igce3 La 1 3/1/2010 11:13 AM Page 1 The Globe

Department News

and Highlights

Faculty and Alumna

Profiles

Faculty and

Student Awards

AN AFGHAN SUCCESS STORYTHE BALANCED SCORECARD AND IMPROVED HEALTH SERVICES

IN MEMORIAMPROFESSOR CARL TAYLOR, 1916–2010

DEPARTMENT'S FOUNDING CHAIR

The GlobeNEWSLETTER OF THE DEPARTMENT OF INTERNATIONAL HEALTH l SPRING 2010 l WWW.JHSPH.EDU/DEPT/IH

springcover3_Layout 1 3/1/2010 11:13 AM

www.jhsph.edu/dept/ih

From the ChairRobert Black, MD, MPH

Spring 2010

3 An Afghan Success Story

7 In Memoriam

8 News & Highlights

13 Faculty Profiles

13 Alumna Profile

ABOUT THE DEPARTMENT

From a modest beginning in 1961, the JohnsHopkins Bloomberg School of Public Health’sDepartment of International Health hasgrown into a global leadership role in healthresearch, policy analysis, and program imple-mentation. e Department is divided intofour areas: Global Disease Epidemiology andControl; Health Systems; Human Nutrition;and Social and Behavioral Interventions. Weoffer master’s and doctoral level training inthese areas of international health, as well asdoctoral training in public health practice.

Assistant Professor Caitlin Kennedy,PhD, MPH

Assistant Professor Pamela Surkan,PhD, ScD

e Balanced Scorecard and Improved Health Services

Cover photo credits, clockwise from top left:Kabul, Afghanistan, 2002, Prof. Gilbert Burn-ham; a health clinic in Afghanistan, Prof. Burn-ham; Professor Carl Taylor in Afghanistan,Future Generations; a road in Afghanistan,Prof. Burnham.

In 2002 after the defeat of the Taliban, Afghanistan had some ofthe worst health statistics in the world and the health system wasvirtually destroyed after decades of conflict and neglect. An in-ternational commitment of many donors and partners workingwith a dedicated, but overwhelmed, Ministry of Public Healthand non-governmental organizations began to rebuild the sys-tem. e faculty and students of our Health Systems Programplayed a critical role from the inception of this effort by provid-ing the approach and tools to ensure accountability for the statedgoals of service quality, access and equity. Progress has been meas-ured by these activities, showing improvements in health servicesand a 25 percent reduction in child mortality. Another Depart-ment faculty member, Associate Scientist Linda Bartlett, MD,MHSc, will be directing a large survey to determine if there hasbeen a reduction in maternal mortality, which she demonstratedto be among the world’s worst in a survey she conducted in 2002while she was working in Afghanistan with CDC and UNICEF.

Just a couple of weeks ago the Department mourned the loss ofProfessor Carl Taylor, an esteemed international public health pro-fessional, a pioneer in community-based primary health care andwomen’s empowerment, and the first chair of our Department.Carl was a visionary with aspirations of global health equity, butas important he was a man of action who practiced his commit-ment every day of his long and exceptional career. ere aremany of his contributions that need to be recognized and his lifecelebrated. e School will do that in a symposium that is cur-rently being planned. Suffice for now to recall that his last majorprofessional engagement was in Afghanistan. From 2004-2006he was the resident Country Director for Future Generations,leading the efforts to provide education to Afghan women andempowerment-based training for community health workers.He returned to Afghanistan in 2008 at age 92 to assess howwomen’s action groups can contribute to solving family healthproblems. Many Department faculty and students had the op-portunity to work alongside Carl in his efforts to document theprogress made in Afghanistan. His vision and commitment havebeen an inspiration for generations of health professionals inmany countries. We will deeply miss his wisdom and passion tohelp the world’s poor, but many of his lessons will remain withus.

Anne Rimoin, PhD, MPHAssistant ProfessorDepartment of EpidemiologyUCLA

Faculty and student honorsNew staff and facultyNew publications and projects

Professor Carl Taylor1916–2010

THE GLOBE | Spring 2010

AN AFGHAN SUCCESS STORY: THE BALANCED SCORECARD AND IMPROVED HEALTH SERVICES

Since 2003, the Department’s HealthSystems Program has been a majorforce in the reconstruction of the

Afghanistan health sector. After the fall of theTaliban, the Afghanistan Ministry of PublicHealth was left with a system in near ruins.e Ministry decided that to achieve its vi-sion of a sustainable, transparent, and equi-table health system it needed independenttechnical assistance to monitor and evaluatethe delivery of health services. After success-ful bidding and negotiations with the gov-ernment and other stakeholders, HealthSystems faculty, led by Drs. David Petersand Gilbert Burnham, began developing aninnovative system for assessing the perform-ance of Afghanistan’s national health system:the Balanced Scorecard.

While the Scorecard has been used for yearsin the healthcare sector, it had never beforeserved as a management tool for a country’s entire health sys-tem. More than a mere tool to monitor and evaluate servicedelivery, the Scorecard defined an approach to help the Min-istry assess its progress in realizing its core goals of quality, ac-cess and equity.

Afghanistan Basic Package of Health ServicesIn 2002, after decades of conflict, the Afghanistan health sys-tem was among the worst in world. e infrastructure was inshambles and trained personnel were scarce. In rural areas thesituation was even more severe. With the help of the EuropeanCommission, United Nations Children’s Fund (UNICEF),United States Agency for International Development(USAID), World Bank (WB), and the World Health Organ-ization (WHO), the Ministry was able to start rebuilding.

