Global Public Health

Assisting Somalia’s Ministry of Health to evaluate proposals for NGOs to run essential medical services in Somalia and Somaliland.
Photo: Copyright © Cathy Baldwin 2020.

I am a generalist global public health researcher and research consultant with specialist knowledge and practical experience in psychosocial and environmental health. I also have a background in communications and media as a former BBC World Service, Radio 4 and Radio 3 broadcast reporter and NGO press officer/advisor which enables me to advise on communicating health issues to the public.

I have eleven years of consulting experience on applied public health research projects, Health Impact Assessments (HIAs), and monitoring and evaluation (M&E) for global public health interventions. I recently produced my first health-related Behaviour Change Communications Strategy for the United Nations Development Programme (UNDP) in North Macedonia.

I hold a Masters of Public Health with High Distinction (1st) from the University of New South Wales (Sydney, Australia) in addition to a PhD in Social Science from the University of Oxford (UK) and completed a Postdoc at the World Resources Institute/WRI (Washington DC, USA) on social and behavioural science approaches to community climate resilience in urban development and planning. I am a candidate for a Masters in Psychology (University of Glasgow) to supplement the social psychology training I obtained through my PhD (Oxford).

Health Systems Strengthening

To strengthen health systems means analysing and identifying areas of weakness in the multi-level structure, and flow and accessibility of resources within the primary, secondary and tertiary health systems, institutions and organisations, and related organisational, administrative, staffing and clinical practices across a given national health infrastructure. It then implicates making evidence-based decisions to improve weaknesses through the systematic prioritisation of specific areas of financing, organisation, facilities, bureaucratic, surveillance and medical activities and practices in the fields of health prevention, protection, diagnostics, treatments, delivery of healthcare, and health promotion among societies, communities and individuals. It also means to enhance existing strengthens and supplement them with key innovations where there are deficits, gaps opportunities and room for improvements.

I have contributed to health systems strengthening programmes in Somalia, Russia, across the Commonwealth of Independent States (CIS), Central Asia and other Post-Soviet countries, and across many African countries. I was a proposal evaluator on FCDO’s (ex-DfID) Somali Health and Nutrition Programme (SHINE) scoring proposals from NGOs to provide healthcare and nutrition services in four regions of Somalia and Somaliland. I proposed criteria for DfID to negotiate with the winning bidders and also provided input into the Gender and Social Inclusion (GESI) Strategy. I researched and wrote eight topical reports on the state of cancer care in Russia, Belarus, Ukraine, Georgia, Armenia, Uzbekistan, Kyrgyzstan, and Azerbaijan for International SOS. I have reviewed and designed monitoring and evaluation frameworks , such as one for the health science study, Tacking Infections to Benefit Africa (TIBA). I conducted a desk-top Social Impact Assessment (SIA) for FCDO’s health systems strengthening programmesand Tackling Deadly Diseases in Africa Programme (TDDAP) (see Monitoring and Evaluation (MEL) below).

I have researched and analysed weak health systems, I led a data-collection team of clinicians in Moscow, and researched and wrote a set of MEDCO country of origin report, for the European Asylum Support Office (EASO) on health and healthcare across the Russian Federation. For this assignment, I also wrote 10 topical reports on different disease and patients groups in the former Soviet country. These consisted of psychiatry, endocrinology, pulmonology, nephrology, neurology, infectious diseases, cardiovascular diseases, disabled patients, paediatrics, and geriatric patients. These reports are designed to provide health background information on all asylum claimants in EU countries and also for use by other EU institutions such as the International Criminal Court in The Hague. They are official EU documents.

Health Impact Assessment

Health Impact Assessment (HIA) is a process for assessing the effects of social and environmental change on our health and well-being in daily life. A full description is available here. I have led the research and community engagement components of several large-scale HIAs of nationally-significant infrastructure projects in the UK, and contributed research and analysis to others. My work covers high speed rail, nuclear power, nuclear waste and a multipurpose stadium. I have also conducted research on HIAs of built environments developments and petrochemical plants. This works covers Australia, New Zealand, Indonesia, USA, Japan and Thailand, See my CV for full details.

Monitoring and Evaluation (MEL)

As part of my international development consulting, I have contributed to monitoring and evaluation systems for global health programmes in Africa. I designed a framework, theory of change, and Logframe with indicators for a complex research programme, Tackling Infections to Benefit Africa (TIBA), a 9-African country study led from the University of Edinburgh lasting four years and aimed at improving the management of emerging and endemic diseases. The involved countries are: Botswana, Ghana, Kenya, Rwanda, South Africa, Sudan, Tanzania, Uganda and Zimbabwe. The M&E Framework can be downloaded here. As a result, I contributed to an expert workshop at Chatham House to provide feedback on a global M&E framework for the World Health Organization to monitor national government policies on ‘One Health’ around the world. I also supervised a desk-top Social Impact Assessment (SIA) of DFID’s Tackling Deadly Diseases in Africa Program operating in Cameroon, Uganda, Côte D’Ivoire, Niger, Mali, and Chad.

I have peer reviewed M&E terms of reference and reports in this thematic area for FCDO (formerly DfID). For example, I peer-reviewed evaluation reports for the FCDO programme, Accelerating Control and Elimination of Neglected Tropical Diseases (ASCEND) in East and West Africa. I have also been evaluation peer reviewer of several FCDO programmes aiming to tackle violence against women and girls, namely Violence Against Women and Girls Prevention and Response Programme, Malawai and Increasing Access to Gender Based Violence Response Services in Afghanistan – Phase II. I worked briefly as a Public Health Intelligence Adviser for NHS Health Scotland contributing to evaluations with the Scottish context, including a national vaccine transformation programme, and the implementation of a smoking ban in Scottish prisons.

