Good Health at Low Cost - Understanding the Contribution of Political, Economic and Structural Factors Promoting Good Health

Supervisor:          Professor Mushtaq Khan ( SOAS)

Co-Supervisor:     Dr Dina Balabanova (LSHTM)

In this proposal a research student will analyse data collected under the Good Health at Low Cost project and develop innovative and analytical approaches and apply frameworks from both health systems and policy research, as well as political science.

Rationale, aims and objectives (GHLC project)
Under the Good Health at Low Cost (GHLC) project funded by the Rockefeller Foundation, LSHTM and five partner institutions are conducting a series of case studies to explain why a selection of countries have achieved better health outcomes, as measured by under five mortality and other outcomes, compared with other countries in a similar economic position.  The overall objective of the analysis is to determine associations between changes in health policies and health outcomes, and specifically, explore the role of the health system in achieving good health outcomes.  This is a continuation of the well-known GHLC Bellagio work from the 1980s which demonstrated how the range of factors beyond delivery of health care have played a crucial role in improving health incomes (eg. political mobilisation of women in Kerala).  This report has had a major influence on international debates and policy processes, and has led to significant interest in the current project.
Case studies are being currently undertaken in 5 countries, all of which have maintained or improved their health indicators during the past decade, in the context of proactive government stewardship, demonstrated through introduction of comprehensive and innovative reforms.  Two of these countries can be described as improvers (Bangladesh and Tamil Nadu), two as innovators (Ethiopia and Thailand) and one as a performer (Kyrgyz Republic).
The project recognises that good health at low cost is determined by a diverse range of factors: some may be common across countries (eg. access to trained health workers) while others may be specific to the individual country (eg. geography, socio-political context).  The study approach aims to ensure methodological and conceptual consistency across countries, which allow comparative analysis and pattern recognition beyond individual case studies

The analytical work will be underpinned by a determinants of health model.  The proposed approach to the work is iterative:  following identification of any associations, plausible hypotheses that might explain these are generated and tested.  At the first stage, we will explore health outcomes (under-5 mortality, maternal mortality etc.) and their determinants (coverage of health interventions, household characteristics) for each study country using DHS and other national survey data, seeking to identify outcomes that may have been influenced by health systems factors.  The second stage will explore these factors using a framework for analysis of health systems and the wider policy context in which they operate.  Case-studies employing quantitative and qualitative methods will be undertaken using a core set of common propositions and examinable indicators complemented with country-specific assessments.  The third stage is mainly analytical, integrating the findings from the previous two stages, and seeking to explain how policies have been implemented and how they have affected not just health system functioning but, ultimately, the health outcomes observed in each country.

Rationale, aims of proposed PhD
We are proposing that a student jointly supervised by Prof Khan from SOAS and Dr Balabanova (who is working on the above project at LSHTM), conducts further analysis of the collected data (within the third stage, as described above), focusing on one or two countries where findings are least explored, through a multi-disciplinary lens.  A focus on Bangladesh and Thailand will be preferred but is not mandatory.
The GHLC project will generate rich data sets from the five countries involved;  however the emphasis is on generating cross country analyses and outputs, and it is expected that a lot of the country level material will not be fully analysed.  Even in cases where detailed country-specific analyses are conducted, these may not draw sufficiently on theories and approaches from political science and development economics.  The specific emphasis of the investigation will be the contribution of political, economic and structural factors to good health outcomes, and the way these factors interact with health system impacts.  For example, it is important to consider the ways in which governance arrangements in a country may influence population health outcomes- whether through influencing health system governance, or influencing directly the way population groups seek care.  Another theme is to investigate synergies between patterns of public policy making generally and policies in the health systems.  We believe this analysis will add value beyond the original project and benefit from the ideas developed within it.

The researcher will be able to access a dataset that is already collected, to liaise with partners, to conduct country visits to obtain additional key informant interviews to fill gaps in the analysis.  We are seeking an experienced and enthusiastic researcher with an interest on issues of governance, political economy or political science as applied to health policy in low income settings.  Previous training in development economics or in health sciences (health policy, economics, public health), or in development studies will be preferable.  The candidate will have excellent skills in research design, data collection and analysis as well as proven ability to produce high-quality written work for academic and policy audiences.

The researcher will undertake a PhD for a term of 3 years, with fees at the Home/EU level plus a maintenance stipend covered by the Bloomsbury Colleges.  They will greatly benefit from the exposure to expertise both on health systems and policy (LSHTM) and political economy and development economics (SOAS), and will have access to a wide choice of training options and contacts (for example, courses on institutional economics and regional economical development courses on South and South East Asia at SOAS and health policy and health economics at the LSHTM).

Key References

1.  Halstead, S., Walsh., Warren K., Ed. (1985).  Good Health at Low Cost. Bellagio, Italy, The Rockefeller Foundation.
WHO (2007).  Everybody's business:  Strengthening health systems to improve health outcomes.  WHO's framework for action.  Geneva, World Health Organisation
2.  Derick , W., Brinkerhoff and Thomas J. Bossert. (2008).  Health Governance:  Concepts, Experience, and Programming Options.  Health Systems 20/20.

Further details about the project may be obtained from:

Supervisor:          Professor Mushtaq Khan, mk17@soas.ac.uk

Co-Supervisor:    Dr Dina Balabanova, dina.balabanova@lshtm.ac.uk
http://www.lshtm.ac.uk/people/balabanova.dina

How to Apply

Applicants must complete the attached Bloomsbury College PhD Studentship application form.
http://www.bloomsbury.ac.uk/studentships/soas-app-form2

The completed application form should be returned to:
Alicia Sales
Scholarships Officer, Registry
SOAS
Thornhaugh Street
London WC1H 0XG

E-mail:  as100@soas.ac.uk

Applicants must also complete the Application for Admission as a Postgraduate Student:
http://www.soas.ac.uk/admissions/pg/howtoapply
NB:  This form should be returned as soon as possible but no later than four weeks before the studentship's closing date as they must be accepted for a Research Degree place.

The Application for Admssion as a Postgraduate Student form  should be completed and returned either online or to the following address:
Head of Admissions and Recruitment
SOAS
Thornhaugh Street
London
WC1H 0XG
UK

Closing date for Applications:  1st March 2010