Owing to capacity, infrastructure and administrative issues,the Ministry decided that the best course for ramping up serv-ice delivery across the country was to contract with non-gov-ernmental organizations (NGOs) which already providedabout 80 percent of health services in the country. e Min-istry would therefore play an oversight role to ensure that agen-cies were providing services effectively and efficiently. As aroadmap for these providers the Ministry developed the BasicPackage of Health Services (BPHS), which includes a set of

cost-effective primary health care services with emphasis onthe needs of rural areas and women and children. With cleargoals defined, the next step was to develop a system to assesshow well NGOs and Ministry providers performed in order tomake evidence-based decisions with regard to future contract-ing and funding.

The Balanced ScorecardWith no routine national health information system in place,the Ministry of Public Health had to start from scratch. In arather unusual arrangement for the Department, the Ministrycontracted directly with a team of researchers from our HealthSystems Program and the Indian Institute of Health Man-agement Research (IIHMR) to provide independent techni-cal assistance in building a new monitoring and evaluationsystem from the ground up. rough a collaborative processthat included representatives from the government, interna-tional agencies and NGOs, the research team facilitated thedevelopment of a set of indicators that the government coulduse to objectively measure performance. e decision to im-plement the Scorecard at the national level was both an excit-ing and daunting challenge for all parties involved, not onlybecause it had never been done before but because the cir-cumstances inside Afghanistan—from security to resources—presented many extraordinary difficulties.

Business Management RootsRobert Kaplan and David Norton conceived of this new man-agement tool in their book entitled, e Balanced Scorecard:Translating Strategy into Action. e authors developed theScorecard to measure more than just the bottom line. eyalso wanted to help organizations translate overall vision andstrategies into practice. For an organization to realize its mis-sion statement, objective milestones had to be defined. Andto get buy-in from all levels of the organization, the develop-

A health clinic in Afghanistan.Photo by Professor Gilbert Burnham

The Balanced Scorecard had never before served as a management tool

for a country’s entire health system.


ment process had to be collaborative to ensure confidence inwhat was being measured. Organizations that have success-fully used the Balanced Scorecard include Cornell University,IBM, Verizon, and Walt Disney (http://www.balancedscorecard.org/).

The Afghanistan Balanced ScorecardAfter the fall of the Taliban, the Ministry of Public Healthdeclared its top priority

to strengthen the delivery of sustainable,quality accessible health services, especiallytargeted at women, through planning for,and the effective and efficient implementa-tion of the basic health services package.*

Because the Scorecard is designed explicitly to align an organiza-tion’s actions with its vision, the Ministry decided to adapt it withthe technical assistance from the team led by the Health SystemsProgram. While the Department faculty were hired by the gov-ernment, their role was to provide independent advice and medi-ate between the various stakeholders in the development ofindicators. In order to engender trust in this new system amongpersonnel at all levels of the system, a series of workshops wereheld with the Ministry, NGOs and other partners in the healthsector.

Six domains to assess were identified during the developmentprocess:

1. Patients and community perspective2. Staff perspective3. Capacity for service provision4. Service provision5. Financial systems6. Overall vision for the health sector

Twenty-nine core indicators along with two composite scores wereagreed upon by the stakeholders. For each indicator, achievablebenchmarks were set based on the realities of the country. Upperbenchmarks were set at a level that was currently being achievedby 6 of the 33 provinces in 2004.

Every year, a sample of over 600 facilities from across the countryis surveyed—the largest independent facilities survey globally. edomains are analyzed at the provincial level in large part becausethe government contracts with NGOs are arranged at this level.

Green-Yellow-RedTo make the Scorecard easy to interpret, it is color-coded.Green=top quintile; yellow=middle 3 quintiles; red=bottom quin-tile. is makes comparisons easier across provinces and allowsstaff at all levels to quickly see where extra effort is needed or wheregovernment support is lacking relative to other provinces. “In thered zone” has even been appropriated by health sector personnelto describe areas that need special attention.

Administrators conduct a facility assessment in Afghanistan.Photo by Prof. BurnhamThe Afghanistan

Balanced ScorecardA. Patients & Community1. Overall Patient Satisfaction 2. Patient Perception of Quality Index 3. Written Shura‐e‐sehie activities

B. Staff4. Health Worker Satisfaction 5. Salary payments current

C. Capacity for Service Provision6. Equipment Functionality Index 7. Drug Availability Index 8. Family Planning Availability Index 9. Laboratory Functionality Index10. Staffing Index—Meeting minimum staff guidelines11. Provider Knowledge Score12. Staff received training in last year 13. HMIS Index14. Clinical Guidelines Index 15. Infrastructure Index 16. Patient Record Index 17. Facilities having TB register

D. Service Provision18. Patient History and Physical Exam 19. Patient Counseling Index 20. Proper sharps disposal 21. Average new outpatient visit per month (BHC > 750 visits)22. Time spent with patient (> 9 minutes)23. BPHS facilities providing ANC 24. Delivery care according to BPHS

E. Financial Systems25. Facilities with user fee guidelines26. Facilities with exemptions for poor patients

F. Overall Vision27. Females as % of new outpatients 28. Outpatient visit concentration Index 29. Patient satisfaction concentration Index

*Ministry of Health. A basic package of health services for Afghanistan.Kabul: Islamic Transitional Government of Afghanistan, February 2003.


Brandon Brown in Peru

ChallengesSecurityAlthough travel never proved easy—with Soviet-era high-ways that abruptly end and poor access to many rural re-gions—Department staff were able to visit survey sites inrelative safety when the project first began. Over the last fewyears, however, the security situation has deteriorated, mak-ing it nearly impossible to visit many parts of the country.Local staff must be relied on to make visits to most rural fa-cilities.

Female staffOn top of the many security challenges that exist in thecounty, recruiting women to conduct maternal interviewshas been a continuing challenge. Many women inAfghanistan do not have a formal education and are not lit-erate. Moreover, women who are literate and permitted towork require a male family member to escort them. In ad-dition to limiting the available workforce, this also createsexceptional demand for qualified women.