Psychosocial Research

Psychosocial health is concerned with the psychological effects of social experiences, so the effect of factors in the wider society outside ourselves, on our mental health. I conduct research and design assessment processes, and data collection and analysis tools for HIAs and other applied health evaluation procedures to collect data on psychosocial health. I have published scientific articles outlining some of these frameworks and tools, see Psychosocial Health for full details.

I am Principal Investigator of a mixed methods study for the United Nations Development Programme (UNDP) in North Macedonia looking at, among other things, public awareness of the health effects of burning biomass, and indoor and outdoor air pollution as well as the relationship to climate change. For this, I designed a psychometric survey questionnaire using indicators that measured health and environmental psychology constructs such as ‘health risk perception’ and ‘climate change-related health risk perception’. The survey was distributed to a sample of 1188 people across North Macedonia from seven marginalised and vulnerable groups. The subsequent data, once analysed using statistical testing, has been used to underpin a Behaviour Change Communications Strategy and an application to the UN Joint SDG Fund – Component 2 – Call on SDG Financing to fund the Green Finance Facility to Improve Air Quality and Combat Climate Change in North Macedonia. This will be implemented in 2022 and I will act as Adviser to UNDP during this time.

Behavioural Science Advisory

I am a trained Social and Behavioural Scientist (PhD Social and Cultural Anthropology with Sociology and Social Psychology, University of Oxford). I furthered my knowledge with study modules on public health approaches to mental health and social and behavioural epidemiology during my Masters of Public Health (UNSW, Australia). I am experienced at looking at the social, cultural, and psychosocial factors that underpin human behaviour, attitudes and psychological responses to life experiences, institutional structures, social organisation, and relationships. I use a combination of participatory and non-participatory observational methods, interviews, document review, surveys, and other methods to understand the contexts of human behaviour and the structures, norms, attitudes, values, beliefs and material and economic resources shaping it. My approach can be applied in all cultural and country contexts, and used to understand the behaviours that contribute to health problems, or fail to prevent and control them.

Behaviour Change Communications Strategies

As a former BBC World Service (UK international radio)/Radio 4 and Radio 3 (UK domestic radio) radio researcher and reporter, and a former NGO media adviser, I enjoy bringing together my skills and expertise in social and behavioural science with my media skills and knowledge to create media and communications campaign strategies. I use theories, models and approaches from social and cultural anthropology, and social, environmental, health and community psychology to underpin them and provide a guide for the change process that the strategies hope to influence.

A Recent Example: For UNDP, I designed and wrote a behavioural change communications strategy to inform a public information, engagement and media campaign by banks in North Macedonia to promote uptake of UNDP’s ‘green subsidised loan’ scheme. It comprised of two main components.

The first component was a public engagement plan through the use of ‘change agents’ and ‘community embassadors’ to counsel households through the process of deciding to change their energy use and consumption behaviours to switch from use of biomass to renewable energy and energy efficiency technical solutions for clean energy generation. They would also support these households through making an application for a subsidised loan to fund the purchase and installation of these technologies. The public engagement component also proposed discursive ’round-table’ events to engage marginalised community groups in dialogue with the scheme’s proponents and involved institutions. The second component is a national media and communications campaign using direct communications and targeted marking, new/social media and electronic/digital media (i.e. television shows and television advertising) to disseminate key messages and information about the scheme and its target benefits.

The strategy was underpinned by three psychology theories: ‘diffusion of innovation theory’, ‘social practice theory’, and ‘the Integrated Framework for Encouraging Pro-Environmental Behaviour (IFEP)’ and a model of home-based, family counselling using storytelling and negotiation of norm changes using a ‘nudge’ approach for behaviour change: ‘timed and targeted counselling/TTC’ (adapted from World Vision’s TTC for maternal and child health and nutrition).

Social and Cultural Aspects of Infectious Diseases

The Covid-19 pandemic has brought the social and culture nature of infectious disease transmission and prevention to light. Whether a disease is spread via contact (direct and/or indirect), droplet, or is airborne, vector-borne or common vehicle-borne (food, medication, intravenous fluid, or equipment that transmits infection to multiple hosts), it is inevitably linked to contact between humans or humans and animals or products and equipment that humans use. Disease prevention and management requires people to contribute by adopting specific behaviours and/or avoiding others, or workforces be involved in structured mass prevention. Health promotion and prevention initiatives for limiting or eradicating the spread of communicable diseases require human motivation, capability, pro-health attitudes, willingness to follow and comply with prescribed vaccinations and implement prevention measures, participation in health education and promotion, and for some, employment in disease control roles and teams. Perceptions and understanding of infectious diseases transmission and prevention are invariably culturally specific, and sometimes particular socio-cultural norms influence population willingness to do some of the above. Behavioural and social science has a valuable role to play in infectious disease prevention and health promotion.

I have been peer-reviewer and evaluation framework author of several monitoring and evaluation efforts on infectious disease research and/or prevention programmes. These include ASCEND (for FCDO, ex-DfID) and Tackling Infections to Benefit Africa or TIBA (University of Edinburgh). I led a team of three in undertaking a desk-top Social Impact Assessment (SIA) for FCDO’s (ex-DfID) Tackling Deadly Diseases to Benefit Africa.

I have developed a proposal for a multi-sectoral, multi-disciplinary applied research-driven, community-based, gender equitable dengue prevention initiative for implementation in Dar Es Salaam, Tanzania. It (if funded) will explore gender equity between women and men in implementing environmental management-based prevention measures at community level, and government policy contributions to supporting ‘gender transformative’ prevention. Comprising three parts, these are: 1) gender equality and social inclusion training for vector control and Ministry of Health staff, a music, drama and dance-based video to support community-level health education/promotion and a micro entrepreneurship scheme to support female entrepreneurs to run small vector-control businesses.