Learn all about FHI's Health Services Research Group and the Program Sciences Department


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Johannes van Dam, Senior Director, Program Sciences, and Theresa Hoke, Scientist II in the Health Services Research group, will explain the workings of a major department at FHI360 – i.e., the Program Sciences Department. Johannes and Theresa will describe the rationale for the department, what folks there do, and specifically what the Health Services Research (HSR) group does. Come and discuss how the team’s research expertise and skills complement those in the DC office, and explore what might be some fruitful areas of intersection and collaboration.

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  • Part of team of 21 staff who conduct or support programmatic research.The HSR staff members come with diverse backgrounds. One thing we all have in common is research experience in resource-poor settings.
  • Our mission is to conduct applied research to strengthen health services. The term “applied” conveys the idea of our workbeing highly practical. It is driven by country and program needs. Our work is aimed at resolving programmatic challenges and producing evidence to inform programmatic decision making. We typically work in close collaboration with health program managers, host country partners and increasingly FHI 360 country offices.Studies broad range of topics, but most often the research questions revolve around optimizing health services in terms of access, quality, effectiveness at the most affordable cost. Even though our work is largely in the health sector, I suspect these issues affect most programs and services in any sectorCollaborate closely with host country partners build capacity in all steps of the research processSpecial training and technical assistance
  • The usefulness of our work lies in its ability to respond to decision makers’ information needs.Evaluate: projects are implemented as intended and meeting their objectivesWe help to improve the integrity of health programs by examining service delivery processes, identifying problems, and then peeling the onion to understand the full scope of the problem and its underlying root causes.Once an opportunity for service improvement is identified, we conduct operations research to test solutions. In some cases we’re first asked to conduct formative research to support development of evidence-based interventions.In the interest of the sustainability and scaleability of services, we work with our staff economists to measure service costs. In some cases we pair the cost data with service outcome data to assess cost-effectiveness.We also conduct exploratory work to examine the factors associated with the success of health services.
  • Consistent with the mission of legacy FHI, in the earliest days our work was focused almost exclusively on family planning service delivery.In more recent years we have demonstrated the transferability of our research skills to other health domains. Here you see some of the main health services that our work has addressed. I’ll point out one detail. Our work on HIV prevention includes the very current topic of service delivery to support use ofmicrobicides and pre-exposure prophylaxis. HPTN 052, funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID), was the first randomized clinical trial to show that providing early antiretroviral therapy to an HIV-infected person can dramatically lower the risk of sexual transmission of HIV to an uninfected partner — reducing the risk of infection by as much as 96 percent.
  • Medical Waste Management addresses the issue of large amounts of waste generated in a health care system, a good part of which is potentially dangerous, either because it contains medications or infectious material – or even, more so in middle/high-income countries, radio-active. Emily Keyes is working on this, through a CDC-funded activity, Janet Robinson is working on this, and Bitra George is trying to see if we can do this as a for-fee service line. How to dispose of the waste in a safe and efficient manner, is the real issue.Example of health systems strengthening: Job worker retention: Aurélie is doing work on health worker retention, using a Discrete Choice Experiment approach – I think she is doing this in Rwanda. This involves offering health care workers a range of choices for different combinations of incentives to figure out what it takes to keep HCWs in their jobs. This falls under health systems research, and more especially the human resources building block.
  • Our work allows us to work with a variety of partners supporting health service delivery in resource-poor settings. International NGO like Save the Children.In other cases we are called to collaborate with local community based organizations responsible for service delivery.FHI 360’s country programs provide excellent opportunities to conduct applied research highly relevant to ongoing service delivery. Look forward to identifying new opportunities for collaboration with field activities of legacy AED.Finally, we frequently have the opportunity to collaborate with other CAs. Typically they are the lead in implementing a particular service or program, and HSR is called upon to lead research to produce evidence regarding intervention effectiveness.
  • We work at a variety of levels--wherever health services are delivered or decisions about programming get made.Often the context of our work is dictated by the populations being served. For example, services focused on postpartum women leads us to health facilities. Research on services for youth has taken us to schools and CBOs. And not surprisingly, research on most at risk populations has driven us to bars and brothels.
  • With that overview, I’d like to provide some specific examples of the questions HSR researchers have been called on to answer, and the types of projects we have carried out.
  • I mentioned one major aim of our work is to find service delivery solutions to improve access to care. Much of this work has been done in the family planning sector. Several studies have examined whether it is feasible and effective to create linkages between family planning and other health services. For example, we have tested the effect of integrating family planning into VCT (Kenya), PMTCT (SA), immunization (Ghana), C & T (Rwanda, Tanzania) Another potential strategy for increasing access is through task shifting, whereby clinical responsibilities are shifted to providers with less professional training. The best example of that are the studies we’ve conducted with community health workers in Uganda, Madagascar, Malawi, Zambia. We assessed whether family planning uptake increased among women in remote rural areas once community health workers were trained and authorized to provide injectable contraceptives.We have also tested the feasibility and usefulness of providing contraceptives through the commercial sector, such as pharmacies in Jamaica and drug shops inUganda.