Capacity buildingWhile project faculty and staff have made capacity buildinga priority—establishing the first Institutional Review Boardever in the country, for example—long-term capacity build-ing may prove difficult. Because of the security situation,many highly trained Afghanis emigrate. e country has noSchool of Public Health to participate in these efforts. eAfghan Public Health Institute, however, has recently beenestablished and it is hoped that institutional capacity can bebuilt.

SuccessesA stable evaluation system used at all levelse Balanced Scorecard has become the cornerstone of thegovernment’s monitoring and evaluation system. e NGOsthat provide about 80 percent of the services are also utiliz-ing the Scorecard to monitor and improve their own per-formance. Provincial managers are even using the Scorecardas a negotiating tool with the central government. Areas suchas understaffing are reflected in the indicators and can becompared to other provinces. erefore, managers can showhow variables controlled centrally, such as staff funding orequipment availability, are adversely affecting a province’soverall performance.

Indicator ExamplesIndicator 18: Patient History and Physical Exam Index. A composite score of seven itemsassessing whether the provider (1) asks the patient’s age, (2) greets the patient/caretaker,(3) asks about the nature of the complaint, (4) asks about the duration of the complaint, (5)asks about previous treatments, (6) examines the patient, and (7) ensures the patient’s pri-vacy. The overall index score is the median percentage of basic steps taken by the provider ina province.

Indicator 22: Time spent with patient (> 9 minutes). For each province, percentage of pa-tient consultations in which the health worker spent at least 9 minutes with the patient.

Continued improvement in health deliverye latest Balanced Scorecard Report from 2008 shows continuedimprovement since 2004. Overall the national median score acrossall the indicators has increased from 50 percent in 2004 to 72 per-cent in 2008. In fact there has been notable progress in each of thedomains since 2004:

Doctoral Research in AfghanistanFaculty and students have conducted a wide rangeof research in Afghanistan since 2002 with fundingfrom government and international agencies. Beloware four of the doctoral students whose dissertationsfocus on the Afghan health system. Their current po-sition is listed after the dissertation title.

Peter Hansen, PhD: Health service performance as-sessment in AfghanistanGAVI chief of evaluation

Shivam Gupta, PhD: Methods for Population-basedAssessments in Post-conflict Settings: Health Service Per-formance, Economic Status and Equity of Utilization inAfghanistanResearch Associate in the Department

Aneesa Arur, PhD: Contracting for Health Services inAfghanistan: An Analysis of Changes in Service Utiliza-tion and Quality of Care between 2004 and 2005Researcher with Abt Associates

Laura Steinhardt, PhD:Determinants of Access to Pri-mary Health Care Services in AfghanistanTo begin as CDC EIS fellow


• nearly 20-point improvement in the patientand community domain which captures pa-tient satisfaction

• Over 25-point improvement in service provi-sion, which includes antenatal and delivery care

• A 28-point improvement in capacity for serv-ice provision, with large gains in availability offamily planning supplies and lab functionality

Future Worke Health Systems Program and its partner the IndianInstitute of Health Management Research were recentlyawarded the follow-up grant to continue their BalancedScorecard work. As part of this new 4-year project, theywill be redesigning the Scorecard to reflect the healthsector’s achievements. New benchmarks need to be developedsince provinces have surpassed nearly every benchmark basedon 2004 performance levels.

A reminder of war on a road in Afghanistan.Photo by Prof. Burnham

Further Reading: Faculty ArticlesThe Afghan Health System and

the Balanced Scorecard

Measuring and managing progress in the establish-ment of basic health services: the Afghanistan healthsector balanced scorecard. Hansen PM, Peters DH, Ni-ayesh H, Singh LP, Dwivedi V, Burnham G. Int J HealthPlann Manage. 2008 Apr-Jun;23(2):107-17.http://dx.doi.org/10.1002/hpm.931

A balanced scorecard for health services inAfghanistan. Peters DH, Noor AA, Singh LP, Kakar FK,Hansen PM, Burnham G. Bull World Health Organ. 2007Feb;85(2):146-51. http://dx.doi.org/10.2471/BLT.06.033746

Determinants of skilled birth attendant utilization inAfghanistan: a cross-sectional study. Mayhew M,Hansen PM, Peters DH, Edward A, Singh LP, Dwivedi V,Mashkoor A, Burnham G. Am J Public Health. 2008Oct;98(10):1849-56. http://dx.doi.org/10.2105/AJPH.2007.123471

The effect of wealth status on care seeking and healthexpenditures in Afghanistan. Steinhardt LC, Waters H,Rao KD, Naeem AJ, Hansen P, Peters. DH. Health PolicyPlan. 2009 Jan;24(1):1-17. http://dx.doi.org/10.1093/heapol/czn043

Determinants of primary care service quality inAfghanistan. Hansen PM, Peters DH, Edward A, Gupta S,Arur A, Niayesh H, Burnham G. Int J Qual Health Care.2008 Dec;20(6):375-83. http://dx.doi.org/10.1093/intqhc/mzn039

Plans are also underway to capture more provider treatment andcommunity-level information. For instance, in the past, surveysrecorded information about whether a correct diagnosis wasmade. However, no separate assessments of the patient’s diag-nosis or prescription given were collected. Household surveysconducted by Hopkins and IIHMR have shown that coverageof health services is increasing while child mortality is falling. Itis hoped that in future iterations, more in-depth informationsuch as this can be regularly collected and used by the NGOsand Ministry of Public Health.

e success of the Scorecard has also created demand at lowerlevels of the health system. While administrators at the provin-cial level have utilized the Scorecard to make decisions aboutpolicies and staffing, efforts are being made to use the Score-cards at the community, district and facility levels. e Score-card has contributed to a more accountable and effective healthsystem in Afghanistan—questions are also being asked whetherthese efforts can contribute more broadly towards creating sta-ble and trusted public institutions that look out for disadvan-taged groups. e Future Health Systems research consortium,another project based in the Health Systems Program, will belooking at these issues in more depth.

e success of the health sector has been a beacon of hope foran Afghanistan government that has been struggling in recentyears. e Ministry of Public Health’s bold choices have fostereda resurgent health system in a post-conflict environment thatpresents many ongoing challenges, including basic security. Inthe face of the many obstacles, the Ministry established a results-based system rooted in transparency and accountability, whichhas led to better quality healthcare for its citizens and better ac-cess for those who need it most.

