David Peters
Johns Hopkins University, International Health, Faculty Member
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During the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its... more
During the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its performance during the 2014-2015 EVD epidemic. We performed a retrospective descriptive analysis of data collection forms for contact tracing conducted in six counties during June 2014-July 2015. EVD case counts from situation reports in the same counties were used to assess contact tracing coverage and sensitivity. Contacts who presented with symptoms and/or died, and monitoring was stopped, were classified as "potential cases". Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Bivariate and multivariate logistic regression models were used to identify characteristics among potential cases. We analyzed 25,830 contact tracing records for contacts who had monitoring ini...
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Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality,... more
Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhe...
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The capacity to demand and use research is critical for governments if they are to develop policies that are informed by evidence. Existing tools designed to assess how government officials use evidence in decision-making have significant... more
The capacity to demand and use research is critical for governments if they are to develop policies that are informed by evidence. Existing tools designed to assess how government officials use evidence in decision-making have significant limitations for low- and middle-income countries (LMICs); they are rarely tested in LMICs and focus only on individual capacity. This paper introduces an instrument that was developed to assess Ministry of Health (MoH) capacity to demand and use research evidence for decision-making, which was tested for reliability and validity in eight LMICs (Bangladesh, Fiji, India, Lebanon, Moldova, Pakistan, South Africa, Zambia). Instrument development was based on a new conceptual framework that addresses individual, organisational and systems capacities, and items were drawn from existing instruments and a literature review. After initial item development and pre-testing to address face validity and item phrasing, the instrument was reduced to 54 items for ...
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While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access... more
While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project's experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts. We developed a community capability score using a pooled dataset containing cross-sectional household survey data from Bangladesh, India, and Uganda. Our main outcome of interest was whether the woman delivered in an institution. Our predictor variables included the community capability score, as well as a series of previously identified determinants of maternal health. We calculate both population-averaged effect...
Research Interests: Uganda, Bangladesh, Health Administration, Adolescent, Maternal Health, and 15 moreMedicine, India, Library and Information Studies, Pregnancy, Humans, Female, Young Adult, Middle Aged, Adult, Medical Assistance, Public health systems and services research, Community Networks, Cross Sectional Studies, Surveys and Questionnaires, and Residence Characteristics
To better understand the impact of national and global efforts to contain the Ebola virus disease epidemic of 2014-15 in Liberia, we provide a detailed timeline of the major interventions and relate them to the epidemic curve. In addition... more
To better understand the impact of national and global efforts to contain the Ebola virus disease epidemic of 2014-15 in Liberia, we provide a detailed timeline of the major interventions and relate them to the epidemic curve. In addition to personal experience in the response, we systematically reviewed situation reports from the Liberian government, UN, CDC, WHO, UNICEF, IFRC, USAID, and local and international news reports to create the timeline. We extracted data on the timing and nature of activities and compared them to the timeline of the epidemic curve using the reproduction number-the estimate of the average number of new cases caused by a single case. Interventions were organized around five major strategies, with the majority of resources directed to the creation of treatment beds. We conclude that no single intervention stopped the epidemic; rather, the interventions likely had reinforcing effects, and some were less likely than others to have made a major impact. We fin...
Research Interests: Emergency Medicine, United Nations, Culture, International Cooperation, Health Services Research, and 13 moreCommunity Participation, Liberia, Medicine, Trauma, Humans, Public Policy and Administration, Health Policy and Planning, Public Administration and Policy, Public health systems and services research, Ebola Virus, Epidemics, Delivery of Health Care, and Health facilities
To investigate the characteristics of health policy and systems research training globally and to identify recommendations for improvement and expansion. We identified institutions offering health policy and systems research training... more
To investigate the characteristics of health policy and systems research training globally and to identify recommendations for improvement and expansion. We identified institutions offering health policy and systems research training worldwide. In 2014, we recruited participants from identified institutions for an online survey on the characteristics of the institutions and the courses given. Survey findings were explored during in-depth interviews with selected key informants. The study identified several important gaps in health policy and systems research training. There were few courses in central and eastern Europe, the Middle East, North Africa or Latin America. Most (116/152) courses were instructed in English. Institutional support for courses was often lacking and many institutions lacked the critical mass of trained individuals needed to support doctoral and postdoctoral students. There was little consistency between institutions in definitions of the competencies required...
