamic, emergent behavior of the system they are attempting to strengthen. Achieving such an understanding is difficult. Yet, without it, decisions can easily result in unintended consequences or policy resistance. In high-income countries, such understanding is increasingly obtained through the use of complex system modeling and detailed statistical analysis using large datasets. However, in low- and middle-income countries (LMICs) the data available are more limited, introducing higher levels of uncertainty in health system parameters. Despite this uncertainty, systems thinking and system dynamics supplies decision-makers with information needed in HSS efforts.“Systems thinking” provides a comprehensive framework for capturing, from diverse perspectives, how health systems function and how complex changes occur. System dynamics takes this approach to the next level by developing quantitative computer-based simulation models that can analyze system behavior and simulate how systems respond to policy measures and other changes over time.
Objectives To describe system dynamics methodologies employed in the context of a HSS effort in Utah, USA. Methodologies used are explained and ways of applying them in low and middle income countries are explored, based on a case study in Romania. The World Health Organization projects the burden of non-communicable diseases (NCDs) in LMICs to grow from half of total disability-adjusted life years in 2004 to three quarters by 2030. As LMIC health systems are already strained, this awareness necessitates that LMIC policy-makers anticipate and prepare for the consequences of this shift. As many NCDs are best managed in primary care settings, many HSS efforts aim to enhance primary care. System dynamics provides methods for creating custom-tailored tools to do this.HSS efforts in Romania, as in other former communist countries, focus on overcoming a previous neglect of primary health care, while redesigning the provision and financing of primary care at the same time. The goal being to facilitate patient centered care with a whole person orientation, providing all key elements of primary care.
Methodology System dynamics methodology will be presented as used in a high-income country setting and as modified for implementation in a middle-income country setting. In both contexts, the core methodology progresses as follows: 1) develop a conceptual model of the health system, 2) transpose the conceptual model to a dynamic quantitative model of the system, 3) develop and run scenarios simulating the policies and interventions under consideration. This methodology is couched within a participatory action research approach. Methodological tools employed included: Causal Loop Diagrams (CLDs) identifying key system structures such as feedback loops and time delays; statistical analyses and literature review identifying relationships among system variables; model validation techniques and key informant discussions with a diverse set of stakeholders. Decision-makers are involved throughout the project, participating in model development and critique, providing key informant expertise, designing scenarios to be tested, and discussing scenario results.We present differences in high and middle income country data needs, availability and quality. We also discuss how methods can be modified in view of these data constraints. These modifications impact the model produced and the lessons obtained from it. Strengths and limitations of these modifications are discussed.
Results We found that applying a SD methodology in LMICs is possible, but that the level of uncertainty in the model developed depends on the type and amount of available data. CLDs can be developed on the basis of interviews with key stakeholders, as well as using information in the literature. Quantifying the relationship between the identified system variables should ideally use context-specific data to increase model validity. However, model validation techniques can be performed using less data, for example via key informant discussions to elucidate a relationship’s potential behaviour. A health system model can be operationalized using less than ideal datasets. Existing data sources include qualitative and quantitative data on primary care in Romania and nationwide hospital diagnosis-related groups (DRGs) data. Additional low-cost resources would be required to conduct key stakeholder interviews to verify model structure and to design policy scenarios.
Conclusion Applying system dynamics in HSS requires the creative use of mixed methods within the constraints of data availability, transdisciplinary research teams and multi-level stakeholder involvement (of patients, providers, administrators and policy-makers). In particular, in LMICs’ HSS efforts, policy-makers need to know how to adapt innovations to their specific context and health system. System dynamics methodology promises to allow for this kind of tailoring; it also provides a framework for conceptualizing and simulating system behavior. Its design, tools and required parameterization can draw on experiences from elsewhere, while at the same time be adapted to local contexts.

How well do we know the “users” of health interventions? The example of (non-)enrolment in voluntary community-based health insurance schemes in Mali.