The Balanced Scorecard has become the cornerstone of the government’s monitoring

and evaluation system.


Carl E. Taylor, MD, DrPH, founding chair of the Department of International Health, died on Feb-ruary 4, 2010. He was 93. We thought the best way to honor Professor Taylor was to provide a forumfor those who knew him both professionally and personally to share their memories of him. Below areexcerpts from tributes to Professor Taylor that are posted on the Department’s website. We will con-tinue to add to these as we receive them. http://www.jhsph.edu/dept/ih/carltaylor/. In addition, the BloombergSchool is currently organizing a symposium to honor his many contributions to global public health.

Taylor was also senior advisor to Future Generations and Future Generations Graduate School wherea professorship is endowed in his name. For more information, http://www.caringbridge.org/visit/carltaylor/mystory.At the Bloomberg School, the Carl & Mary Taylor Fund was established in 1995 with contributionsfrom faculty and alumni in honor of the Taylors’ commitment to the students of the School of Pub-lic Health and to improving international health through research and action.e fund providessupport to students working in the area of international bioethics.

Professor William A. Reinke, PhD, International HealthWhen I first met Carl Taylor in 1963 I was a neophyte in the field ofinternational public health, and he was already an established leaderin the field, though this at first was not apparent because of his mod-est, low-key demeanor. In working directly with him, however, I sooncame to recognize his contributions to the public’s health, and heserved as a highly valued mentor and friend throughout my career. Hewas a cherished role model while encouraging and facilitating my owngrowth and development.

Henry Perry, MD, PhD, MPH, Sr. Associate, International Health...Carl was a practitioner of medicine, surgery, and public health. He was a teacher, researcher,and scholar. He was a mentor to thousands, and he was a global leader in the field he did so muchto create – international health – and a passionate advocate for community health, women’s em-powerment, community empowerment, and primary health care as defined in the Declaration ofAlma Ata (which he helped write).

Our troubled and hurting world needs more people like Carl Taylor...

Adjunct Associate Professor Robert (Bob) Parker, MD, MPH,Department of International Health ...Carl was my PI, mentor, research guide, and model of how to liveand work at the village level. In spite of the many ups and downs ofthe research projects we were involved in, Carl was always optimisticand full of ideas. e Narangwal project staff called him the big "E!"for his enthusiasm.

Professor Alan Sorkin, PhD, InternationalHealthMy first opportunity to spend much timewith Dr. Taylor occurred on July 20, 1969.is was the day that the first American as-tronauts landed on the moon. Dr. Taylorwatched the moon landing on television atthe American Embassy in New Delhi andthen we drove along the Grand Trunk Roadto Narangwal arriving in the early evening.

Dr. Taylor once described himself at an AIDsite visit as a “villager.” He was most at homein the rural areas of developing countries. Hespent much of his professional life encourag-

ing local people to develop their own solutions to health and socialproblems.

Graduation 2008

Dancing after the dedication of aFuture Generations communityhealth program in Peru, ca. 2005.

At a Shura meeting in a remote valley in Ghazni Province, Afghanistan,ca. 2006.

Assistant Professor, Courtland Robinson, PhD, International HealthIt was this faith that gave Carl the warmth, humility,and vigor with which he undertook every task and en-counter; and it was the same faith that gave him thegrace to be present to the suffering in the world in-cluding, in the end, his own death. In the bulletin forMary’s memorial service several years ago, the Taylorfamily offered a quote from the novelist, E.M. Forster,that had been taped above her desk: “We move betweentwo darknesses, and the two creatures who might en-lighten us about them, the baby and the corpse, fail todo so.” Life begins and ends in mystery but, for Carl, itwas a Great Mystery, God’s Mystery. It was not for theliving to fully understand, but simply to live fully andenlighten the time between the two darknesses.

I am tempted to say “rest well, Carl, in the light per-petual” but something tells me he has his boots on,heading toward the furthest village, farther down theroad.

In MemoriamProfessor Carl Taylor, 1916-2010

Founding Chair, Department of International Health

News & HighlightsFaculty Honors

Professor and Chair Robert E. Black,will receive the 2010 Program for GlobalPediatric Research Award for Outstand-ing Contributions to Global ChildHealth. Dr. Black will be presented withhis award at the PGPR symposium at thePediatric Academic Societies’ AnnualMeeting in May.


First Term

David Peters, AssociateProfessor, Health Systems,Approaches to ManagingHealth Service Organiza-tions: Cases and Applica-tions

Luigi De Luca, Senior Associate, HumanNutrition, Advanced Nutrient Metabolism

Rolf Klemm, AssistantScientist, Human Nutri-tion, Food and NutritionPolicy

Associate Professor David Peters andrecent Hopkins graduates Jessica St.John, MPH, and Laurel Hatt, DrPHwere part of the research team to win aWorld Bank Independent EvaluationGroup Award. ey received the honorfor their work on the ImplementationCompletion Report on the GhanaHealth Sector.

Global Health Faculty Grantse Faculty Grants in Global Health Research provide fund-ing to faculty in the schools of Public Health, Nursing, andMedicine to enable and support global health research proj-ects. Each of ten winners yearly receive $50,000 for their re-search.e goal of the awards is to strengthen the winners'abilities to secure extramural funding.

