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RGHI Newsletter March 2017

Letter from Heads of Institute

Addressing global health inequalities and their social and health care determinants is probably more relevant than ever. As the wealth of nations converges (see ‘Global Inequality’ by Milanovic), the benefits of economic growth and the pain of the economic crisis have been unevenly distributed within countries. The opulence of the rich painfully contrasts with the desperation of those at the bottom.

The Rotterdam Global Health Initiative (RGHI) seeks to contribute to a world where all children, men and women have the opportunity to develop to their fullest potential, to thrive, and to lead healthy lives. This requires multi- and inter-disciplinary research. Through the RGHI, our institutes have joined the forces of the social sciences, economics, health care management, public health, and the (bio)medical sciences. The RGHI builds a community where global health researchers exchange ideas, develop new research projects, and produce collaborative papers; and where PhD students meet with each other and with more senior researchers from other disciplines.

Through coalitions across RGHI institutes we have successfully acquired large projects, for example on Neglected Tropical Diseases funded by the Bill and Melinda Gates Foundation, a Research Excellence Initiative grant on Universal Health Coverage, and an ORIO grant to evaluate Foreign Affairs’ investments in maternal and child health in Ethiopia.

After an energetic pioneering phase led by Godelieve van Heteren, the RGHI has now become truly embedded in our institutes through the Management Team consisting of Tanja AJ Houweling (Dept. Public Health, ErasmusMC), Matthias Rieger (International Institute of Social Studies), Robert Sparrow (International Institute of Social Studies), and Leander Buisman (Institute of Health Policy & Management). They are supported by communications officer Meg Perry-Duxbury (Institute of Health Policy & Management). We value the experience they bring to the table and look forward to the activities that they will develop.

Prof. dr. Johan Mackenbach (Dept. Public Health, Erasmus MC)
Prof. dr. Inge Hutter (International Institute of Social Studies)
Prof. dr. Werner Brouwer (Institute of Health Policy & Management)

News
Farewell drinks – Godelieve van Heteren
On January 31st we had the farewell drinks of Godelieve van Heteren. At her drinks, she handed a pamphlet entitled "EUR - Lof der Zotheid 3.0", containing visionary ideas for Erasmus University, to rector magnificus Prof. Huib Pols.  After several years of working for Erasmus University, and leading the Rotterdam Global Health Initiative, Godelieve will work for the World Health Organisation in the field of global health governance.  We thank Godelieve for the relentless energy that she has invested in setting up the RGHI.  
Dr. Ellen van de Poel to World Bank
Dr. Ellen van de Poel (Institute of Health Policy & Management) has taken up a new position at the World Bank. She will work for the Global Financing Facility , which supports countries in improving maternal, child and adolescent health. You can view her recent TEDx talk here, and follow her on twitter (@EllenVandePoel).

We would like to thank Ellen for her work as part of the RGHI management team.
Cervical Cancer Prevention in Kenya
Famous fistula surgeon from Kenya, Dr. Mabeya, gave a presentation about cervical cancer prevention in Kenya. Dr. Mabeya is one of the few fistula surgeons in Kenya. During his operations he came across many cases of third or fourth stage cervical cancer, driving him to do a PhD about cervical cancer prevention. On 28 February, he gave a presentation about his work at Erasmus MC.
Call for Twitter & Newsletter Content
Network members are encouraged to send any news or information on upcoming events and recent publications the wish to be advertised to Meg, the new communications officer (perryduxbury@bmg.eur.nl). This information will then be distributed through twitter, the website and the newsletter. 

Events

RGHI Network Meeting
March 22nd, 2017
15:00-1700, Na-2102, Erasmus MC
With: presentation of the new RGHI Management Team, presentation about the RGHI, a 3-minute Thesis Competition, and drinks. The 3-minute thesis competition is an exciting opportunity for PhD students to present their research – in 3 minutes or less! – and to meet other global health PhD students and their supervisors from the EUR and Erasmus MC. The competition is open to all EUR and Erasmus MC PhD students working in the broad field of global health. With prizes for the best talks! Registration for the competition is now closed, however you can still register for the meeting with Tanja Houweling using the button below. 
 
Register
The LolaHESG 2017 conference will be held on 11-12 May at Zalmhuis in Rotterdam. Keynote speakers will be Pedro Pita Barros (Universidade Nova de Lisboa) and Eddy van Doorslaer (Erasmus University and  RGHI). RGHI will organize a special session on Global Health. Registration as discussant or chair is open until13 March, through the lolaHESG  website.
Register
Seminar by Alec Morton (University of Strathclyde)
6 April 2017, 12:00-13:00 at EUR Room: H12-30
"Allocation Rules for Global Donors"
Seminar by David Eton (ass. Prof. in health sciences research, Mayo Clinic, Ireland)
7th April 2017, Erasmus MC Room: OWR-36
“The burden of treatment in chronic illness: Exploration of the concept and development of a measure to assess it". Register with Anja Bik (a.bik@erasmusmc.nl).
Seminars
To stay up do date with seminars from iBMG and ISS please check the links below:
Health Economics Seminars (iBMG/ESE)
ISS Events
Upcoming Global Health Conferences
2017 International Health Conference, 29th June - 1st July, Oxford UK.
Theme: Patient Centered Care
Submission deadline is 20th March
iHEA Biennial Congress, 7th-11th July, Boston, USA. 
Theme: Revolutions in the Economics of Health Systems
Pre-congress sessions on UHC and evaluations in low - and middle- income countries. 

