Dozens die in Burkina Faso crash

On November 16, 2008, in Burkina Faso, road traffic injuries, by Karen Grepin

BBC NEWS | Africa | Dozens die in Burkina Faso crash

Generally I am very happy to read anything in the international media about Burkina Faso – a country where I spent a great deal of time a few years back and one of my favorite places in the world. Last night, however, I was saddened to read about a horrific traffic accident that has claimed the lives at least 66 people, likely many more, on the road a few hundred kilometers west of Ouaga.

Road traffic accidents claim thousands of lives every year in countries like Burkina, and as this article suggests, their incidence is not totally haphazard. Accidents can largely be predicted, hence they can also be prevented. What could have been done in this case? Well for starters, perhaps not crowding almost a hundred people into a single truck would have least minimized the losses. Not traveling at night on roads that are poorly lit and known to be in poor shape. Maybe working on the roads so that they are not always in such bad shape. I’ve seen potholes so bad and so deep on roads in Northern Ghana that flipped a transport truck over.

My thoughts are with the families of this horrific accident. Most were traveling to Cote D’Ivoire, presumably to earn a living to feed and school their families.

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Sorry for the silence

On November 16, 2008, in Africa, aid effectiveness, global health, health systems, research, by Karen Grepin

As you may have noticed, my posting has become a bit irregular as of late. That is because I am in crunch time right now trying to get my papers out. Anyway, if anyone is interested in reading the latest version of my paper on the effect of health aid, in particular HIV/AIDS funding, on health systems, it is available here. See the paper entitled “Too much of a good thing”. Comments are most welcome!

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Doctoral studies in global health

On November 11, 2008, in education, global health, by Karen Grepin

Although I have recently blogged about new masters programs in global health, as well as a post-doc in global health, I have not posted about doctoral programs. A reader recently asked me to make such a post, so here goes.

To answer the reader’s question, what doctoral program is best for you I think depends heavily on what you plan to do with the degree. I am currently in my final year of my doctoral studies and am “on the market” looking mainly for academic positions that would allow me to continue to teach and research my particular interests in global health. I have made a few observations:

First, I have been somewhat surprised at how few non-academic positions there are that are requiring doctoral qualifications. Most of the more interesting positions that I have thought about applying to seem to be happy with either a masters and a few years of experience or a doctorate, which does lead to the question, why did you do I do a doctorate in the first place? While there is a lot of activity ongoing in global health, so far there is not as many research as perhaps there should be. This could change, hopefully this will change, but I don’t see it yet. The only places that seem to require this are places like the World Bank and the IMF, so if this is where you want to go, then a doctorate is required. PhDs are long and painful, and not necessarily for everyone, so I would give this some careful thought.

Second, global health programs are hot. I can’t get over the number of schools now interested in having a course, or two, or more on global health. This is true at the undergraduate and graduate levels. Plus, there is interest in creating more doctoral type programs. The main shortage appears not to be a lack of interest among students, universities, or donors, but rather a lack of faculty to mentor and teach in this programs. The interest from students and universities is so great, and the lack of faculty is so pronounced that many of the programs don’t seem to care what discipline the professor is from. This might be a good thing in the sense that it means more interdisciplinary environments and more opportunities, but it could also represent a lack of focus. It could also be a sign that there are not enough doctoral programs producing enough qualified professors.

Third, I think it does matter what discipline you have, and that I think it is important that you do the best you can in the discipline you are interested in. If it is economics, you need to be taking very advanced economics courses in your program, and my own observation is that not all programs are currently offering this to their students. This is true for anthropology, sociology, history, and just about everything else as well. My own training has been very rigorous, painful at times, but in retrospect I am now very happy to have had this chance. So to some degree I would say if you really do want to do rigorous academic research in global health, choose a discipline and get a doctorate in the top school in that discipline even if there is no one else there doing global health. It would be great if there was someone at that place who could mentor you. Plus, it would help that if there is a global health related program at your university of choice, so that you can get connected to what is going on in the field through lectures and contacts.

