I supported research, data analysis, case study development and dissemination, and the
successful production of a series of articles for the Rwanda- and Bangladesh-based
implementation research study, Maintaining Essential Health System Delivery of
Evidence-Based Interventions During COVID-19 (University of Global Health Equity, Kigali, Rwanda, 2020-2025).
Publications:
VanderZanden A, Amberbir A, Sayinzoga F, et al. Evidence of health system resilience in primary health care for preventing under-five mortality in Rwanda and Bangladesh: Lessons from an implementation study during the Millennium Development Goal period and the early period of COVID-19. J Glob Health. 2024 Jul 5;14:05023. doi: 10.7189/jogh.14.05023. https://pubmed.ncbi.nlm.nih.gov/38963883/ We used mixed methods implementation research to understand factors and strategies associated with resiliency in Rwanda and Bangladesh, focusing on how evidence-based interventions targeting amenable under-five mortality that had been used during the Millennium Development Goal period (2000-15) were maintained during the early period of COVID-19.
Amberbir A, Sayinzoga F, Mathewos K, Ntawukuriryayo JT, VanderZanden A, Hirschhorn LR, Binagwaho A. Maintaining Delivery of Evidence-Based Interventions to Reduce Under-5 Mortality During COVID-19 in Rwanda: Lessons Learned through Implementation Research. Ann Glob Health. 2024 Jul 23;90(1):47. doi: 10.5334/aogh.4348. https://pubmed.ncbi.nlm.nih.gov/39070076/ The COVID-19 pandemic resulted in drops in access to and availability of a number of evidence-based interventions known to reduce under-5 mortality across a wide range of countries, including Rwanda. We aimed to understand the strategies and contextual factors associated with preventing or mitigating drops nationally and subnationally, and the extent to which previous efforts to reduce under-5 mortality supported the maintenance of healthcare delivery.
Amberbir A, Huda FA, VanderZanden A, et al. Mitigating the impact of COVID-19 on primary healthcare interventions for the reduction of under-5 mortality in Bangladesh: Lessons learned through implementation research. PLOS Glob Public Health. 2024 Mar 6;4(3):e0002997. doi: 10.1371/journal.pgph.0002997. https://pubmed.ncbi.nlm.nih.gov/38446832/ The COVID-19 pandemic posed unprecedented challenges and threats to health systems, particularly affecting delivery of evidence-based interventions (EBIs) to reduce under-5 mortality in resource-limited settings such as Bangladesh. We explored the level of disruption of these EBIs, strategies and contextual factors associated with preventing or mitigating service disruptions, and how previous efforts supported the work to maintain EBIs during the pandemic.
I developed, strengthened, and edited a series of large case studies conducted for the
Exemplars in Under-5 Mortality project (University of Global Health Equity and Exemplars in Global Health, Kigali, Rwanda, 2019-24). I led the production of a research supplement based on this work, coordinating teams across six countries to develop and submit articles, commentaries, and cross-country analyses, as well as supporting dissemination of our findings through workshops and conference presentations.
Publications:
Binagwaho A, VanderZanden A, et al. Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000-2015. BMC Pediatr. 2024 Feb 28;23(Suppl 1):652. doi: 10.1186/s12887-023-03906-5. https://pubmed.ncbi.nlm.nih.gov/38413879/ Using implementation research, we conducted a cross-country analysis to compare decision-making pathways for how these countries chose, implemented, and adapted strategies for health system-delivered evidence-based interventions that mitigated or leveraged contextual factors to improve implementation outcomes in reducing amenable under-5 mortality.
Subedi RK, VanderZanden A, et al. Integrated Management of Childhood Illness implementation in Nepal: understanding strategies, context, and outcomes. BMC Pediatr. 2024 Feb 28;23(Suppl 1):645. doi: 10.1186/s12887-023-03889-3. https://pubmed.ncbi.nlm.nih.gov/38413892/ Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use implementation research to identify strategies used in Nepal's adaptation and implementation of IMCI.
Hirschhorn LR, Frisch M, Ntawukuriryayo JT, VanderZanden A, et al. Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda. Gates Open Res 2021, 5:72 (https://doi.org/10.12688/gatesopenres.13214.1) 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.
I conducted research to understand gaps in the knowledge of how to measure and improve
primary health care in low- and middle-income settings (Ariadne Labs, Boston,
Massachusetts, 2018-19). I developed a research protocol, conducted primary research and
logistical coordination, analyzed data, and authored a manuscript based on our findings,
published in BMJ Global Health.
Publications:
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 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.
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
An essential element of global health research output is the dissemination of our findings and support of their uptake.
Implementation Research Toolkit
In 2023-24 I developed a toolkit meant to provide action-oriented guidance for implementers, practitioners, and policymakers to apply the implementation research methodology and the findings from the Exemplars in Under-5 Mortality and Maintaining Essential Health System Delivery of Evidence-Based Interventions During COVID-19 projects to their own work. This toolkit was used to support close work with two francophone African country teams working to identify and improve strategies to reduce under-5 mortality in their countries.
Disease Elimination Curriculum and Training
In 2024 I updated and expanded a curriculum on disease elimination for mid-career practitioners across Africa and southeast Asia, and facilitated the delivery of the training course on site in Rwanda, at the University of Global Health Equity. I developed a series of online presentations, gave in-person lectures, and mentored students for the duration of the course.
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
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