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Research Interests: Health Care, Africa, Health Management, Developing Countries, Comparative Study, and 15 moreBenchmarking, Medicine, Humans, Health Service utilization, Health Services, Government expenditure, Health System, Health Expenditures, Private Sector, World Health Organization, Household Survey, Outcome Assessment, Health Expenditure, health status indicators, and Medical and Health Sciences
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ABSTRACT
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Reconstruction efforts to strengthen the capacity of the health system include the implementation of a basic package of health services to ensure optimal service delivery in Afghanistan. The performance of health services have been... more
Reconstruction efforts to strengthen the capacity of the health system include the implementation of a basic package of health services to ensure optimal service delivery in Afghanistan. The performance of health services have been assessed through the national health services performance assessment conducted annually by the Ministry of Public Health. In 2006, 630 health facilities were selected through a stratified sampling methodology and assessments on quality of care were made on a random sample of 2912 sick children under-five years. Results: The primary complaint was fever, followed by diarrhea and cough or difficulty in breathing. A majority of the caretakers were mothers (67%) and only 6% of the caretakers were literate. Only 43% of the providers counseled the caretakers on signs for immediate return to the clinic, and 47% informed the caretakers the date of the follow-up visit. More than 50% of the caretakers reported receiving information on the disease and appropriate hom...
Using a cross-sectional survey design from 11 public tertiary hospitals (a specialist hospital, four Chinese medicine hospitals, and six general hospitals) in the urban areas of Heilongjiang, we determined the nature of workplace violence... more
Using a cross-sectional survey design from 11 public tertiary hospitals (a specialist hospital, four Chinese medicine hospitals, and six general hospitals) in the urban areas of Heilongjiang, we determined the nature of workplace violence that medical staff have encountered in Chinese hospitals and identified factors associated with those experiences of violence. A total of 1129 health workers participated. The specialist hospital had the highest prevalence of physical violence (35.4%), while the general hospitals had the highest prevalence of non-physical violence (76%). Inexperienced medical staff (p < 0.001) were more likely to suffer non-physical violence than physical violence in Chinese medicine hospitals compared to experienced staff. Medical units (p = 0.001) had a high risk of non-physical violence, while surgical units (p = 0.005) had a high risk of physical violence. In general hospitals, staff with higher levels of anxiety about workplace violence were more vulnerable...
Research Interests: China, Injury Prevention, Multidisciplinary, Workplace, Humans, and 15 moreEnvironmental public health, Female, Workplace Violence, Male, Occupational Safety and Health, Physical Abuse, Risk factors, Prevalence, Adult, Risk Factors, Public Art Hospitals, Cross sectional Study, Cross Sectional Studies, Logistic Models, and Surveys and Questionnaires
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The rapid evolution and spread of health markets across low and middle-income countries (LMICs) has contributed to a significant increase in the availability of health-related goods and services around the world. The support institutions... more
The rapid evolution and spread of health markets across low and middle-income countries (LMICs) has contributed to a significant increase in the availability of health-related goods and services around the world. The support institutions needed to regulate these markets have lagged behind, with regulatory systems that are weak and under-resourced. This paper explores the key issues associated with regulation of health markets in LMICs, and the different goals of regulation, namely quality and safety of care, value for money, social agreement over fair access and financing, and accountability. Licensing, price controls, and other traditional approaches to the regulation of markets for health products and services have played an important role, but they have been of questionable effectiveness in ensuring safety and efficacy at the point of the user in LMICs. The paper proposes a health market systems conceptual framework, using the value chain for the production, distribution and reta...
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This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of... more
This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. A common thread is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. They each address problems of complexity, which is a frequent challenge in global health. The different methods and tools are suited to different types of inquiry and involve both qualitative and quantitative techniques. The paper concludes by emphasizing that explicit models used in systems thinking provide new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to im...
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Informally trained village doctors supply the majority of healthcare services to the rural poor in many developing countries. This study describes the demographic and socio-economic differences between medical representatives (MRs) and... more
Informally trained village doctors supply the majority of healthcare services to the rural poor in many developing countries. This study describes the demographic and socio-economic differences between medical representatives (MRs) and village doctors in rural Bangladesh, and explores the nature of their interactions. This study was conducted in Chakaria, a rural sub-district of Bangladesh. Focus group discussions and in-depth interviews were conducted, along with a quantitative survey to understand practice perceptions. Data analysis was performed using grounded theory and bivariate statistical tests. We surveyed 43 MRs and 83 village doctors through 22 focus group discussions and 33 in-depth interviews. MRs have a higher average per capita monthly expenditure compared to village doctors. MRs are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less (p<0.001). MRs are the principal information source about new ...