Research & Publications

ISS and EUR Won an Evaluation of ORIO Project 'Boosting Maternal and Child Health in Wollega, Ethiopia'
The Facility for Infrastructure Development (ORIO), implemented by the Netherlands Enterprise Agency (RVO) and financed by the Netherlands Ministry of Foreign Affairs, aims to encourage the development of public infrastructure in developing countries. A few months ago the RVO launched a tender for the evaluation of a project titled, “Boosting Maternal and Child Health in Wollega, Ethiopia”. The ISS, EUR (Institute of Health Policy and Management), Erasmus MC (Dept. Public Health) and Georg-August Universitat Gottingen have won this tender (€ 478,324,-). The primary objective of the project is to improve the quality of maternal health care services to a target population of more than 4.6 million residing in Wollega, Ethiopia. The project is led by Prof. dr. Arjun Bedi (ISS) and Dr. Ellen van der Poel (iBMG). Other team members include Dr. Natascha Wagner (ISS) and Dr. Tanja Houweling (Erasmus MC). The project will run untill early 2020.  
 
Dr. Tanja Houweling (Dept. Public Health) recently published a paper on health insurance coverage and neonatal mortality in Colombia, with colleagues from the UK and Colombia. Using vital registration data for 2.5 million live births, they show that employment-based health insurance is associated with lower neonatal mortality than government-subsidised insurance or lack of insurance. This suggests that universal health insurance alone may not be sufficient to close the socioeconomic gap in neonatal newborn mortality.
A consortium from the Dept. of Public Health and the Institute of Health Policy & Management recently published a series of papers in the high ranking journal PLOS NTD. These papers were the output of a project for the Bill & Melinda Gates foundation. In these papers the consortium describes the health burden and economic burden of NTDs, their inequitable distribution between and within countries, and the socioeconomic benefits of tackling NTDs.
 
As more and more countries are shifting towards Universal Health Coverage (UHC), it is essential to gauge the aggregate impacts of such a policy. RGHI members Matthias Rieger, Natascha Wagner and Arjun Bedi from the ISS used synthetic control methods to construct counterfactuals in order to estimate the impact of Thailand's UHC reform on a set of macroeconomic and health outcomes. Results suggest that UHC managed to alleviate the financial consequences of illnesses, while there was no effect on GDP per capita. The study complements previous studies at the micro level and may inform other countries about the aggregate effects of UHC.
Zemzem Shigute, Anagaw Mebratie, Robert Sparrow, Zelalem Yilma, Getnet Alemu and Arjun Bedi, published a paper in which they assess the interaction between a Community Based Health Insurance in Rural Ethiopia and the Productive Safety Net Program, the flagship social protection initiative of the Ethiopian government. They find that participation in existing social protection programs can be leveraged to increase informal sector uptake of health insurance.
RGHI members Arjun Bedi and Robert Sparrow, together with colleagues from the SMERU Research Institute in Jakarta, look into the proliferation of local health care financing schemes in Indonesia over the last decade. These schemes, implemented and operated by district governments, can indeed play a role in meeting the missing middle coverage gap and improve access to public health care in remote and rural areas. However, the results also reflect the limited scope of local schemes, as they are hampered by regional disparities in resources and quality of public service.
Igna Bonfrer, Lyn Breebaart, and Ellen Van de Poel from the Institute of Health Policy & Management recently published a paper in which they evaluate the early effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization. They find that National Health Insurance Scheme had a modest impact on the use of antenatal and delivery care.
The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. Adam Wagstaff, Daniel Cotlear, Patrick Hoang-Vu Eozenou, and Leander Buisman published a paper in which they propose a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving the care. In a sample of 24 countries for which they have detailed information on UHC-inspired reforms, they find that countries have mostly improved their UHC scores between the earliest and latest years for which they have data—by about 5 points on average. However, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.
New PhD Students
Three new PhD students have joined the RGHI network in the last half a year:
Evgenia Kudymowa (ESE), Kaya Verbooy (iBMG) and Pugo Sambodo (iBMG).
Evgenia's is involved at present in a field experiment on cardiovascular disease risk perceptions in the Philippines, Kaya is currently working on supply-side readiness in Indonesia, and Pugo is looking into Universal Health Coverage in Indonesia. 
We are looking forward to hearing more about their research in the future!

