2012 Cohort of HGHI Burke Global Health Fellows

Dr. Nava Ashraf’s research combines psychology and economics, using both lab and field experiments to test insights from behavioral economics in the context of global development in Africa, Latin America, and Southeast Asia. She also conducts research on questions of intra-household decision making in the areas of finance and fertility. Her research is published in leading journals including the American Economic Review, the Quarterly Journal of Economics and the Journal of Economic Perspectives.

Dr. Ashraf has engaged in ongoing field experiments in Zambia, a nation with one of the highest rates of maternal deaths in the world, combined with an unmet need for family planning. Her research there focuses on the areas of health services delivery and educational investment. The Burke Fellowship allowed her to build upon her previous work in Zambia regarding a maternal mortality curriculum for men. The curriculum is based on the premises that while child-bearing imposes a large health cost on women, male partners do not always fully internalize this cost, both because it does not impact them directly, and because it is less salient to them. Dr. Ashraf and her team hypothesized that expanding men’s knowledge about the risks of childbearing for their wives can contribute to aligning the fertility preferences of men and women in households, and increase the use of family planning, ultimately decreasing maternal mortality rates. A pilot study showed promising results, with men’s support for family planning increasing fivefold after they receive education on maternal mortality with a voucher for family planning services, versus receiving a voucher for family planning services alone.

The combination of these results and Burke Funding led Dr. Ashraf to design and implement a randomized control trial to evaluate the impact of couples’ community workshops where the male or female partner is trained through a traditional family planning or a materiality mortality curriculum. The support of the Burke Fellowship also allowed Dr. Ashraf to hire and train field project staff to supervise the experiment.

The study is currently ongoing and the results will aid in assisting the Zambian Ministry of Health (MOH) and Ministry of Community Development, Mother and Child Health (MCDMCH) in implementing workshops nationwide to train community health assistants (CHAs), who are based in rural communities across Zambia to learn and teach the curriculum material to patients and community members.

Dr. Jessica Cohen is a health and development economist with research that applies experimental and quasi-experimental methods to programs and policies affecting maternal and child health in sub-Saharan Africa and the United States. Dr. Cohen’s early work focused largely on randomized control trials (RCTs) related to appropriate treatment for malaria, technology adoption, messaging and behavior change, and pharmaceutical supply chains.

As a Burke Fellowship recipient in 2012, Dr. Cohen was able to broaden the scope of her research. She notes that the fellowship, “supported me in branching out to a new area of inquiry—maternal and neonatal health. [It] supported early qualitative and quantitative research to design two randomized trials in Nairobi, Kenya that apply behavioral economics principles to maternal and neonatal health.” The study aimed to understand how to help pregnant women to deliver their babies in high-quality facilities. Through qualitative interviews and basic surveys, Dr. Cohen and her team found that there is very little planning for delivery — women haven’t saved enough money, do not know much about the options for delivery facilities, and are uncertain about which facility they will choose for their deliveries. Thus, women arrive too late and/or choose to deliver in poor-quality facilities, resulting in lower maternal and child health outcomes.

With the early support of Burke funding, Dr. Cohen was able to secure a Gates Grand Challenges Explorations grant to co-fund the Nairobi project. She credits the Burke Fellowship with seeding the research that made her competitive enough to receive the Gates Grand Challenges award, allowing her “to explore methods to encourage women to utilize higher quality facilities for delivery and also to improve birth planning and safe, early arrival at delivery facilities.”

Dr. Cohen’s most recent work surrounds malaria and risk perception—specifically how people perceive the risk of contracting malaria for themselves and their children. She is working to develop sound, validated measures of risk perception, to integrate these measures into malaria transmission models and policy design, and to design an RCT testing the impact of more accurate malaria risk perceptions on malaria prevention and treatment behavior.

Dr. Cohen is Assistant Professor of Global Health at Harvard T.H. Chan School of Public Health and Affiliated Professor at the Jameel-Poverty Action Lab (J-PAL).

Dr. Jennifer Kasper developed a passion for teaching during her pediatric chief residency at Boston City Hospital. Upon completing residency in 1996, she spent two years caring for pediatric patients and facilitating community health worker trainings with Doctors for Global Health in El Salvador. Since then she has developed curricula and delivered training for medical professionals in multiple underserved communities across the globe.

At Harvard Medical School (HMS), Dr. Kasper co-directs “Introduction to Social Medicine and Global Health.” This required course prepares first-year students to recognize and understand the social, economic, and political factors that affect patient health. Students explore the root causes of health disparities and the role that medical and public health interventions play in addressing them.

In 2012, Dr. Kasper successfully applied for a Burke Fellowship award to enrich and evaluate the HMS course. “The Burke Fellowship was fantastic because there are relatively few funding opportunities for faculty who want to pursue this kind of work as opposed to bench research,” she said.

Through her fellowship, Dr. Kasper developed new course content, identified resources to support student learning, and attended the Harvard Macy Institute’s Program for Educators in Health Professions. The Burke Fellowship also enabled her to design and implement a pre- and post-course knowledge assessment. Preliminary findings will be published this fall and suggest that the course deepens students’ understanding of the social determinants of health and equips them to conduct and use patient social histories. Dr. Kasper explained:
If you provide medication to a patient with diabetes but they don’t have access to food or live in a neighborhood where it’s safe to exercise, these factors will likely have a greater impact on their health than the clinic visit between you and the patient. It’s jarring for some students to hear this, so our course provides them with tools and examples they can use to promote patient health both within and outside of the clinical setting.
Dr. Kasper is a primary care pediatrician at Massachusetts General Hospital Chelsea Healthcare Center and a faculty member in the Global Health Division of Massachusetts General Hospital for Children. At HMS, she is an Instructor in Pediatrics and Chair of the Faculty Advisory Committee on Global Health.

