The Consortium

The Institute of Tropical Medicine, Antwerp, Belgium (ITM) has a long record of research on health service organisation, health sector reform and health care financing in a variety of countries, including in the countries of study. It organises an international Master in Public Health (MPH) focusing on health care systems management and health policy. Participants are mainly health managers and policy makers from Africa, Asia and Latin America. ITM has identified a strong multidisciplinary research team for this project.

Two units of the department of Public Health are involved in this research:

1. Quality and Human Resources Unit (Q&HR), which will be leading the work package on local health systems

The Q&HR Unit aims at contributing to better health care services and systems in LMIC through research, education and services. Q&HR research focuses on the management of health care organisations (HCO), by which we understand any organisation responsible for organisation or provision of health care and services. Currently, research themes include: organisation of the management of chronic diseases, strengthening policies for effective local health systems, health workforce and health service management, safe motherhood and reproductive health policy.

Vincent De Brouwere is a Public Health medical doctor, reader at the Institute of Tropical Medicine, Antwerp (ITM-A), and, from October 07 to September 10, Director of Research based at IRD-INAS, Rabat, Morocco. He has a field experience of 15 years in Developing Countries (7 years in ex-Zaire; then 5 + 3 years in Morocco). His main field of research interest is the health care system, with a particular focus on maternal health and the quality of care, including the management of human resources required for the good functioning of health systems. His role in FEMHealth will be to lead the WP3 and to participate in the overall WP3 development and implementation. He will be a link person for the Moroccan team.

Fabienne Richard is registered midwife who specialised in tropical medicine and public health (MSc). She has 10 years experience as clinical midwife and a field experience of 5 years in developing countries (Kenya, Somalia, Sri Lanka, Afghanistan, Burkina Faso). Her field of research is maternal health, access to health care and quality of care. She recently coordinated the writing of a monograph on financial barriers to obstetric care (see www.itg.be/shsop). She is currently doing a PhD on access to quality C-section in Africa. She will be involved in the implementation of the WP3 (leading the rapid assessment and POEM development, and contributing to the realist studies) and will be a link person for the Malian team.

Bruno Marchal is a medical doctor who specialised in public health (MD, MPH).

He managed a district hospital in Kenya for 4 years and has done research in healthcare management in Ghana, Kenya, Tanzania and Zambia. He is currently doing a PhD study on strategic management and performance of hospitals in Africa, in which he applies realist evaluation as a methodology to deal with complexity. He would lead the development of the WP3 realist case study development and the comparative analysis of the realist evaluation results.

Sara Van Belle is a political scientist and an anthropologist. She worked for2 years as Programme Manager for Africa and Latin America at Marie Stopes International HQ, London and was Programme Monitoring & Evaluation Officer at UNFPA's sub-regional Country Support Team in Senegal for 2 years. She has field experience in francophone West Africa, as well as Sierra Leone and Ghana. She joined the Q&HR Unit at the ITM in 2008 and is currently engaged in a PhD at the London School of Hygiene and Tropical Medicine that focuses on global non-state actor involvement in district decision-making processes in sexual and reproductive health. She will be involved in the WP3 realist case study development and the comparative analysis of the realist evaluation results with a specific focus on the linkages between policy and implementation.

2. Health Policy and Financing Unit, which will be leading the Community of Practice

The research, teaching and service provision of the unit are aimed at the development, in a complex globalising world, of high-quality, pluralistic and accessible health care systems. The area of activity of the unit encompasses the broad field of health systems in developing countries, with special emphasis on health policy at national and international level on the one hand, and financing of health care on the other.

Dr Bruno Meessen is a health economist, who has a great deal of practical experience with the design of health sector reforms and their analysis. He frequently provides expertise to governments and international agencies through consultancies, expert meetings or policy technical notes. He was the coordinator of a recent review of user fee removal reforms in sub-Saharan Africa for UNICEF. His research portfolio focuses on new institutional economic analysis applied to public health sector in low-income countries, access to health care, health care financing schemes and performance-based financing.

The London School of Hygiene and Tropical Medicine (LSHTM) will be primarily responsible for WP 4 (impact of health outcomes and quality of care) and the health policy component of WP 4 (health policy and finance.

The LSHTM is Britain's national school of public health and a leading postgraduate institution worldwide for research and postgraduate education in global health. Part of the University of London, the London School is the largest institution of its kind in Europe with a remarkable depth and breadth of expertise encompassing many disciplines. It is one of the highest-rated research institutions in the UK.

The staff members who will be undertaking the work are based in the Maternal and Neonatal Group within the Department of Epidemiology and Population Health. The Department of Epidemiology and Population Health, with almost 300 staff and over 125 research students, conducts methodologically rigorous and innovative research to inform the understanding of diseases and to provide evidence for decision making in public health. The Maternal and Neonatal Group comprises anthropologists, health economists, statisticians, epidemiologists, and demographers.