Author(s) Alexander Schulze1.
Affiliation(s) 1Global Health, Novartis Foundation for Sustainable Development, Basel, Switzerland.
Country - ies of focus Mali
Relevant to the conference tracks Social Determinants and Human Rights
Summary For health interventions to be successful, not only the health system needs to be considered, but also the patients understood. However, often in health research this understanding is reduced to their socio-economic status.
The present empirical study, focusing on the reasons for (non-) enrolment in voluntary health insurance schemes in rural Mali, expands the analysis of household characteristics to sociocultural orientations and intra-familial structures, including decision-making patterns.
The results reveal that the socio-economic status of households does not explain membership in a health insurance scheme, whereas the attitudes heads and family decision making patterns clearly do.
Background Systematic, quantitative evidence on user characteristics of health interventions is mostly limited to socio-demographic features and economic status. Yet, as research in medical anthropology has revealed, the acceptance of health related innovations is not only dependent on these factors.The example of (non-)enrolment in voluntary health community-based insurance schemes in sub-Saharan Africa mirrors this research gap. These schemes are characterized by modest enrolments rates and do not tap their potential in an already limited catchment area. In order to increase their coverage, the reasons for (non-)enrolment need to be better understood.However, to date, research has focused on the supply side, i.e. features of the insurance schemes and their contracted providers. On the demand side, comparative studies of enrolled and non-enrolled households have mainly concentrated on their socioeconomic status.Three research gaps remain which are not unique to the analysis of community-based health insurance: 1) sociocultural features are not analyzed in a quantifiable manner as socio-economic characteristics are. 2) household and family structures and their decision making patterns are not considered. Thirdly, significant factors are not explained and related to each other.
Objectives The present empirical study aims to fill the following research gaps:1) to expand the analysis of household characteristics beyond households’ socio-economic status by also taking account of their sociocultural orientations and intra-familial structures, including decision-making patterns. The main hypothesis underlying this approach is that socio-economic differences have been overestimated regarding their importance in determining the uptake of innovations, i.e. in the presented case membership in health insurance schemes, whereas attitudes and values, such as openness to or mistrust of social innovations, have been underestimated.2) A further goal is to systematically bring together and interrelate influencing factors that are meaningful beyond statistical significance, in order to ultimately reveal different lifestyle patterns associated with membership in, or refusal to join, a health insurance scheme.3) A further aim of this study is to present an analytical framework that links the socio-economic characteristics of households with their sociocultural orientations as well as with household and family structures.
Methodology A mixed methods approach, with different instruments employed sequentially, was developed. The central rationale behind a mixed-methods approach of this type was the idea to use qualitative methods of data collection not only in the exploratory phase but also at a later stage, to enhance interpretation of results from quantitative statistical data analysis and to develop explanatory patterns.The core element of the mixed methods approach chosen was household surveys on lifestyle patterns and social protection strategies. A total of 600 heads of households were interviewed in two localities. Of these, in each locality 200 had no insurance, while 100 did have insurance. In a second survey round, half of these household heads were again interviewed about their social protection strategies. In each study area this round covered 100 households with insurance and 50 households with no insurance.Households were the focus of research for two reasons: on the one hand, they are the unit of membership in the community-based health insurance schemes being studied. On the other hand, households are important repositories of lifestyle patterns within society and have a great degree of influence on the activities of their members. This is manifested, for example, in the transmission of values between generations and in the sharing of resources. Moreover, households are units of decision-making in different areas of life.Comparison of two rural areas in Mali had been considered useful insofar as community-based health insurance schemes are being advocated for peasant populations, primarily in French-speaking Africa. Furthermore, the two localities differ in terms of climate and in socio-economic and sociocultural terms but have a very similar health insurance scheme. Comparison of two areas also made it possible to examine to what extent social differences exist in rural Mali.

The household surveys were preceded by an exploratory phase including group and individual discussions, which primarily served to identify locally relevant categories of social differentiation. Following the household surveys, preliminary results were presented to representatives from the municipalities. These discussions brought out new points of view that were of use in further data collection and analysis. Following this, 20 group discussions and 24 individuals from selected families were interviewed in order to obtain insights into household and family decision-making patterns.

Results The results reveal that the socio-economic status of households does not explain membership in a community-based health insurance scheme, whereas the attitudes of household heads and family decision-making patterns clearly do. For instance, households of the lower socioeconomic tercile were even slightly more likely to be members than those of the middle tercile (p-value: 0.669; CI: .63-2.02; OR: 1.13).Households that are single households or are not part of a large family have greater freedom in decision-making. Moreover, heads of households with insurance appreciate different social changes (e.g. existence of new, formal organizations including community-based health insurance schemes), take on responsible roles in their communities and plan in a manner where the benefit is unsure or not immediately given, significantly more often than heads of uninsured households. For instance, those heads of household who only utter negative social changes are significantly less likely to be insured than those who also mention positive changes (p-value: 0.000; CI: .21-.57; OR: .35).Based on the results, a typology of households and their lifestyle patterns was empirically determined in both study areas. Each of the two study areas, two different household types were identified that are distinct not by their socio-economic status but by family structure and sociocultural orientation. The existence of different household types in both areas underscores the clear social differences that exist in rural Mali.
Conclusion The findings from this research on the reasons for (non-)enrolment of households in community-based health insurance schemes in rural Mali reveal that limiting the "users" of health interventions to their socio-economic status in many circumstances does not sufficiently explain why people "lack access to" or do not take up the services offered through health interventions.In order to better target potential users of health interventions and increase coverage, a more comprehensive but systematic analysis of their characteristics must be done. This includes socio-cultural features such as attitudes towards social innovations and change, leading values, consumption priorities as well as decision making patterns at household and family level.In other words, for health interventions to be successful, not only the heath system and its actors need to be considered, but also the patients. However, they must not be reduced to people living in poverty. Rather research must acknowledge that they are characterised by different livelihood patterns that expand beyond the issue of poverty.