Research Interests: Marketing, Communication, Focus Groups, Health, Bangladesh, and 15 moreHumans, Female, Male, Physicians, Income, Prescription drugs, Middle Aged, Information Dissemination, Adult, Educational Status, Drug Industry, Surveys and Questionnaires, Delivery of Health Care, Rural Population, and Medical and Health Sciences
Despite progress in improving health outcomes in Afghanistan by contracting public health services through non-governmental organizations (NGOs), inequity in access persists between the poor and non-poor. This study examined the... more
Despite progress in improving health outcomes in Afghanistan by contracting public health services through non-governmental organizations (NGOs), inequity in access persists between the poor and non-poor. This study examined the distributive effect of different contracting types on primary health services provision between the poor and non-poor in rural Afghanistan. Contracts to NGOs were made to deliver a common set of primary care services in each province, with the funding agencies determining contract terms. The contracting approaches could be classified into three contracting out types (CO-1, CO-2 and CO-3) and a contracting-in (CI) approach based on the contract terms, design and implementation. Exit interviews of patients attending randomly sampled primary health facilities were collected through systematic sampling across 28 provinces at two time points. The outcome, the odds that a client attending a health facility is poor, was modelled using logistic regression with a rob...
Research Interests: Business, Contracts, Poverty, Primary Health Care, Afghanistan, and 14 moreMedicine, Community Health Workers, Humans, Female, Male, Public Policy and Administration, Health Policy and Planning, Public Administration and Policy, Public health systems and services research, Health surveys, Construction of Statistical Models, Rural Health Services, Health facilities, and healthcare disparities
Research Interests: Cell Phones, Quality of Mental Health Care, Bangladesh, Adolescent, Medicine, and 15 moreMultidisciplinary, Humans, Female, Male, PLoS one, Aged, Middle Aged, Adult, Sex Factors, Age Factors, Educational Status, Socioeconomic Factors, Health Services Accessibility, Rural Population, and Quality of health care
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Inequalities in the burden of disease and access to health care is a prominent concern in Uganda and other sub-Saharan African countries. This is a systematic review of socio-economic differences in morbidity and access to health care in... more
Inequalities in the burden of disease and access to health care is a prominent concern in Uganda and other sub-Saharan African countries. This is a systematic review of socio-economic differences in morbidity and access to health care in Uganda. It includes published studies from electronic databases and official reports from surveys done by government, bilateral and multilateral agencies and universities. The outcome measures studied were: the distribution of HIV/AIDS; maternal and child morbidity; and access to and utilisation of health services for people belonging to different socio-economic and vulnerability groups. Forty-eight of 678 identified studies met our inclusion criteria. Results indicate that the poor and vulnerable experience a greater burden of disease but have lower access to health services than the less poor. Barriers to access arise from both the service providers and the consumers. Distance to service points, perceived quality of care and availability of drugs are key determinants of utilisation. Other barriers are perceived lack of skilled staff in public facilities, late referrals, health worker attitude, costs of care and lack of knowledge. Longitudinal and controlled studies are needed to see if strategies to improve access to services reach the poor.
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India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic... more
India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information.
Research Interests: Economics, Anthropology, Market Orientation, Public Health, Medicine, and 15 moreCivil Society, India, Commerce, Humans, Health Services, Health System, Health Care Delivery, Delivery System, Public Interest, Private Sector, Group, Ministry of Health, Government Regulation, Health Services Accessibility, and Delivery of Health Care
10 India: Equity Effects of Quality Improvements on Health Service Utilization and Patient Satisfaction in Uttar Pradesh State David Peters, Krishna Rao, and GNV Ramana During the past half century, India has made substantial improvements... more
10 India: Equity Effects of Quality Improvements on Health Service Utilization and Patient Satisfaction in Uttar Pradesh State David Peters, Krishna Rao, and GNV Ramana During the past half century, India has made substantial improvements in health outcomes (Ramana ...