  • Other sectors: Microfinance (India), environment (GBM, Kenya), agriculture (LandoL, Kenya)
  • Our health economists use their skills to assess how programs are using their resources, and the implications for the cost of programs and program effectiveness.  Since the need for resources typically exceeds the pool of available resources, making the most of limited resources becomes essential when trying to increase access, improve quality, or increase the effectiveness of programs.FHI360’s health economics group (part of HSR) is collaborating with the Social Marketing and Communication Center at FHI D360 to respond to an opportunity from the Center for Medicare and Medicaid Services (CMS).  FHI360 economists are helping to define the cost savings associated with an initiative to improve palliative care for Medicare beneficiaries. 
  • Increasing recognition of the need to invest in the most effective and cost-efficient program strategies possible Better use of evidence to inform programming Generation of new evidence where gaps exist(Program Research for Strengthening Services) is a five-year project awarded to Family Health International (FHI) by the U.S. Agency for International Development (USAID) in June 2008.  The project seeks to improve access to family planning among underserved populations in developing countries by providing global technical leadership and undertaking concentrated activities in selected countries. In addition to strengthening our internal research presence in SSA, we are working with two local bodies to install programmatic research capacity (specifically around RH). The goal is for these bodies to become recognized local producers of high-quality programmatic research for both the Ministry of Health and other  implementing partners.  The longer term goal is for these organizations to be able to compete for and win external funding for programmatic research.
  • D 360’s: With extensive expertise ranging from behavioral research to surveys to rapid needs assessments to program evaluation, AED helps ensure that strategies and programs are firmly grounded in science
  • Learn all about FHI's Health Services Research Group and the Program Sciences Department

    1. 1. FHI 360 – Program Sciences and Health ServicesResearch (HSR)Presented byJohannes van Dam Sr. Director, Program SciencesandTheresa Hoke, Scientist IIJanuary 10, 2012
    2. 2. Introduction Frank Beadle de Palomo Senior Vice President and Director, GHPN
    3. 3. Presenters Johannes van Dam Theresa Hoke Director, Program Sciences Scientist III
    4. 4. Program SciencesPresented by Johannes van Dam Sr. Director, Program Sciences
    5. 5. Overview• New organizational structure - ??• New opportunities• Collaboration between country programs and US- based programs
    6. 6. Global Health and Development(effective Oct. 1 2010) Chief Operating Officer Global Research Services Health and Development Global Portfolio Sciences Management Country Office Country Office Country Office Country Office Science to Practice Sites ... 1 2 3 N Practice Areas Global Systems Africa Team 1, Program Management Africa Team 2 Africa Team 3 APRO Team Global Projects Support including Haiti Program Sciences Behavioral and Social Sciences Science and Technical Learning Services Clinical Sciences Quantitative Sciences Science Facilitation Product Quality and Compliance Information Technology (IT) Operations Support (OS) (includes Knowledge Management)
    7. 7. Program Sciences• Africa Regional Technical Team• Health Services Research• Health Systems Strengthening• Strategic Information/M&E• Technical Support• Laboratory Services• PROGRESS
    8. 8. Program Sciences – interface of science and programs• Health Services Research (HSR) – To follow• Strategic Information – M&E, HMIS and surveillance – Data Quality Assessment tool – BBSS
    9. 9. Program Sciences - continued• PROGRESS – Expanded access to quality FP services (R to P) – Task shifting: e.g. CBA2I – Increase method mix: post-partum IUD, sino-implant, LNG IUS – Non-health sector: MF institutions; environmental groups; agriculture sector (LOL)• Health Systems Strengthening (HSS) – HSS strategy – Rapid assessment tool – QA/QI and CQI model to go to scale
    10. 10. Program Sciences - continued• Laboratory Sciences – Lab quality improvement (incl. international accreditation) – Medical waste management – Expand in Africa and Asia• Technical Assistance and Support – A global network, with a hub in the Africa Regional Technical Team – Provides TA in program design and implementation – Support for research & builds research capacity
    11. 11. FHI 360 Global TA System• Push and pull system, meeting program needs (“pull”) and quality assurance (“push”)• Linked to Technical Quality Assessment tool, currently being field-tested• Seeks to make optimal use of technical expertise in FHI 360, regardless of location• Africa Technical Team well positioned to identify, nurture and broker regional TA• Track and monitor quality of TA provided
    12. 12. New Funding Environment• Country ownership• Responsive to national priorities• Better M&E, more operational research• Better value for money: – Costing – Efficiency – Outcomes and impact• Sustainability• From implementation to capacity building