Aruna Chandran,Assistant Scientist Development ofan Innovate Toolfor Emergency

Care Surveillance in Karachi,Pakistan.

MyaingNyunt,Assistant ProfessorAntimalarialtreatment effi-cacy of

artemether-lumefantrine inHIV-infected pregnant women.Teaching Excellence

Recognition AwardSecond Term

Adnan Hyder, AssociateProfessor, Health Systems,Confronting the Burden ofInjuries: A Global Perspec-tive

Elli Leontsini, Associate,SBISocial and Behavioral Inter-ventions Program SeminarII: Structured Methods inQualitative Research

Peter Winch, Professor, SBI,Social and Behavioral InterventionsProgram Seminar I

Peter Winch, Professor, SBIDoctoral Seminar in Research Methodsin Applied Medical Anthropology II

37th AnnualGlobal Health

Conference

Global HealthGoals & Metrics

June 14–18, 2010Omni Shoreham Hotel

Washington, DC

The Johns Hopkins Global Water ProgramSeed Grant AwardAssistant Professor Christian Coles received a$25,000 Award from the Johns Hopkins GlobalWater Program. His proposal was “Impact ofwater characteristics on the epidemiology of an-tibiotic resistant E. coli in rural Tanzania.” emission of the Water Program is to pursue train-ing and research to meet the global water chal-lenge of providing the quality and quantity of water needed tosustain human health and the environment.

News & HighlightsFaculty PromotionsIngrid Friberg, PhD, MHS, Assistant Scientist, GDEC and IIP

Maria Knoll, PhD, Associate Scientist,Health Systems

Amnesty LeFevre, PhD, MHS, Assistant Scientist, Health Systems

Robinder K. Bhangoo, MD, Associ-ate, Social & Behavioral Interventions

Sara Bennett, PhD,Associate Professor,Health Systems

Xiaoli Chen,MD, PhD, MPH,Assistant Scientist,Human Nutrition

Howard Choi, MHS, Research Asso-ciate, GDEC

Claudia Morrissey Conlon, MD,MPH, Associate, Health Systems

Yvonne Davis,MPH, Research As-sociate, HS/CAIH

Christopher Finucane, MA, Associ-ate, Health Systems

Daniel Feikin, MD, MPH, Associ-ate, GDEC

Daniella D. Fridl, PhD, Associate,Health Systems

Lindsay R. Grant, PhD, MPH, As-sistant Scientist, Health Systems andCAIH

New Faculty

Caitlin ElizabethKennedy, PhD,MPH, AssistantProfessor, SBI

Sosena Kebede, MD,MPH, Associate, HealthSystems

Laura Lamberti,MHS, Research Asso-ciate, GDEC/IIP

Andres G. Lescano, PhD, MHS, Associate, GDEC

Allan E. Massie, MHS, Research As-sociate, Human Nutrition

Monica McGrath, ScD, MHS, Asso-ciate, GDEC

Gina Meza, MPH, BSN, ResearchAssociate, GDEC

Kavitha N. Nallathambi, MS, Re-search Associate, HS/IVAC

Andrew Prendergast, MBBS, DPhil,Associate, GDEC

Nicholas P. Risko,MHS, Research As-sociate, Health Sys-tems, IVAC

Paul B. Spiegel, MD, MPH, SeniorAssociate, Health Systems

John T. Walkup, MD, Adjunct Pro-fessor

New Staff Deborah Christo-pher, Budget Spe-cialist, HealthSystems

Milena Gatto, SeniorResearch Nurse, Centerfor Immunization Re-search (CIR)

Courtney Lancaster, Budget Assis-tant, Health Systems

Sam Lovato, Research Program As-sistant II, CAIH

Kirk Massey, Program Coordinator,CAIH

Sandra Muhanuka, Research Nurse,Global Disease Epidemiology andControl (GDEC)

Elliot Rosen, Fi-nancial Manager,Health Systems

Kathryn Sanderson,Administrative Co-ordinator, Institutefor InternationalPrograms (IIP)

Papa Seye, BudgetAnalyst, Health Sys-tems, BloombergGlobal Road Safety Program

Cecilia Tibery, Physician Assistant,CIRHelen Yoon, Research Assistant,GDEC


News & HighlightsFarrah J. Mateen, PhD candi-date, GDEC, received theAmerican Academy of Neurol-ogy Founders Award. isaward is designed to encourageclinical and translational re-search in neuroscience by physi-cians in clinical neurologytraining programs. e AllianceAwards Subcommittee consid-ers originality, scientific merit,

neurological interest, and clarity of expression as criteria forreview. Her subject was “Cognitive Outcomes of Long TermSurvivors of Defibrillation for Out-of Hospital Cardiac Arrest:A Population-Based Study.”

Monica Mispireta, PhD candidate,Human Nutrition, won the AmericanHeart Association Fellowship and theHonorary Weinberg Foundation Re-search Award for her project entitled,“Long-term effects of individual differencesin fetal autonomic control on early mark-ers of cardiovascular risk.” e foundationstipulates that the chosen project shouldfocus on a subject that is applicable tosocio-economically disadvantaged populations of BaltimoreCity. Findings from this study will increase the understandingof the processes by which the prenatal nutritional environmentaffects the risk of cardiovascular disease later in life.

CongratulationsSuccessful Thesis Defense

Zohra Patel Balsara, Health Systems, “Neonatal Morbidity in theUrban Slums of Meerut, Uttar Pradesh, India: Perceptions and Care-Seeking Behaviors.”

Gillian Buckley, Human Nutrition, “e Impact of Early Vitamin ASupplementation on the Cognitive and Motor Development of School-Aged Children in Rural Nepal.”

Lindsay Grant, Global Disease Epidemiology and Control, “Etiologyof Viral Gastroenteritis and Rotavirus Vaccine Effectiveness amongNavajo and White Mountain Apache Children.”