Princeton’s University Global Health Program: Research and teaching at the nexus of science, policy and social science

Author(s) Kristina Graff1, Peter Locke2
Affiliation(s) 1Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, United States, 2Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, United States, 3.
Country - ies of focus Global
Relevant to the conference tracks Education and Research
Summary Princeton University’s Global Health Research and Teaching Program is anchored in the philosophy that complex problems demand a comprehensive and integrated approach, in which players from a range of academic and technical areas collaborate to analyze global health problems and explore innovative solutions. Princeton’s Global Health Program generates the scholarship fundamental to health improvements at the nexus of science, policy and social science, and educates students who will become leaders in these fields. Its defining elements are a cross-disciplinary approach, hands-on field research and a focus on the policy dimensions of global health.
What challenges does your project address and why is it of importance? Global health challenges go far beyond clinical issues. These problems are rooted in economic, social and political forces, geographical and logistical hurdles as well as the dynamic impacts of globalization and governance. Solutions to global health problems demand an interdisciplinary response –one that integrates the expertise and perspectives of a range of sectors and specialties. A holistic approach to global health looks beyond what medicine alone can achieve and addresses all the elements that contribute to improved wellbeing, ranging from population and system-based interventions to an understanding of how broad public health initiatives affect individual lives.
Princeton University’s Global Health Program is anchored in the philosophy that complex problems demand a comprehensive and integrated approach, in which players from a range of academic and technical areas collaborate to analyze global health problems and explore innovative solutions. Princeton’s Global Health Program generates the scholarship fundamental to health improvements at the nexus of science, policy and social science, and educates students who will become leaders in these fields. Its defining elements are a cross-disciplinary approach, hands-on field research and a focus on the policy dimensions of global health.
How have you addressed these challenges? Do you see a solution? Princeton’s Global Health Program operates integrated research and teaching initiatives that span the breadth of faculty expertise. The global health program supports a multi-disciplinary research agenda and curriculum bridging engineering, the humanities, and the social and natural sciences.The University sponsors innovative and exploratory research, which is scaled up to draw external grants. Faculty lead projects that engage undergraduates, graduates and postdoctoral researchers. They extend into the classroom and into students’ research and internships.The global health program also supports students’ internships and research in laboratories and field sites around the globe, academic and public events, and student participation in external conferences. This program model simultaneously fuels research and teaching in key areas of global health.A key program focus is on high-quality, hands-on learning. Students conduct research and internships in 20+ countries, based at research centers, NGOs and grassroots organizations, academic institutions, hospitals and clinics. Junior researchers mentor many student projects, providing training in topics such as technical methods for research and analysis, to the ethics and principles of sound and responsible global health research. These field experiences are life changing for many students and form the basis of their future pursuits in domestic and global health.A final critical factor in the success of Princeton’s global health program is a strong and longstanding partnership with the institutions where students and faculty conduct research. Solid institutional relationships allow for regular exchanges, high-quality research, expanded opportunities for collaborative projects and more efficient administration. Two key governing principles for the program’s collaborations are reciprocity and on-site advising by Princeton researchers based in the field. Princeton hosts faculty members and graduate students from partner institutions for varying periods of time. Postdoctoral fellows have proven highly effective as on-site research coordinators and advisors.

By centering its research and teaching activities on interdisciplinary and integrated principles, Princeton’s global health program facilitates cross-departmental engagement of faculty and prepares students to address the increasingly complex slate of global health challenges.