Burke Publication

Kasper J, Green JA, Farmer PE, Jones DS. All Health Is Global Health, All Medicine Is Social Medicine: Integrating the Social Sciences Into the Preclinical Curriculum. Acad Med. 2015 Dec 22.

During her PhD program in health policy and decision sciences, Dr. Jane Kim traveled to Haiti to study cervical cancer prevention services at a rural clinic. Immediately, she was struck by the number of women who lined up outside the clinic daily to be screened and the opportunity this visit presented to provide them with other health services. Dr. Kim and her colleagues wanted to determine which additional services could be offered in conjunction with cervical cancer screening in order to maximize patient health gains. They used mathematical modeling and operations research methods to define an optimal package of services given patient health needs and the clinic’s budgetary and personnel constraints.

A few years later, Dr. Kim had the opportunity to build upon this work in South Africa. Looking at HPV vaccination programs for female adolescents, she wanted to design a framework that decision makers could use to identify the most cost-effective package of services to offer patients during vaccination appointments. Her goal was to enhance program leaders’ ability to consider costs, benefits, and non-budgetary constraints at the same time when deciding how to leverage patient visits.

The Burke Fellowship made it possible for Dr. Kim to develop models, collaborate with in-country partners around data collection, and train a Masters student in quantitative methods to support the project. The student, who has a strong interest in global health, is now pursuing a PhD in health policy at the Harvard T.H Chan School of Public Health. Dr. Kim is in the process of strengthening the dataset that will be used to run the models her team built.

“This award enabled me to reinforce collaborations with public health researchers, which has greatly enriched my professional network and shaped my research ideas,” Dr. Kim said. “Through these relationships, I have been exposed to the broader and complicated context of real-world obstacles that impede the successful provision of public health interventions otherwise found to be highly efficacious in controlled clinical trial settings.”

Dr. Kim is Associate Professor of Health Decision Science in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.

Dr. Danny Milner has been studying malaria and delivering pathology diagnostic services in Malawi since 2000. In 2012, he applied for a Burke Fellowship award to study how HIV infection affects the progression of cerebral malaria in pediatric patients. “We didn’t require very much funding, but we needed to be able to conduct a very specific set of experiments to understand the relationship,” he said. Dr. Milner partnered with the University of Malawi College of Medicine to study more than 3,000 cerebral malaria pediatric patients.

The Burke Fellowship provided Dr. Milner a unique opportunity to build upon his malaria research portfolio: “When you go to the NIH with a grant application for an area in which you haven’t published very much, it’s very difficult to get money. I had published extensively on cerebral malaria at that point but had very few publications on HIV. Having the opportunity to apply for a smaller grant on a more focused, experimental question was really helpful.” The Fellowship supported critical study components that would have been difficult to fund through other sources, including purchasing a flow cytometer and paying local team members to perform CD4 and viral load measurements.

Through his research, Dr. Milner discovered that children who die of “cerebral malaria” actually die of multiple causes, and HIV co-infection is one of them. Furthermore, HIV co-infection accelerates the progression of cerebral malaria, causing patients’ brains to swell more quickly than they would otherwise.

Dr. Milner’s findings have important implications for pediatric malaria screening and treatment. He has published three articles using data collected during the fellowship and is awaiting publication of a fourth article. He is planning a follow-up study to understand more precisely how HIV infection affects the spleens of cerebral malaria patients to advance the disease.

Dr. Milner is an Associate Professor in the Department of Immunology and Infectious Diseases at the Harvard School of Public Health. He is a Pathologist and the Assistant Medical Director of Microbiology at Brigham and Women’s Hospital, and an Associate Professor of Pathology at Harvard Medical School.

Related Publications

HochmanSE, Madaline TF, Wassmer SC, et al. Fatal Pediatric Cerebral Malaria Is Associated with Intravascular Monocytes and Platelets That Are Increased with HIV Coinfection. MBio. 2015;6(5):e01390-15.

Dr. Rebecca Weintraub has led the Global Health Delivery (GHD) Project at Harvard since 2007. GHD produces a variety of open-access courseware in global health, including Harvard Business School-style teaching case studies. Cases are designed to educate current and future managers on how governments and organizations strategize and design systems for health in resource-limited settings. A teaching note that guides instructors in preparing for and leading classroom discussion accompanies each case.

In 2012, Dr. Weintraub applied for a Burke Fellowship award to develop a case study on health care investments in rural Malawi. The case, Partners In Health in Neno District, Malawi, examines the relationship between investments in health infrastructure and economic development in Neno, as well as the decisions international partners made to improve and expand health services alongside the Malawian Ministry of Health.

The Burke Fellowship enabled Dr. Weintraub and her team to dedicate time and resources to researching and writing the case study and its teaching note. “It created intellectual space for me to concentrate on the research itself,” she said. Dr. Weintraub hopes the case will help students think about the complexities of leadership needed to scale and sustain a set of interventions as they become integrated into the local public health system.

Since publication in July 2013, Partners In Health in Neno District, Malawi has been taught at multiple graduate schools at Harvard and beyond. “We appreciate that the Burke Fellowship understands this is part of Harvard’s unique role as a global institution—to facilitate and speed the dissemination of public goods for global health,” Dr. Weintraub noted. “The Fellowship and university have been pivotal early investors, enabling us to attract other funding sources to build upon this work.”

Both the teaching case and its teaching note are available to download for free at www.ghdonline.org/cases, Harvard Business School Press, and The Case Centre.

Dr. Weintraub is Faculty Director of the Global Health Delivery Project at Harvard University. She is an Assistant Professor at Harvard Medical School and an Associate Physician at Brigham and Women’s Hospital, Division of Global Health Equity.