Jennifer Ransford Scott, Global Disease Epidemiology and Control,“Impact of Long-term Routine Pneumococcal Conjugate Vaccine Usein Navajo and White Mountain Apache Communities.”

Laura Steinhardt, Health Systems, “Determinants of Access to Pri-mary Health Care Services in Afghanistan: Geographic and FinancialFactors.”

Student Honors

Health Systems Program’s

MHS Practicum Scholarship

e Health Systems Program is offering onepracticum scholarship (up to $5,000) for anMHS student in the Health Systems Pro-gram. International-based practicum only.Preference will be given to a practicum lo-cated in a low- or middle-income country.

Application materials are due on April 1,2010. Applications received after this date willnot be considered. For complete details: https://my.jhsph.edu/sites/IH/Lists/Announcements/DispForm.aspx?ID=735

Center for Refugee and Disaster Response in Haiti

e Johns Hopkins Office of Critical Event Preparedness andResponse (CEPAR) deployed a group of Johns Hopkinsphysicians, nurses and other experts to Haiti to help the na-tion's injured and suffering.

Leading the Hopkins mission was Associate Professor TomKirsch, MD, MPH, an emergency physician and co-directorof the Center for Refugee and Disaster Response. More up-dates from Dr. Kirsch are available on the School’s website:http://www.jhsph.edu/publichealthnews/haiti/kirsch_haiti.htmlCRDR website: www.jhsph.edu/refugee/Also find the Center on Facebook.

Triage area in Haiti where everyone lined up for care.


News & Highlights

Rotavirus vaccine—A powerful tool to combat deaths fromdiarrhea, editorial by Professor Mathu Santosham in theNew England Journal of Medicine.JHSPH news: http://content.nejm.org/cgi/content/extract/362/4/358

e post-partum mid-upper arm circumference of adolescentsis reduced by pregnancy in rural Nepal, by Joanne Katz, Sub-arna K. Khatry, Steven C. LeClerq, Keith P. West and ParulChristian. Maternal and Child Nutrition.http://dx.doi.org/10.1111/j.1740-8709.2009.00211.x

Antenatal and Postnatal Iron Supplementation and Child-hood Mortality in Rural Nepal: A Prospective Follow-upin a Randomized, Controlled Community Trial, by ParulChristian, Christine P. Stewart, Steven C. LeClerq, LeeWu, Joanne Katz, Keith P. West Jr., and Subarna K.Khatry. Am J Epidemiol 2009;170:1127–1136. http://dx.doi.org/10.1093/aje/kwp253

Exposure to indoor biomass fuel and tobacco smoke and riskof adverse reproductive outcomes, mortality, respiratorymorbidity and growth among newborn infants in southIndia, by James M Tielsch, Joanne Katz, Ravilla D u-lasiraj, Christian L Coles, S Sheeladevi, Elizabeth L Yanikand Lakshmi Rahmathullah. International Journal of Epi-demiology 2009;38:1351–1363. http://dx.doi.org/10.1093/ije/dyp286

Incidence and Seasonality of Hypothermia Among New-borns in Southern Nepal, by Luke C. Mullany, JoanneKatz, Subarna K. Khatry, Steven C. LeClerq, Gary L.Darmstadt, and James M. Tielsch. Archives of Pediatrics &

Recent Publications

An article by lead author Assistant Professor An-tonio Trujillo was recently accepted by WorldHealth & Population. e paper, entitled, “De-terminants of gender differences in health amongelderly in Latin America,” identifies the main gen-der differences in health and socio-economiccharacteristics of the elderly in four Latin Amer-ican cities. For all countries, the analyses showed

a gender gap in health in favor of males at each age. e complete ar-ticle will appear in an upcoming issue of the journal.

New Website

http://www.jhsph.edu/ivac

Adolescent Medicine/vol 164 (no. 1), January 2010. http://archpedi.ama-assn.org/cgi/content/full/164/1/71

e global impact of Hepatitis E - new horizons for an emerging virus,by Alain B. Labrique, Mark Kuniholm and Kenrad Nelson. In:Emerging Infections, W. Michael Scheld, Scott M. Hammer, and JamesM. Hughes (eds.), American Society for Microbiology Press (in press).

Cost-effectiveness of skin-barrier-enhancing emollients amongpreterm infants in Bangladesh. Amnesty LeFevre, Samuel D Shill-cutt, Samir K Saha, ASM Nawshad Uddin Ahmed, SaifuddinAhmed,d MAK Azad Chowdhury, Paul A Law, Robert Black,Mathuram Santosham & Gary L Darmstadt. Bulletin of the WorldHealth Organization. 2010;88:104–112. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814477/

Maternal vitamin A supplementation before, during and after preg-nancy improves lung function in preadolescent offspring, by IH au-thors William Checkley, Lee Wu, Steven LeClerq, Parul Christian,Joanne Katz, James Tielsch, and Alfred Sommer, was accepted bythe New England Journal of Medicine.

Association of antiretroviral therapy adherence and health care costs.Jean B. Nachega, Leisegang R, Bishai D, Nguyen H, Hislop M,Cleary S, Regensberg L, Maartens G. Annals of Internal Medicine.2010 Jan 5;152(1):18-25.http://www.jhsph.edu/publichealthnews/press_releases/2010/nachega_health_costs.html

Professor Timothy Bakere Department celebrated 50 years of Dr. Baker’s contri-butions to international public health and the School onDecember 21, 2010. Watch Dr. Baker on Youtube discussthe former dean of the School, Ernest Stebbins:http://www.youtube.com/watch?v=Gh4rCJzC-ls

Drs. Peters, Baker, and Black at the reception honoring Baker.