    13. 13. New and Old Priorities• Increase efficiency of ART programs• Chronic/non-communicable diseases (CVD, hypertension, diabetes, lung disease, cancers)• Health Systems Strengthening• HIV prevention (PrEP, male circumcision, microbicides)• Prevention for Positives• Strengthen PMTCT• FP/RH, including maternal health• Other infectious diseases (TB, malaria)
    14. 14. Programs and Program ScienceProgram Science in support of Country Programs
    15. 15. HEALTH SERVICES RESEARCH (HSR) Presented by Theresa Hoke, Scientist II
    16. 16. Who We AreSpecialists in…• Public health• Maternal and Child Health• Economics• Statistics• Epidemiology• Health behavior• Health policy• Engineering• Medicine
    17. 17. What we do• Conduct APPLIED RESEARCH• Focus on optimizing – Access – Quality – Effectiveness – Cost• Build capacity in research and evidence-based programming
    18. 18. Why applied research is usefulThrough applied researchwe…• Evaluate programs• Identify and diagnose service delivery problems• Develop and test programmatic solutions• Examine costs and cost- effectiveness• Investigate determinants of intervention effectiveness
    19. 19. Traditional research contexts• Family planning• HIV prevention, care and treatment• Maternal and newborn health• Post-abortion care• Reproductive health services & education for youth• Male circumcision for HIV prevention
    20. 20. Moving into new sectors• Agriculture• Environment• Micro-finance• Waste management• Behavioral economics• Health systems research
    21. 21. Who we work with• Host country government partners• NGOs• Grassroots organizations/ CBOs• FHI360 Country offices• USAID CAs
    22. 22. Where we work• National, regional and district levels• Facilities – clinics – schools – program sites• Communities• Sub-group populations – postpartum women – PLWHA – youth – MARPs
    23. 23. Selected examples of recent HSR research
    24. 24. Increasing access to family planning services•Is it feasible and effective to strengthening linkageswithin health services?•Does task shifting/task sharing increase access toservices?• What are the alternatives to public sector services?
    25. 25. Increasing access: Facilitated referrals in TanzaniaAimDevelop & test a facilitated referral model to integrate FP and HIV servicesApproach• Trained providers• Introduced service delivery guidelines & job aids• Evaluated service delivery process & measured impact of contraceptive uptake by Care & Treatment clientsKey Findings• Modern FP use increased from 78% to 93%• Service quality improved
    26. 26. Improving quality• How is service quality affected – by integration? – by task shifting?• What is the effect of trainings and job aids on provider performance?• Does client satisfaction increase with service innovations?• How can systems be strengthened to ensure technical and material resources are in place to permit high quality service delivery?
    27. 27. Improving Quality: Emergency Obstetric & Newborn CareAimTo identify gaps in delivery ofessential emergency obstetric andnewborn care (EmONC)ApproachProvide TA to MOH and UN partnersin conducting national facility-basedsurveysAssess availability of “signalfunctions” for EmONC servicedelivery
    28. 28. Improving effectiveness• How can we encourage full use of available technologies?• Is integration of family planning into the work of other sectors an effective approach to achieving mutual programmatic goals?
    29. 29. Improving effectiveness: Integrating Family Planning Promotion into the Green Belt MovementAim• Assess the feasibility and effect adding FP promotion to the duties of Green VolunteersApproach• Design and implementation of multi-component intervention• Collect post-intervention data collection to assess Green Volunteers’ success with incorporating the innovation into their duties.
    30. 30. Cost Issues: Improving efficiency & increasingsustainability • Estimating the cost of service delivery • Estimating cost of scaling-up interventions • Assessing cost-effectiveness of alternative approaches to service delivery • Documenting resources required to support transition to local ownership • Preparing costed implementation plans to support resource mobilization • Linking resources used to outputs produced (value for money assessments)
    31. 31. Capacity BuildingAfrica Regional Technical Team is strengthening FHI360staff capacity to:• Identify challenges and knowledge gaps• Articulate research questions• Integrate evaluation and research into program proposals• Conduct programmatic research and evaluationPROGRESS Project: Building programmatic research skillswith local partners• National University of Rwanda School of Public Health• National Institute of Medical Research – MMRC (Tanzania)
    32. 32. How we can collaborateTransferability• Our skills in applied research / program evaluation are transferable to programs outside the health sector.Complementarity• Skills in study design, operations research, data collection and analysis, and results interpretation and dissemination complement program implementation capabilities.
    33. 33. Conclusion• Donors/programs in all sectors are increasingly concerned about issues of access, quality, effectiveness, and cost.• Opportunities to conduct applied research continue to arise.• We are seeking mutually beneficial opportunities to collaborate and learn more about the programs you support.
    34. 34. Discussion
    35. 35. THANK YOU!!!