How do you know whether you have made a difference? The Princeton Global Health Program tracks the impact of its research and teaching programs over time, and it also devotes ongoing attention to ensuring that its international partnerships are mutually beneficial. For research we monitor how the work is scaled up into larger programs, published in academic and other journals, and translated into policy and practice changes. We do this through reporting by recipients of internal grants and through tracking global health faculty member’s work.For teaching we follow the threads of students’ academic progress over multiple years and then track their career trajectories once they graduate. We do this through a combination of quantitative measures (number and proportion of global health students who pursue related graduate study and careers) and qualitative data (asking students over time how their experience in Princeton’s global health program shaped their understanding of global health issues and the evolution of their careers). We also link current students to program alumni, in order to create an informal network for advising and guidance.For international partnerships we work with our collaborating institutions to identify mutually beneficial projects at the start of our cooperative efforts. We also commit to a true exchange, whereby our partner institutions can send faculty or graduate students to Princeton for periods of research or study. We communicate frequently to keep things running smoothly, set agreements about use of data and publications resulting from the collaboration, send as many field-based researchers to our partner sites as possible, and conduct periodic site visits for monitoring and relationship management.
Have you or the project mobilized others and if so, who, why and how? The international partnerships have resulted in a range of studies, projects and grants to address global health challenges around the world. Some of these have been the result of student projects that were designed to address pressing issues facing a particular partner institution. Princeton’s participants were called upon to address the economic, social, cultural and logistical factors affecting health care access and overall wellbeing. One example is Princeton’s global health program partnership with Wellbody Alliance, a community-based healthcare organization in rural Sierra Leone. Under the supervision of a global health program postdoctoral fellow, Princeton students conduct summer field research focused on helping Wellbody to better understand community needs and evaluate the impact of its services.Based on a student’s project analyzing barriers to tuberculosis (TB) treatment adherence, Wellbody applied for and received a grant from the World Health Organization’s STOP-TB Partnership to implement an innovative district-wide home-based TB screening and treatment system. As part of this project, Wellbody Alliance has hired and trained 150 community health workers, upgraded laboratory and administrative capacity, and secured additional medication needed to treat hundreds of new TB patients. All patients diagnosed with TB in Kono District are now assigned a Wellbody Alliance community health worker who visits patients in their homes to administer medication and evaluate their progress. Additionally, community health workers offer early testing and treatment to high-risk individuals, saving lives and preventing others from becoming infected.In the summer of 2013, students returned to support and evaluate the implementation of the program by accompanying supervisors and health workers as they carried out their duties in the community. Their findings will be essential to identifying and overcoming unexpected challenges in the field and to facilitating the renewal of the WHO grant beyond the first year.
When your donor funding runs out how will your idea continue to live? In the research dimension, the University’s initial investment in global health research is being translated into support from external donors whose primary agenda is to further these lines of inquiry. The research projects will then ultimately become a self-sustaining entity. The program also maintains endowed funds so that there will always be avenues to seed innovative ideas and projects until they can be scaled up for broader external funding. In the teaching dimension, the philosophy of Princeton’s global health program is present in the University’s core educational curriculum. Therefore the program and its guiding principles will remain at the center of all pedagogical initiatives as ongoing and standard academic offerings.In its international collaborations, these costs will ultimately be moved from the category of “special initiatives” over to a standard part of normal program operations, so that they become part and parcel of global health partnerships – both at Princeton and within its partner institutions. When the partnerships prove to be mutually beneficial they can then merit a spot as an essential element of both collaborators’ regular operating budgets.

Strengthening Referral Linkages for Malaria in Nigeria.