Associate Professor Adnan Hyderwill lead the Bloomberg School’s efforton Michael Bloomberg’s $125 millionGlobal Road Safety Program. e In-ternational Injury Research Unit(IIRU), which Hyder directs, will joinforces with five partner organizations,including the World Health Organiza-

tion, to implement and coordinate activities with local gov-ernmental and non-governmental organizations in 10countries to avert injuries and fatalities caused by road trafficcrashes. “is is an excellent opportunity and a superb groupof partners to develop and implement strategies for reducingthe extraordinary number of preventable traffic-related injuriesand fatalities worldwide,” Hyder said.http://www.jhsph.edu/publichealthnews/press_releases/2009/hyder_bloomberg_roads.html

Professor Robert Black is chairing thenew Institute of Medicine committee com-missioned by Congress to evaluate the $48billion US President’s Emergency Plan forAIDS Relief. e plan for the evaluationwill be finalized in June 2010 and the fullevaluation completed in late 2012. eevaluation report will be submitted to Con-gress during consideration of the authori-zation of funds for the following 5 years for HIV/AIDSprevention, treatment and care in low- and middle-incomecountries receiving US assistance.

Abdullah Brooks, Associate Scien-tist, Professor Santosham and Pro-fessor Moulton were awarded a grantby the Bill & Melinda Gates Founda-tion for the project “Vaccine Efficacyagainst Childhood Pneumonia in alow-Income Tropical Setting.”

News & HighlightsNew Projects

School’s Health Advisory Board, Deans, and Thai Princess Visit the JiVitA Project in northern Bangladesh

Dean Michael Klag led the Johns Hopkins Bloomberg School of Public Health’sHealth Advisory Board and select senior faculty on a visit to Bangladesh, high-lighting the JiVitA Project. HRH Princess Maha Chakri Sirindhorn of ailand, amember of the School’s International Honorary Committee, joined the delegation to see the field research activities in Gaibandha andRangpur, and experience typical village life. Pictured below are a few members of the Board with Nobel Laureate Prof. MohammadYunus, HRH Sirindhorn, and Department faculty leading the JiVitA project.

From left to right: Dean Mike Klag; Ed Ludwig (CEO of Beckton Dickinson); Asst. Professor Alain Labrique; Professor Keith West; NobelLaureate Professor Mohammad Yunus; HRH Princess Maha Chakri Sirindhorn; the Ambassador Designate of Bangladesh to Thailand;Asst. Scientist Rolf Klemm; Manfred Eggersdorfer (CEO of DSM); and Assoc. Professor Parul Christian

New 4th Term CourseFood Technology and Health

Mondays and Wednesdays 10:30–11:50 a.m.

Primary Instructor: Dr. Jed W. Fahey



DEPARTMENT AluMNA ANNE RIMoIN, PHD, MPHASSISTANT PRoFESSoR, DEPARTMENT oF EPIDEMIoloGy, uClA

New Faculty in theSocial & Behavioral Interventions

Program

Department alumna Anne Rimoin, PhD, MPH, was recently in Baltimore for the American Society for Microbiology’s Biodefenseand Emerging Disease Research meeting. She presented her findings there on the rising incidence of monkey pox in the DemocraticRepublic of Congo (DRC). While visiting friends and colleagues at the Bloomberg School, she agreed to discuss how she becameone of the world’s preeminent experts on emerging infectious diseases, especially monkey pox, and to offer some advice to currentand future students interested in global epidemiology.

Dr. Rimoin, a graduate of the Global Disease Epidemiology and Control Program (GDEC), is currently an assistant professor in theDepartment of Epidemiology at UCLA where she focuses on emerging infectious diseases, especially those of animal origin thataffect central Africa. e majority of her research is based in the Democratic Republic of Congo, a country she has long had an affin-ity for. She is fluent in French and conversant in the local Bantu language, Lingala, which helped her establish trust with local ruralpopulations, who can be wary of outsiders—for good reason based on their history of colonization and civil wars. She has even es-tablished a foundation to help build local capacity in the country called Congo BioMed. Its mission is to promote local biomedicalresearch and training, and to deliver aid (http://www.congobiomed.org/). “My philosophy is that you can’t just take data out of a coun-

Assistant Professor Caitlin Kennedy, PhD, MPHAs a new faculty member, one of the first projects Dr. Kennedyis working on is an R01 examining the efficacy of behavioral in-terventions for HIV prevention in low- and middle-incomecountries through systematic reviews and meta-analyses. isproject is conducted jointly with the Medical University ofSouth Carolina and the World Health Organization, and find-ings will be used to provide the evidence base for future WHOguidelines on HIV behavioral interventions globally.

Dr. Kennedy’s currentresearch is a natural ex-tension of her graduatework at Hopkins. At the2008 InternationalAIDS Conference, shepresented her findingsfrom a qualitative studyof a matrimonial servicefor people living withHIV in Chennai, India.e service had 200 ac-tive dating profiles andhad matched 20 cou-ples. As dating servicesfor HIV-infected indi-

viduals become more common, it becomes increasingly im-portant to better understand how the services work. Kennedy’sstudy showed that matrimonial services for HIV-infected indi-viduals may be a creative and culturally appropriate way toachieve HIV prevention goals and improve quality of life forHIV-infected individuals.

is term, Kennedy will be co-instructor for a course, entitled,“Qualitative Research eory and Methods,” with ProfessorGittelsohn. e course introduces students to theoretical foun-dations of qualitative research and different approaches to qual-itative inquiry, including ethnography, phenomenology,grounded theory, and narrative and case study approaches.

Asst. Professor Caitlin Kennedy in Indiawhere she conducted a study on a matrimo-nial service for people living with HIV.

Assistant Professor Pamela Surkan, PhD, ScDDr. Surkan’s studies the role of maternal mental health and theeffects of family life on early growth and childhood develop-ment. Originally basing this work on a study in northeasternBrazil, she is currently studying these issues using longitudinaldata from the US. Her other research focuses on the interactionsbetween social conditions and other factors that impact health,such as dietary behaviors andenvironmental exposures.

