Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda
Gates Open Research
We describe the development and testing of a hybrid implementation research framework to understand the pathways, successes, and challenges in addressing amenable under-5 mortality – deaths preventable through health system-delivered evidence-based interventions – in low- and middle-income countries. We found that a hybrid framework building on and adapting existing frameworks was successful in guiding data collection and interpretation of results, emerging new insights into how and why Rwanda achieved equitable introduction and implementation of health system EBIs that contributed to the decline in U5M, and generated lessons for countries working to drop U5M.
Hirschhorn LR, Frisch M, Ntawukuriryayo JT, VanderZanden Amelia, et al. Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda [version 1; peer review: awaiting peer review]. Gates Open Res 2021, 5:72 (https://doi.org/10.12688/gatesopenres.13214.1)
It takes a community: a landscape analysis of global health research consortia
BMJ Global Health
The increased recognition of the core role of effective primary healthcare has identified large gaps in the knowledge of components of high-quality primary healthcare systems and the need for resources positioned to better understand them. Research consortia are an effective approach to generate evidence needed to address knowledge and evidence gaps and accelerate change. However, the optimal design of consortia and guidance on design decisions is not well studied. We report on a landscape analysis to understand global health research consortium models and major design decisions that inform model choice.
VanderZanden A, Langlois EV, Ghaffar A, et al. It takes a community: a landscape analysis of global health research consortia. BMJ Global Health 2019;4:e001450.
https://gh.bmj.com/content/4/Suppl_8/e001450
Causes of death and predictors of childhood mortality in Rwanda: a matched case-control study using verbal social autopsy
BMC Public Health
Rwanda has dramatically reduced child mortality, but the causes and sociodemographic drivers for mortality are poorly understood. We conducted a matched case-control study of all children who died before 5 years of age in eastern Rwanda between 1st March 2013 and 28th February 2014 to identify causes and risk factors for death. We identified deaths at the facility level and via a community health worker reporting system. We used verbal social autopsy to interview caregivers of deceased children and controls matched by area and age. We used InterVA4 to determine probable causes of death and cause-specific mortality fractions, and utilized conditional logistic regression to identify clinical, family, and household risk factors for death.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6282-z
Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.
The Lancet
Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31012-1/fulltext
Examples of case studies and reports I have developed or co-authored for major global health organizations include:
What Does Community-Oriented Primary Health Care Look Like? Lessons from Costa Rica
I partnered with researchers and decision-makers from Ariadne Labs and the Commonwealth Fund to develop a decision brief exploring Costa Rica's successful institutionalization of an equity-minded, community-focused primary health care system.
WHO Primary Health Care Case Studies
I developed the following case studies for the 40th anniversary of the Alma Ata Health Care Declaration, the Global Conference on Primary Health Care and the Declaration of Astana.
Ghana: community engagement, financial protection and expanding rural access. https://apps.who.int/iris/handle/10665/326258
China: multidisciplinary teams and integrated service delivery across levels of care. https://extranet.who.int/iris/restricted/handle/10665/326085
Realising the Potential of Primary Health Care
In the OECD Health Policy Studies series
I co-authored Chapter 5, Primary health care in low- and middle-income countries.
https://www.oecd.org/health/realising-the-potential-of-primary-health-care-a92adee4-en.htm
I created modules meant for accessible use by health system planners and implementers in low- and middle-income countries, for the Primary Health Care Performance Initiative, a partnership between Ariadne Labs, R4D, the World Bank, WHO, Unicef, and the Bill & Melinda Gates Foundation.
Primary Health Care Policies
Good governance is a core component of resilient health systems. Increasingly, the challenge for primary health care systems is not in determining what needs to be done to improve population health but rather in garnering political will and uniting states and stakeholders to work together to prioritize health and health care goals.
https://improvingphc.org/improvement-strategies/governance-leadership/primary-health-care-policies
Primary Health Care: Facility Infrastructure
Facility infrastructure captures the physical availability and quality of facilities, including facility density and distribution, design, amenities, and safety equipment and precautions. Ensuring access to thoughtfully designed, safe, and well-equipped facility infrastructure is an important step to providing high quality primary health care.
https://improvingphc.org/improvement-strategies/facility-infrastructure
I worked with the in-house graphic designer at IHME to develop infographics, including the following:
Cardiovascular Disease Worldwide, 1990-2013
JAMA: The Journal of the American Medical Association
This Visualizing Health Metrics infographic, based on the Global Burden of Disease Study 2013, provides information about cardiovascular disease mortality, prevalence, and the effect of population change on cardiovascular mortality from 1990 through 2013.
https://jamanetwork.com/article.aspx?articleid=2468880
Global Burden of Air Pollution
Institute for Health Metrics and Evaluation
More than 5.5 million people die prematurely every year due to household and outdoor air pollution; more than half of deaths occur in two of the world’s fastest growing economies, China and India.
Selected essays:
Back pain: One of the top 10 causes of disability worldwide
Visualizing cervical cancer
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