RGHI Member in Focus - Natascha Wagner

Can you tell us a little bit about yourself and your research interests?
NW: I am an assistant professor of Development Economics at the International Institute of Social Studies, Erasmus University. My research interests lie in international economics, health and development. I have participated in various impact evaluation projects in Africa and Asia ranging from the assessment of public health and insurance programs to HIV sensitization efforts and a program to promote retention and adherence in HIV/AIDS care.
You mention a project on HIV/AIDS. What is this research about?
NW: I am the principal investigator of a randomized controlled trail in Burkina Faso. We evaluate the impact of SMS reminders on retention and adherence of people living with HIV. The project is financed by the International Initiative for Impact Evaluation, 3ie, and carried out in collaboration with the University of Bobo-Dioulasso. The research idea was triggered by the rapid uptake of mobile phones across the developing world in recent years. This development has inspired a host of innovative concepts for how mobile phones can be harnessed to promote public health. Yet, to date, few rigorous evaluations have been conducted demonstrating the impact of “mobile health” (mHealth) interventions. For more details see here
 
What are some of the early lessons learnt from this ongoing project?
NW: In the course of the project it became apparent that the SMS reminders are not perceived as simple reminders but rather as a form of psychosocial support. Recipients report to us that they feel appreciated and encouraged through the messages.
 
Aside from that, the study setting and timing of this project are particularly interesting. Since we first started the project, Burkina Faso has experienced two coups d’état and a major terrorist attack. While these events delayed our activities, we were lucky to have dedicated colleagues on the ground, who kept working for the project even when the conditions were rough.
 
Finally, let me ask you what you find valuable about the RGHI network?
NW: RGHI is a great platform to connect health researchers from the different departments of Erasmus University with each other, but more importantly with researchers, practitioners and policy makers outside of Erasmus University. Furthermore, I like that the network acknowledges the need for interdisciplinary research and collaborative efforts. I share RGHI’s mission that researcher and health practitioners should work together to help diminish health inequalities between and within countries.

PhD Student in Focus - Zemzem Shigute Shuka

Which institution/ dept. are you working at? Who are you working with? 
I am a PhD Researcher in the International Institute of Social Studies. I work in the Economics of Development and Emerging Markets (EDEM) research group with prof. Arjun Bedi as my promotor and dr. Matthias Rieger as my co-promotor.
 
How long have you been working there?
I have been in the PhD program for three and half years.
What is your research focused on? 
My PhD research focuses on analysing social protection programs in Ethiopia, in particular, the two main programs in the country: the Productive Safety Net Program (PSNP) and Community-Based Health Insurance Scheme (CBHI). I am examining their joint impacts on labour supply and asset accumulation as well as the role of community participation in the PSNP and the quality of infrastructure created through the PSNP.
 
You recently published a paper “Uptake of Health Insurance and the Productive Safety Net Program in Rural Ethiopia” in Social Science & Medicine, could you tell us more about this research? 
Yes, indeed. This is a co-authored paper which was motivated by the low uptake of voluntary health insurance programs in developing countries and I wanted to examine whether participation in one program – in this case the PSNP, could be used to promote uptake of health insurance.
 
I used longitudinal household surveys, a health facility survey, and qualitative information obtained through key informant interview and focus group discussions and found that participating in the PSNP increases the probability of enrolment in the CBHI by 24 which the PSNP influences CBHI uptake and it seems that, contrary to the idea of voluntary uptake, explicit and implicit pressure is applied on PSNP beneficiaries which is responsible for the large effect of PSNP participation on CBHI uptake. Whether this is ethical or not could be debated, but I was able to clearly show that bundling social protections programs maybe one way of enhancing uptake of health insurance.          
 
What drew you to Global Health? 
After completing my Bachelor’s degree at Addis Ababa University I worked for the government and for various NGOs. One of my assignments dealt with managing the PSNP program. While working for the program I noticed that a number of PSNP participants could not contribute work effort when they were ill. In other words, I noticed a strong correlation between different types of shocks or the so-called, “illness-poverty trap”. This led me to my PhD research project as well as fueled my interest in global health issues.
 
What are your main ambitions for the future? 
My immediate goals are to build a stronger research profile by carrying out multidisciplinary global health-related research which has societal and policy relevance. I would like to develop a career as a researcher/academic especially focusing on Sub-Saharan Africa.
 
Do you have a paper/TED Talk/ Podcast that you enjoy and would recommend us to listen to? 
Yes, I have. It is a YouTube video dealing with the opportunities and challenges of Ethiopia's Pilot Community Based Health Insurance.
Research funding
See: http://rghi.nl/calls-2/calls/ . Log in with your RGHI password.
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RGHI, c.o Erasmus University – iBMG, PO Box 1738, 3000 DR Rotterdam – The Netherlands
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