Surkan holds doctorate de-grees from the Harvard Schoolof Public Health in Society,Human Development andHealth, and the Karolinska In-stitute in Clinical Cancer Epi-demiology. Before joining theIH faculty in 2008, Surkanwas a research fellow at Har-vard School of Public Healthwhere she bridged social epi-demiology with other disciplines, as well as helped to oversee apsychosocial intervention with HIV-affected youth in ruralHaiti.

One of her current research projects examines the effect of ironand zinc supplementation on development in Nepalese children.While studies have shown links between deficiencies of thesetwo nutrients and impaired behavioral and cognitive develop-ment, the data are inconclusive. e burden of iron and zincdeficiency among children in the Sarlahi district of Nepal is ex-tremely high. Dr. Surkan, in collaboration with a team of Hop-kins-based researchers working in Nepal, will estimate the effectsof iron and zinc supplementation on (1) infant temperament,(2) quality of feeding interactions, and (3) language develop-ment. Moreover, results will lay the groundwork for future stud-ies that can provide more in-depth information about infantsocial and cognitive development in Sarlahi.

In 4th term, Dr. Surkan and Professor Gittelsohn will teach thecourse, entitled, “Qualitative Data Analysis,” which focuses onthe management and analysis of qualitative data in public healthresearch and introduces various interpretive analytic approachesand guides students in applying them to data.

Cont. on next page


The Globe Spring 2010

Johns Hopkins Bloomberg School ofPublic HealthDepartment of International Health615 N. Wolfe StreetBaltimore, MD 21205410-955-3734www.jhsph.edu/dept/IH

Robert Black, ChairAssociate Chairs:James Tielsch, Academic ProgramsJoanne Katz, Director, Global DiseaseEpidemiology and ControlDavid Peters, Director, Health Systems Keith West, Jr., Director, Human Nutrition Peter Winch, Director, Social and BehavioralInterventions

Writer/Designer, Brandon Howard

Department AlumnaAnne Rimoin, PhD, MPH, Assistant Professor, Department of Epidemiology, uClA(continued from previous page)

try. It’s very hard to build capacity through standard researchgrants. Nevertheless, one can’t expect people who receiveworld-class training abroad to go back to their home coun-tries if there’s no place for them to use that expertise.”

“Hopkins is my benchmark,” Dr. Rimoin began when askedabout her time at Hopkins and how it prepared her for hercurrent research work. “Methods and mentorship is mymantra, and I had both at Hopkins,” she continued. Whileher passion has always been pediatric and emerging infec-tions, she explained, her dissertation was on the diagnosisand treatment of strep throat to prevent rheumatic heart dis-ease. At first, she wasn’t certain how strep throat fit into herplan to work in global infectious diseases. She soon learnedthat rheumatic heart disease—the result of untreated strepthroat—is a leading cause of cardiac illness in the develop-ing world. Unlike in the U.S., the infection is not always di-agnosed or treated appropriately in much of the world.

Her advisers, Professors Joanne Katz and Mark Steinhoff, alsostressed how important it was to learn research from the groundup. “Professor Steinhoff gave me a lot of responsibility. I was theprogram manager for a multi-center study to look at diagnosisof strep throat. I had to develop research protocols, train staff,and supervise the data management, among other things.” Witha grant from the Center for Clinical Trials, she developed herown nested study to assess the intravenous versus oral treatmentof strep throat. She summed up her training at Hopkins with astring of superlatives, saying that Professor Katz continues to beher role model as a woman in epidemiology and internationalhealth.

Anne Rimoin, PhD, MPH and GDEC alumna interviewing apatient in the Democratic Republic of Congo

After graduation Dr. Ri-moin became a programofficer at the National In-stitute of Child Healthand Development(NICHD). One of herprojects there was to set upa malaria study in Africa.While the malaria workwas based in the DRC andZambia, the focus was noton emerging infectionsand zoonotic diseases.“My training from the De-partment, however, pre-pared me to propose myown add-on study.” Shesuspected that the preva-lence of monkey pox washigher in the DRC than

estimated, but there was no funding to do disease surveillancebecause it was perceived to be too difficult given the lack of in-frastructure in the country. “I had learned the tools doing mydissertation research, so I was able to apply them however Iwanted.” Because her proposal leveraged the resources of thelarger malaria project, she was awarded the funds to pursue theresearch she was most passionate about.

at research has revealed that the prevalence of monkey poxhas increased twentyfold over the last 30 years in the DRC. “Inan ironic twist, one of the triumphs of public health—the erad-ication of small pox—has created an opening for monkey pox toreemerge.” People are no longer vaccinated against small pox,which also provided protection against monkey pox. In addi-tion, the displacement of much of the population has resultedin an increase in the consumption of bush meat, the primarysource of transmission. For many reasons, the conventional wis-dom held that monkey pox did not pose a viable threat, whichunderscores the importance of disease surveillance. Monitoringdisease patterns not only makes it possible to know which dis-eases to addresses, but by being prepared to react quickly it canprevent epidemics before they start.

‘Methods and mentorship’ is my mantra, and I had both at Hopkins.

In an ironic twist, one of the triumphs of public health—the eradication of small pox—has created an opening for

monkey pox to reemerge.

As a final piece of advice to students, Dr. Rimoin “can’t stressenough the importance of doing primary data collection incountry. ey must get their hands dirty because there’s no wayto replicate that experience in high-income countries.” She tellsher students at UCLA what one of her mentors told her, “Every-one has to be willing to do windows. Handing everything tostudents is actually a disservice because that’s not how it hap-pens in the real world.”

To learn more about Dr. Rimoin’s work, visit her UCLA web-site: http://www.ph.ucla.edu/epi/faculty/rimoin/rimoin.html

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