How local scientists are shaping health equity

Imagine waking up feeling under the weather. Sure, reaching for the phone to schedule a doctor's appointment might be easy. But what if the nearest healthcare facility is hours away? Or perhaps you don’t have health insurance? This scenario, unfortunately, is a reality faced by millions around the globe.

Our personal experiences with health and wellness are like threads in the intricate fabric of global health. As we navigate our day, our well-being is not just a personal matter but a reflection of a complex web of interconnected factors shaping health outcomes worldwide. 

How can the discipline of Development Studies contribute towards the goal of equitable global health?

‘Health and poverty are interconnected issues. Untreated illness perpetuates a vicious cycle of poverty, by impacting an individual's ability to work and ultimately affecting income and consumption, consequently exacerbating, and reinforcing health risks. The vicious cycle, in turn, has broader implications for a country's development and economic growth. By critically analyzing this interconnectedness and providing empirical evidence, we contribute to policy discussions aimed at addressing the link between health, income and development.’

In which projects are ISS researchers currently involved at RGHI?

‘We're deeply involved in a project on Community-Based Health Insurance (CBHI) schemes in Ethiopia, aligned with the Rotterdam Global Health Initiative. Our team rigorously analyzes implementation, drawing policy insights and closely collaborating with government stakeholders. Despite social health insurance being in its early stages, our research provides crucial baseline evidence and ongoing monitoring. The government's uptake of our policy recommendations validates our impact. Additionally, my affiliation with a university in Ethiopia allows me to contribute to evidence-based discussions and developments of local-level interventions targeting health, like the community-based health insurance developments example, the health extension workers and the Health Development Army.’

What is your role as a researcher when working with various stakeholders?

‘As a researcher, I'm deeply invested in the social impact of my work. Having been involved in implementation of government led development programs, I've firsthand experienced challenges and drawbacks. This background informs and motivates my research efforts, particularly as someone who is Ethiopian. My insider perspective facilitates trust and openness within the community, ensuring that our contributions are seen as coming from within rather than outside sources.’

Is it difficult to encourage people to enrol in the community-based health insurance?

‘Initially, enrollment in the scheme was around 40%, but lessons from the pilot phase led to improvements before scaling up. While making the scheme universal and mandatory has been considered, affordability isn't a barrier. However, the scheme has limitations on where healthcare can be accessed in Ethiopia, with a tiered system from primary to tertiary care. Despite initial hesitancy, there was demand for the scheme due to high out-of-pocket expenses. Earlier healthcare financing relied heavily on user fees and donor contributions, leading to unreliability. Mass awareness campaigns and leveraging adverse selection tactics helped boost enrollment, demonstrating demand for schemes to reduce out-of-pocket costs and improve healthcare access.’

Have you seen positive results from this project?

‘Our research findings show a significant improvement in healthcare utilization that can be attributed to the implementation of the CBHI scheme.  Initially the scheme was piloted in 13 districts found in four regions. The scheme has now expanded to 1011 schemes in all over the country, benefiting over 55% of the country's population. This expansion demonstrates the positive impact of increased healthcare access. In addition, healthcare financing reform implemented in the country allows reinvestment of the financial resources obtained from the scheme in healthcare quality, creating a virtuous cycle of improvement. While universal access remains a goal, these steps represent progress, and I'm proud to have contributed to evidence-based improvements in scheme design.’

How has the multidisciplinary approach enhanced RGHI’s goals to ultimately reduce health inequalities?

‘International collaboration enriches research by connecting theoretical knowledge with real-world experiences. Partnerships with local researchers provide invaluable insights, while multidisciplinary collaboration ensures a comprehensive approach to complex issues. By combining public health expertise with economic evaluation, we strengthen the evidence base and highlight the importance of collaboration across disciplines and with local partners.’

Ultimately, how do you see this collaboration continuing?

‘Collaboration enhances the solidity of evidence, especially in multidisciplinary analyses like health inequality. Despite its seeming simplicity, health inequality requires nuanced analysis across various dimensions. Personally, I aim to broaden my research beyond Ethiopia, exploring health disparities in other Sub-Saharan African and other countries in the global south. Additionally, I want to compare health inequalities between the global south and north, recognizing that such disparities exist worldwide. Through multidisciplinary collaboration, both internally and externally, I aim to strengthen research efforts and contribute meaningfully to addressing global health disparities.’

Thanks for the interview, Dr Shuka!