Author(s) Chinazo Ujuju1, Ernest Nwokolo2, Jennifer Anyanti3, Chinwoke Isiguzo 4, Onoriode Ezire 5, Ifeanyi Udoye6, Wellington Oyibo7
Affiliation(s) Research and Evaluation Division, Society for Family Health, Abuja, Nigeria, Global Fund Malaria project, Society for Family Health, Abuja, Nigeria, Technical Services, Society for Family Health, Abuja, Nigeria, Research and Evaluation, Society for Family Health, Abuja, Nigeria, Research and Evaluation, Society for Family Health, Abuja, Nigeria, Research and Evaluation, Society for Family Health, Abuja, Nigeria, College of Medicine , University of Lagos, Lagos, Nigeria, 8
Country - ies of focus Nigeria
Relevant to the conference tracks Education and Research
Summary Lack of referral linkage from PPMVs to health facility may have contributed to increased mortality due to the home management of malaria illnesses. This study showed that of the 461 clients who were tested for malaria at PPMV outlet, 88 tested positive while 365 who tested negative were referred to a nearby health facility for further diagnosis and treatment. Only 18 referral cards were retrieved from health facilities. There is a need to integrate PPMVs into the national referral system to ensure appropriate treatment for severe malaria, other febrile infections and reduce morbidity and mortality due to home management of illnesses.
Background In Nigeria malaria remains a major cause of morbidity and mortality among children under 5 years of age. Most of the early treatments of fever and malaria occur through self medication with anti malarial bought over the counter from drug vendors. The Nigerian health system provides for three tiers of health care: primary, secondary and tertiary. The primary health centers should be the point of first contact for patients from where they are referred to other levels of health care. This is far from reality as Private Patent Medicine Vendors (PPMVs) found across Nigeria are the first point of call for malaria treatment. Global malaria initiatives highlight the potential role of PPMVs in improving access to early effective malaria treatment. Parasitological diagnosis before administration of anti-malarial treatment has recently been recommended by WHO for everyone presenting with symptoms compatible with malaria at all level of the health system.
Objectives In Nigeria, more than half of household members sought treatment for fever at PPMV shops. Anecdotal evidence suggests that PPMVs do not refer clients to the health facility. There is a need to explore whether PPMVs would actually refer clients who accessed the malaria rapid diagnostic test (RDT) from their outlet to a health facility. This study was conducted to determine whether PPMVs referred clients who visited their outlet for malaria diagnosis to a health facility.
Methodology A cross-sectional pilot study to explore RDT feasibility and use was conducted in six states (Adamawa, Cross River, Enugu, Lagos, Kaduna and F.C.T) of Nigeria, each representing a geo-political zone of the country. About 20 registered PPMVs were selected from each of the selected states. Multi-stage purposive sampling was used to select the state and the PPMVs that participated in the study. These outlets were grouped into clusters of 6 per state. Two days of curriculum based training was conducted for the selected PPMVs. Nurses and laboratory personnel were recruited to monitor the PPMVs as they conducted the malaria RDT. The RDT test was conducted for clients aged 18 years and above after obtaining informed consent to participate in the study. Clients who tested negative were referred to a higher health facility identified within the cluster for further diagnosis and treatment, while those who tested positive for malaria were offered a full course of medicine according to Nigerian malaria treatment guidelines. During the study, referral was tracked in two states; Kaduna and Lagos state. Ethical clearance was obtained from the National Health Research and Ethics Committee prior to commencing the study. Data generated from the study was entered and verified using data management software, CSPro 2.6. The data was subsequently imported into SPSS (version 18) for statistical analysis. Descriptive statistics were used and data for the two states where referrals were tracked were analysed for this paper. Socio economic status of the respondents was calculated based on reported household’s ownership of consumer goods, dwelling characteristics, source of drinking water and sanitation facilities. To construct the index, each asset was assigned a weight (factor score) generated through principal component analysis, which was divided into quintiles from one (lowest) to five (highest).
Results 461 clients who visited PPMV outlet in Kaduna and Lagos received malaria RDT as confirmatory diagnosis of their illness. The proportion of males in the population was slightly higher (58%) than the proportion of females (42%). More than half (69%) of the respondents were married. There was variation in the educational attainment of respondents who participated in the survey. While about 48% had attained a secondary level of education, about one in four (23%) of the respondents had attained a higher level of education. A higher proportion of respondents were aged between 25-34 years (36%) and ranked as average socio economic status (26%). The reported symptoms experienced by most of the respondents can be associated with malaria illness. These symptoms include fever (55%), headache (77%), joint pains (54%), tiredness (39%), bitter taste (27%) and poor appetite (25%). About 88 clients tested positive for malaria while 365 who tested negative were referred to a nearby health facility for further diagnosis and treatment. A few visited the health facility for further diagnosis and treatment and 18 referral cards were retrieved from the health facilities.
Conclusion There is a need to integrate PPMVs into the national referral system and strengthening referral of client from drug store outlets to a higher quality of care. There is a need to implement malaria RDT among PPMVs and ensure that this group of health workers is trained and their activities monitored effectively to ensure proper management of malaria illness at the community level. It would also provide avenue for PPMVs to refer febrile clients who tested negative to malaria RDT to a health facility for further diagnosis and treatment. It would reduce the possibility of parasitic resistance as a result of repeated home treatment of unconfirmed malaria cases. Hence, this would increase clinical effectiveness of recommended drug regimen, Artemisinin-based Combination Therapies (ACTs). It would strengthen the referral linkages for treatment of severe malaria, treatment for other febrile infections and ultimately reduce the morbidity and mortality due to home management of illnesses.