Previous relevant experience

The Maternal and Newborn Health Group has extensive relevant experience carrying out research to contribute to, and inform, international debate on key policy issues related to the health of young children and their mothers. This includes epidemiological research of maternal and newborn health and research on specific interventions and service content to improve maternal and neonatal care and development of methods for monitoring and evaluation of maternal and neonatal health programmes. The group also has experience conducting social scientific research on health policy and health system issues. The group has established partnerships in Benin and Burkina Faso (as well as in many other countries). The group’s principal funders include the UK Department for International Development (DfID), European Union, Wellcome Trust, Economic and Social Research Council (ESRC) and Immpact.

Carine Ronsmans is professor of epidemiology with degrees in medicine, demography and epidemiology and has been working on maternal health within the LSHTM since 1993. She has relevant expertise in the methodological and conceptual aspects of the evaluation of maternal and perinatal health programmes and the measurement of maternal morbidity and mortality. She has experience working in Benin and Morocco, as well as other countries. Professor Ronsmans has received EU funding before. She was the principal investigator for a feasibility project on near-miss audits to improve the quality of obstetric care in referral hospitals in Morocco, Benin and Cote d’Ivoire financed by the INCO DC funding programme of the EU. She is also collaborating on a trial of audits funded by the EU FP6 (please see http://www.lshtm.ac.uk/ideu/mp/audobem/). Her details and publications can be found at: http://www.lshtm.acuk/people/ronsmans.carine.

Veronique Filippi is senior lecturer with degrees in demography and epidemiology and is deputy director for the DFID funded Research Programme Consortium 'Towards 4+5' on maternal and neonatal health. She has relevant experience in the measurement of reproductive and maternal morbidity and its consequences in developing countries; learning from near-miss events in health services; and improving quality of obstetric care through audit. She has extensive research experience in Burkina Faso and Benin. Her details and publications can be found at: http://www.lshtm.ac.uk/people/filippi.veronique

Carine Ronsmans and Veronique Filippi will lead WP4 together. Veronique will act as link person for one or two African partners.

Isabelle Lange, a Research Fellow and anthropologist, will develop the quality of care work in WP 4 and the health policy analysis in WP 2. Her details can be found at: http://www.lshtm.ac.uk/people/lange.isabelle

A second part-time research fellow will be recruited with a background in statistics or epidemiology to support the analysis of secondary data and of near-miss incidence in well and poorly performing areas.

The Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD) was founded in 1987 with funding from the Human Reproduction Programme at the World Health Organization. The centre has participated in several international studies including an INSERM-coordinated multi-country study on complications of the first trimester of pregnancy and risk factors for unsafe abortion and a study coordinated by the Institute of Tropical Medicine (Antwerp) on the heterogeneity of HIV in four African cities.

CERRHUD was a partner in an earlier project field testing near-miss audits in North and West Africa funded by FP5 INCO DEV and has since participated in scaling up activities towards the routine implementation of audits in hospital practice.

At the moment, CERRHUD is involved in a very large RCT of near-miss and criterion based audits, which involves 16 hospitals in Benin (finishing end of 2010) and funded by FP6 INCO DEV.

CERRHUD will lead the research and dissemination in Benin.

The staff involved in this project will include:

• Dr Sourou GOUFODJI: she is a field epidemiologist/reproductive health specialist. She has several years experience in running projects. She will assume the managerial responsibilities for the project in Benin and oversee the collection of data on near-miss events and quality of care indicators.
   
• Lydie KANHONOU: she is a senior social scientist who has worked on several international projects. Her main areas of responsibilities will include the preparation and management of the implementation of interviews and participant observations, training of interviewers, supervision of collection of qualitative data and analysis of qualitative data on health policy.
   
• Victorin CAPO-CHCHI: he is a health economist who has worked on many projects of measuring of health costs. He will look at financing and costing. He will be involved in health financing assessment.
   
• Narcisse SINGBO: he is a statistician and data manager. He will manage the data collected and process and analyse them.

MARIKANI will lead the FEMHealth research and dissemination work in Mali.

The work was previously undertaken by an independent research and consulting group based in Bamako- CAREF. To date, CAREF has led 60 studies of which 46 relate specifically to health. CAREF works in partnership with research institutions, academic institutions, and nongovernmental organizations. In six years of existence, CAREF has worked with or performed services for 42 organizations throughout the world. CAREF is currently working with the National Directorate of Health of Mali on evaluation of free Caesarean section policy and fee exemption for the treatment of malaria in Mali for the under 5s.

