I am hiring in Kenya

On January 31, 2012, in jobs, Kenya, by Karen Grepin

I will be kicking off 2 exciting maternal health experiments in Kenya in the coming months: one looking at the impact of financial and informational incentives in incentivizing use of maternal health services in Western Kenya and the other looking at the savings behavior of pregnant women in Nairobi. For both, my awesome co-authors and I are looking to hire a full-time Research Assistant to work for us and with our collaborating partners in Kenya – who are also awesome.

We are looking for people who could start in the few months (ideally in March), have solid quantitative training at least at the undergraduate level (masters preferred), and who are willing to commit to these projects for at least a year, ideally more. Some developing country experience is desired, although if your training is amazing, we might overlook it. If you are interested, google me and send me your CV. Please only email me if meet the above criteria.

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PBF: Plumbing Based Financing?

On January 27, 2012, in aid effectiveness, health financing, Rwanada, by Karen Grepin

One of the most remarkable parts of being engaged on Twitter is the types of global health “celebrities” who have begun to engage actively on this network. Whether it be Richard Horton, the editor of the Lancet asking readers for input, Rob Yates, Senior Health Economist at the WHO extolling the virtues of free health care services, or Martin McKee linking to his weekly publications in top ranked journals, there is never a dull moment for me.

But perhaps one of the most interesting personalities to have begun to engage actively via Twitter is Agnes Binagwaho, the Minister of Health of Rwanda, who in addition to tweeting actively runs a regular #MinisterMonday discussions where she asks Tweeps to submit questions in real time and she responds to them publicly via Twitter.

This morning she used Twitter in another way: she announced that the Ministry of Health has issued a 3-month ultimatum to all hospitals in Rwanda to build sufficient toilets in their facilities or risk losing the additional financing that has come online in Rwanda through what is known as the “Performance Based Financing (PBF)” scheme. I love it: it is bold, it is unconventional, and it might even work. Toilets are not sexy but I can tell you as a pregnant woman myself, they are completely indispensable in my life and the thought of spending anytime at a facility – even a hospital – without one is unthinkable (and we wonder why women don’t like delivering in public hospitals?).

In my view, Rwanda has become a bit of an outlier in recent years in health system improvement efforts, largely due to this unconventional approach to implementing programs and their willingness to try new things. Perhaps this initiative might even catch on elsewhere?

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Earlier today the UK government announced that it was increasing by five (5!!) fold its funding commitments to tackle the Neglected Tropical Diseases in the developing world. It has committed to increase its contributions to the NTDs to $380 million over four years. That may not sound like a lot of money relative to what is spent on HIV or malaria but for the group of diseases known as the NTDs, this is actually a lot of money. It probably means tens of millions of treatments against these diseases will be able to be delivered in the coming years.

Other donors have also recently announced significant increases to tackle these diseases, including Sight Savers, a charity that targets onchocerciasis, a leading cause of blindness globally among other vision related causes. And I’ve heard word that we should expect some big announcements, in particular from the Gates Foundation, in the next few weeks of more resources to be given to the NTDs.

So why are the NTDs doing so well at attracting funding in the current funding climate? Perhaps it has to do with the perceived and mostly demonstrated effectiveness and cost-effectiveness of the interventions being proposed. Perhaps the fact that is is by nature an extremely equity enhancing set of diseases to go after (they tend to only affect the poorest of the poor). Perhaps it is the feeling that with proper scale up donor commitments might actually lead to elimination of these diseases. Or perhaps it has just been continued advocacy efforts from those who believe in the cause.

Regardless, it is good news, and I am looking forward to more good news in the coming weeks.

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My New Year’s Resolutions

On January 19, 2012, in books, by Karen Grepin

So as you may have noticed my blogging has been sparse of late, and while I have lots of minor excuses to report (heavy fall teaching load, two big grants launching in Kenya, lots of papers) the best excuse I have is that I am now 5 months pregnant (again) expecting another little boy in May (i.e. 2 weeks after classes end). This pregnancy has been a bit harder on me than my last, making more dizzy and exhausted, leaving little energy or enthusiasm for reading or for writing. The good news is that I seemed to have turned the corner and among my New Year’s resolutions is to get back to reading and to blogging once again.

Also among my New Year’s resolutions is to read more, specifically to read more books. I spend so much time reading blogs and online materials that I never seem to find the time to read real books, and I miss it. Last year I think I managed to only read a handful of books. So this year, the plan is to read at least 30 books.

How am I doing so far? Well since the start of the year I have finished Jacques Pepin’s book “The Origin of AIDS” and am mostly through Vinh-Kim Nguyen’s “The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS“.

Up next? I plan to read “The Grandest Challenge” by Abdallah Daar and Peter Singer, “Changing Planet, Changing Health” by the recently deceased Paul Epstein, and “A Heart for the Work: Journeys through an African Medical School“.

For the good ones, hopefully I’ll get some reviews up here. But in the meantime, if you have any suggestions as to what I should be reading on global health, please share….

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Blogging has been light around here lately (more on all the things happening in my life shortly) but in the meantime, a comment published in the Lancet this week was so right on the money that I knew I had to blog about it…immediately.

In this comment, Wendy Graham (whose work I profoundly admire) and Beena Varghese argue that current proposed efforts to improve Maternal and Child Health via the UN Secretary-General’s new Global Strategy for Women’s and Children’s Health are nothing less than “insane”. They argue it is time to, in their words:

…seize this opportunity to address a global insanity—continuing over and over again to deliver poor-quality health services for women and children and yet expecting positive results.

What is the problem with current efforts? They argue that current efforts are too focus on expanding “coverage” and are not focused enough on exactly what is delivered and how – that is the quality of services delivered. I could not agree more.

“What you count is what you do” is a reality that helps to explain the national and international neglect of quality targets. There is a danger of presuming sustained reductions in mortality on the basis of increased coverage of services but without intelligence about the content and quality of care.

Specifically, they argue:

This repositioning requires something else to be done differently: to routinely and robustly monitor quality along the continuum of care, including users’ perspectives as well as providers’.

What?! Asking women what they actually want and what it is they value in terms of the services that are being made available to them?! That is just crazy talk! What do they know! Actually, that has been a big part of some of the new projects I have been working on this past year in Kenya and to some extent in Ghana (see excuse above to justify the lack of blogging).

A highly recommended read.

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