Look to see where students from your program of interest go when they graduate. I find that is perhaps the best way to judge. Do most end up in quasi-research positions in international health organizations? Is that what you want? Do many end up in universities? Is that what you want? Chances are you’ll end up in a very similar position to other graduates in your program.

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More beautiful photos from Africa

On November 7, 2008, in Africa, photography, by Karen Grepin

A few weeks back, I posted a link to some photos from chronicling the spread of multi-drug resistant tuberculosis across Africa. The famed fashion photographer – Rankin – has now added his skills to the mix in capturing the faces and challenges of Africa.

In his photos, recently taken a refugee camp in the “Democratic” Republic of Congo, he captures the human side of this conflict, which has raged throughout the region for over a decade. Rather than capturing these people in the typical milieu we have come to expect from this type of situation, he sets their photos against a white backdrop, leaving us unable to escape the personalities and emotions of the people in the photos.

Click here for a link to the photos.

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One of my current research areas focuses on the effect of health development assistance on health systems and health in developing countries. There have been a number of other scholars who have looked at the question of whether or not donor priorities “match” disease priorities in developing countries. I have blogged about them before, including the work of Devi Sridhar, Jeremy Shiffman, and others.

In JAMA this week, there is another related editorial on this topic. In this piece, the authors argue not that there is a mismatch between donor priorities and disease burden, but make a different point. Rather they argue that HIV/AIDS treatment programs are much less cost-effective than other programs that do not receive nearly as much attention from donors. They argue that the US government could be achieving much more health if they were to focus on better buys, in particular by focusing on maternal and child health programs.

While I agree with the point the authors make, I want to argue that even this type of thinking misses the point. I think any attempt to tackle poor health in developing countries must take a systems view. The assumptions that have been made to come up with calculations for cost-effectiveness rarely take into consideration whether or not the resources are available to scale up the programs. What might be true in a few studies is rarely true at the national level.

Investments into education, training, sustainable financing that creates incentives for quality care, and infrastructure is what is needed to build health systems. It is not sexy stuff, plus it will take years before this type of approach will generate results, but it is what is going to be needed if real improvements in health are our goal.

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Rigorous health-systems research?

On November 6, 2008, in health systems, political economy, research, by Karen Grepin

Last week’s Lancet had an editorial from Anne Mills and co-authors that discusses the inherent difficulties in conducting health systems research. They argue that while the standards for such types of studies will never reach the standards required in medical research, they must be improved over the current state of affairs.

As I health systems researcher myself, I could not agree more. I get frustrated at the lack of efforts to properly evaluate health system interventions. I spent last week attending health systems research sessions at the annual APHA conference, and I am not sure I attended a single lecture that even bothered to include a control group. Just because a non-control group study design is a “study design”, it does not make it a good one. A while it is fine to go ahead with such evaluations, because I also agree we can learn from these exercises, caveats must be made, major ones, in the interpretation of the results.

The Mills editorial points out that a major policy initiative, that of user-fees, had limited evaluation prior to its widespread introduction. Had the results of two widely-cited early studies been more carefully examined, or the generalizability of these studies been questioned, we may have come up with a different conclusion about the expected effects of user-fees.

Political scientists, in particular political economists, I feel do a much better job of learning about system level changes. I think health system researchers could learn a lot from learning more about the methods that are employed in these types of studies.

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Donor financing for malaria in Rwanda

On November 1, 2008, in health financing, malaria, Rwanada, by Karen Grepin

Bill Brieger blogged about a session I also attended last week at the APHA conference in San Diego. At the session, an Abt associate presented results on donor financing for malaria in Rwanda. Rwanda is one of the countries which is currently receiving praise for its successes at reducing malaria burden.

What the Abt NHA report shows, is that despite an increase in overall expenditures on malaria, governments expenditures decreased in both relative and absolute terms over this time period. When donors scaled up their support for malaria control, public sources actually dried up.

Should governments be expected to pay for thees programs? Is this an appropriate response of government? It is certainly a move away from sustainability, but at what point do we begin to expect sustainability in financing of large scale programs of this nature?

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