Mamadou Kani Konaté is a senior sociologist with 33 years research experience using qualitative and quantitative techniques. His research for international organizations has covered the health sectors. He has designed and implemented Mali first national Demographic and Health Survey (DHS) and analyzed and published the results. He is former Member of two WHO Geneva Committees: Research Strengthening Group - RSG (2001-2003) and Strategic Social, Economic and Behavioural Research - SEB (2003-2004). He was also Chairperson of the WHO Geneva ‘Committee “Research Capability Strengthening Plus (RCS+) for Health Social Sciences in Implementation Research for Tropical Diseases Control” (2003-2006). He will lead WP8 and will supervise the qualitative components of the WP.

Professor Mamadou Traoré is specialized in gynaecology obstetrics and senior lecturer at the faculty of Medicine. Since November 2003, is the head doctor of the district reference health centre (CSREF) of the commune V in Bamako City. This centre is the largest in terms of number of births in Bamako (on average 8000 per year). Pr. Traoré collaborates with the CAREF in the project QUARITE (l’Essai QUAlité des soins, gestion du RIsque et TEchniques obstétricales dans les pays en développement) documenting maternal mortality over a period of 4 years by collecting information on 50,000 deliveries per year, based on a national sample of health centres. He will be in charge of the health system component (POEM study and realist evaluation).

Dr Doufain Traoré is a medical doctor and a health economist. She’s got a Master in Health economics and Public Health. Dr Doufain was resident at the district reference health centre of the Commune V in Bamako where she in charge of consultations and Emergency Obstetric Care. She is the coordinator the project QUARITE at CAREF. He will be in charge of the implementation of the financing component of the project

Assima Amidou is an economist and statistician. After a licence in Mathematics at the University of Lome and a training of engineer at the National High School of Statistics and Applied Economics of Abidjan, he did a professional training at the Directory of Statistics and National accounts. His background in Econometrics and macro-economics models led him to participate to several studies in Côte d’Ivoire, Benin and Togo. He was in charge of the statistics lectures at the Catholic University of Lomé. In CAREF, he is in charge of study design and sample calculation. He will be in charge of the data management of the project.

Abderrahmane Maaroufi is Professor of epidemiology and public health, Head of the Public Health Department at the Faculty of Medicine, University of Casablanca and director of the National Institute of Health Administration. He graduated from the University of Montreal, and is a WHO expert in evaluation, a ‘Partners in population and development’ expert and an evaluator of research projects supported by the Spanish cooperation. He coordinated many national and international projects such as ‘Promotion of physical activity by using marketing methods (Development of multifaceted intervention)’; Co-investigator of the ‘Promotion of Clinical Prevention program in Quebec (Canada)’; Epidemiological studies in the field of HIV, HTLV, Viral hepatitis C, Urinary disorders, obesity; Evaluation of the National Health Care Quality Assurance project; Evaluation of the quality of health care in public hospitals; Arabic Translation and trans-cultural validation of Short-Form Health Survey (SF-36). Pr Maaroufi will supervise the research teams and lead the organisation of national and international events.

Amina Essolbi is a medical doctor with an MPH (Boston University) who has worked for 5 years as medical officer before being recruited by USAID-Morocco as health care specialist (1994-98). Then she joined INAS in 1994 where she is a lecturer. She also teaches in different national and international short courses (VIH-AIDS, Ipact, continuing training) matters in relation to planning, project elaboration and epidemiology. She coordinates a 6-month course in advanced epidemiology and disease surveillance. Her current domain of research is related to the role of home caregivers for diabetic patients. She will lead the WP3 on realist evaluation and share her epidemiological skills for WP4.

Hind Filali is a psycho-social scientist (University Paris V). After two years as psycho-sociologist at the Directorate of Population, MOH, she joined INAS in 1992. She led the implementation of the qualitative part of three major EU-INCO researches in Morocco (STD3 on children health seeking behaviour; STD3 on referral and counter-referral; INCO-DEV on near miss cases). Then she worked at CERED from 2000 until 2006 (as a sociologist research) before coming back to INAS in 2006. She is co-author of several articles in relation to the research mentioned above and led the publication of several reports in relation to adolescent reproductive health, abortion, and VIH. She will lead the qualitative work in Morocco.

Hafid Hachri is a medical doctor with a MPH (INAS). He worked as medical officer in a rural district 5 years before joining the Directorate of Hospitals and Ambulatory Care in 2004 where he coordinated an important program (25 million €) on regionalization and strengthening of basic health services. He joined INAS in 2008 to start a PhD on Family medicine and quality of care in health centers. He is a lecturer in different modules taught in the INAS MPH course and coordinates a short course on planning, contracting and evaluating budgets. Dr Hachri will help the WP3 as a resource person for realist evaluations.

