Too many of the world’s poorest and most marginalized populations are not benefiting from the modern technologies and medical innovations designed to improve human health, says a renowned epidemiologist and public health specialist focusing on global health. Dr. James Blanchard, who holds the Canada Research Chair in Epidemiology and Global Public Health at the University of Manitoba, is bridging the health equity gaps by taking a “program science” approach to the problem.
It sounds esoteric, but it is elegant in its simplicity and effective when applied – and best illustrated by example. A decade ago, India was experiencing a substantial HIV epidemic. It was clear that the solution would require effective programs to reduce HIV risk among sex workers. But how? Dr. Blanchard and his colleagues started by involving sex workers in a social mapping process to identify where best to focus resources and efforts, and then moved on to the action phase, which included evolving better ways to implement peer education and community outreach and mobilization efforts. Condom use jumped from less than 50 per cent to almost 90 per cent and the epidemic was reversed. The community mobilization processes were also associated with declines in violence against sex workers.
The program was so successful that it is being expanded in India and adopted by countries in Africa, albeit in customized ways in order to accommodate financial, social, political and cultural barriers. “Kenya had seen it work and said it wanted the program as well,” says Dr. Blanchard.
The beauty of the methodology is that it can be used to combat a broad range of health and social issues; a program is under way to address maternal, newborn and child health. “The solutions may be different but the approach is the same,” says Dr. Blanchard, adding that the program science methodology is also cost effective “because you implement these processes by leveraging already existing resources, introducing efficiencies and then working with government to fill them.”
According to Dr. Stephen Moses, a professor in the University of Manitoba’s departments of Medical Microbiology, Community Health Sciences and Medicine, Dr. Blanchard has addressed the problem of taking small pilot projects and scaling them up, sometimes exponentially. “Dr. Blanchard’s contribution shows that it is possible to design health programs and services that can be implemented on a very large scale, and that it can be done in a systematic and scientific way.”
Dr. Blanchard and his team have received numerous funding awards, including a $21.1-million (U.S.) grant from the Bill and Melinda Gates Foundation (2014) to establish a technical support unit in Uttar Pradesh, India, providing “technical assistance to the government of Uttar Pradesh to improve health, nutrition and development coverage and outcomes” for the state’s 210 million inhabitants.
“When it comes to improving global health, it’s not so much a matter of knowing what to do, but how to implement the technologies and innovations we already have,” says Dr. Blanchard. “The program science approach gives us the tools we need to do just that.”
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