Bouchra Assarag is a medical doctor with a certificate in STI/HIV (University of Rabat), a certificate in sport medicine (EHESS Rennes) and a MPH (INAS). She worked as medical officer in a rural district 6 years before joining INAS in 2008 to start a PhD on maternal morbidity. She is an active member of civil associations in the domain of adolescent health, HIV, and family planning. She participated to several studies (national study on burden of diseases, mandatory declaration of diseases in the private sector, the quality of management of STI in the public sector, children infected and affected by HIV). In INAS, she coordinates a short course on project management in the domain of HIV. Dr Assarag will lead the WP4, focussing on the near miss epidemiological survey.

Amina Abaacrouche is a medical doctor with a MPH (INAS). She has a field experience of 10 years in a rural hospital. Then, she joined the Directorate Population in Rabat where she coordinated an EU partnership program on family planning (93-97) and the monitoring of emergency obstetric care (98-03). She contributed to the writing of many guidelines in the domain of safe motherhood and family planning. She became head of Family Planning Division in 2004 before joining INAS in 2007. In INAS, she is a lecturer of different modules related to safe motherhood, basic concepts in public health and family planning. She coordinates an international short course on maternal and neonatal health (Ipact). She is leading research on maternity waiting homes. Dr Abaacrouche will contribute to WP3 and 4.

Chakib Boukhalfa is a newly recruited assistant professor at INAS. He is an economist graduated from the Université de Bourgogne (Dijon, France), where he obtained his doctorate in economic sciences in 2008. He will coordinate the research project and will work on the financial part of WP2.

The Institute of Research in Health Sciences (IRSS) is a specialized structure of the National Centre of Scientific and Technologic Research (CNRST). CNRST is a state-owned scientific, cultural and technical institution (EPSCT), in charge of scientific and technological research. It was created in 1997. It has legal capacity and financial autonomy. IRSS is one of the four institutes of the Centre and has the responsibility:

• to undertake research providing solutions to the health priority problems of the country
• to coordinate research in the Health sector in Burkina Faso;
• to make use of and disseminate the research findings

IRSS has established, in August 2007, a demographic surveillance site in Kaya (KADESS) in the north part of Burkina Faso. This site covers a population of 48 131 people and will serve as platform of research on HIV and reproductive health. The current director of IRSS is Professor Blaise SONDO.

For FEMHealth, IRSS’s main role is to develop the Community of Practice in the region.

Study participants:

Seni Kouanda, MD, PhD is a senior researcher, head of HIV/AIDS and reproductive health unit, site leader of Kaya Demographic and Epidemiological Surveillance system (Kadess), head of public health department. Dr Kouanda will lead in the development of the CoP in the region.

Dr Ridde Valéry is an associate researcher at the IRSS in charge of various research projects concerning the access for health care to the worst-off. VR is the co-principal investigator with JP Olivier de Sardan (LASDEL, Niger) for a research programme concerning the user fees abolition in Niger, Mali and Burkina Faso. With Dr Kouanda (IRSS) and Dr Yaogo (AFRICSanté) they are in charge of the Burkina Faso project. He was a part of the team directed by Dr Meessen for the UNICEF consultation on user fees abolition in Africa. Dr Ridde will support the development of the CoP in the region, and help to link FEMHealth with other relevant regional research efforts.

Advisory board members

The objective of this board is to give an external point of view on the project advancement and quality, providing advice on methodology and conduct of the research, as well as dissemination of final products.

The following members have kindly agreed to participate:

• Alain Prual, maternal health specialist, Havard School of Public Health
• Allison Kelley, consultant in health financing and co-facilitator, HHA Community of Practice
• Dr Belghriti, Director of Hospitals and Ambulatory Care, Ministry of Health, Morocco
• Dr Guy Clarysse, health specialist, UNICEF WCARO regional office
• Dr Jean Macq, health systems expert, Universite Catholique de Louvain
• Dr Joao Paolo Souza, near miss expert, World Health Organisation
• Dr Katerini Storeng, expert on qualitative research on women's health and health policy analysis, Unversity of Oslo
• Dr Pierre Fournier, expert in maternal health and public health programmes, University of Montreal
• Dr Salif Samaké, Director of Planning, Ministry of Health, Mali
• Dr Tim Ensor, health economist, University of Aberdeen
• Dr Timothy Powell-Jackson, health economist, London School of Hygiene and Tropical Medicine
• Dr. Valère Goyito, Secretary General of the Ministry of Health, Benin
• Professor Adama Traore, Minister of Health, Burkina Faso
• Professor Lucy Gilson, health policy and expert, University of Cape Town, South Africa
• Rob Yates, expert on user fees and donor policies, UK Department for International Development