PhD Defense of Upendra Bhojani on September 16

Upendra Bhojani (DGD/ITM/IPH PhD scholar) has the pleasure of inviting you to the public defense of his PhD thesis “Enhancing care for urban poor with chronic conditions in India”.

Supervisors: Prof. Dr. Stefaan De Henauw (Ghent University), Prof. Dr. Patrick Kolsteren (Ghent University) and Prof. Dr. Narayanan Devadasan (Institute of Public Health Bangalore, India).  

The defense will take place on Friday September 16th, 2016 at 6 p.m., in Auditorium 1 (entrance 42) of the Ghent University, De Pintelaan 185, Ghent.


This thesis focuses on a poor urban neighborhood in south India. It is aimed at understanding the role of the local health system in enhancing care for the urban poor living with chronic conditions. Based on research over five years it reveals a high burden of chronic conditions in the neighborhood where the majority rely on private health facilities for care. Poverty hinders people from accessing health care and those who do, get further impoverished. Socially defined roles and positions particularly limit women and elderly in managing care. Fragmented services imply residents having to visit more than one facility for a single episode of care. The limited use of medical records and the lack of a referral system hinder continuity of care. Poor regulation of the heterogeneous private sector, lack of platforms for patient engagement and widespread bribery mark inadequate governance of the mixed health system. While there is inadequate care provision in the government sector, the private sector with many of its care providers lacking adequate training strives to maximize profits where the care for poor is at best seen as charity. Health service experiments to improve diabetes care delivery reveal the complex nature of the local health system wherein implementing interventions is not easy and requires careful consideration of local dynamics and opportunities.


Update: photos from the event!

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Seminar series on complexity in health, development, research and evaluation

By Bruno Marchal

The Department of Public Health would like to invite you for a first seminar on complexity in health, development, research and evaluation on 30 September 2016, entitled Complex systems thinking in international aid and health development. The starting point will be the publication of the book Development cooperation as learning in progress, edited by Paul Bossyns and Paul Verlé of the Belgian Development Agency BTC. The objective is to bring together policymakers and experts in the field of complex systems in development and evaluation, with a particular attention for the health sector. We would like to identify the challenges of complexity and the existing strategies for complex systems thinking in international aid and health development by creating opportunities for presentation, exchange and discussion.

This is the first seminar of a series, which we organise with support of the Health Department of the Belgian Development Agency (BTC), the Institut de recherche santé et société (Université Catholique de Louvain), and Be-cause Health.

The seminar will have two presentation sessions, with ample time for discussion.

  • This first session – The paradigm shift – will address the shift from linear, results-based management to complexity-sensitive planning and management that is taking place in the world of international aid and development. Speakers include Rosalind Eyben (Institute of Development Studies, University of Sussex) (TBC), Cornelius Eupen (GIZ-European Commission) and Paul Verlé (Belgian Development Agency).
  • In the second session – Complexity-sensitive planning and management – practical complexity-sensitive approaches to development and aid will be introduced with examples from practice. Speakers include Geert Laporte (European Centre for Development Policy and Management – ECDPM), Paul Bossyns (Belgian Development Agency) and Jaap Bijl (ECDPM Programme Associate).

The seminar will take place in Aula Janssen, Campus Rochus of ITM. It will start at 9am and finish at 2pm. Participation is free, but registration is obligatory. Please register here. Deadline for registration is 21 September 2016.

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8th International Congress on Infectious and Parasitic Diseases (CIPIP) in December

In the period of December 8-10, 2016 the 8th International Congress on Infectious and Parasitic Diseases (CIPIP) will be organized by INRB, the DRC’s National Institute of Biomedical Research. ITM, as a partner institution is a co-organizer; Professor Marleen Boelaert is one of the members of the organizing committee.

The main theme of the congress is infectious diseases, co-morbidities, and global health security agenda.

The submission deadline for the abstracts is September 6, 2016. For more information, download the flyer of the conference (in French).

CARPeSS-training in Morocco

by Fahdi Dkhimi

In February 2016, the Department of  Public Health officially took a new step in its collaboration with the Moroccan Ministry of Health.  We agreed to support the MoH in its attempt to develop a relevant training programme for its central and regional directors. For our department, the reason for taking up this challenge was twofold: first, this was seen as a timely opportunity to deepen our current reflections on how best to adapt our training curriculum to the needs of our institutional partners in Low and Middle Income Countries (LMICs); second, it was also considered a unique opportunity to reflect on how best to reach and strengthen capacities of the top-managers of a MoH in a Middle Income Country.

The course objective is to give this public a base of common knowledge in order to be able to interact on major public health issues, to strengthen their analytical capacity as well as to develop their ability to summarize complex issues and identify, as much as possible in an evidence-based manner, operational solutions.

We usually do not reach this high-level audience in our course, here at ITM. In a way, top managers of Ministry of Health “fly under the radar” of our training programmes, mainly because, due to their level of responsibility, they do not have the possibility to attend off-site courses. The challenge was thus to tailor the course content both to their needs and expectations, but also to their limited time availability while also taking into consideration other constraints – e.g. limited resources, tight timing as the course had to start within a couple of months after the official agreement between the MoH and ITM…

What options did we take for this pilot experience? One of our colleagues, Pol de Vos, conducted a need assessment in March 2016, that helped draw the contours of a flexible course structure: 6 themes to be covered over an 8 month-period. Each theme is built around 4 main learning tools: guided reading (3 weeks per theme, each week being introduced via an online video that presents the selected documents), face-to-face sessions (3 days per month), 3 study tours relevant for specific themes (in England, Belgium and France); and finally a written task to be submitted and defended in front of a jury in order to validate the participants’ work.

And that’s how the CARPeSS-training was born !  The acronym stands for « Certificat en Analyse et Renforcement des Politiques et Systèmes de Santé »

And here we are, just back from Morocco where we coached the first face-to-face session that concluded a month of guided readings on Universal Health Coverage and took place in Rabat from 26 until 28 June 2016.

Aside from some structural challenges (e.g. wear shirt and ties, please, not an easy one for our unit), we also added one major challenge to our ordeal by organizing this first encounter in the middle of the holy month of Ramadan (which also gave us the chance to have breakfast in local restaurants, with the traditional Moroccan Soup – the Harira.

Aside from some structural challenges (e.g. wear shirt and ties, please, not an easy one for our unit), we also added one major challenge to our ordeal by organizing this first encounter in the middle of the holy month of Ramadan.  But on the other hand, this also gave us the chance to have breakfast in local restaurants, with the traditional Moroccan Soup – the Harira.

All things considered, everything went really well. Despite their busy agendas and despite Ramadan, most of the participants signed in on Moodle to consult the reading we suggested. And the 3-day face-to-face session was well attended (25 participants, quasi 100% attendance rate).

All things considered, everything went really well. Despite their busy agendas and despite Ramadan, most of the participants signed in on Moodle to consult the reading we suggested. And the 3-day face-to-face session was well attended (25 participants, quasi 100% attendance rate) …


... or would that have been one of the unforeseen effects of the ties ?!

… or was that the unforeseen effect of the ties ?!

There is still a lot to do for this certificate, but it seems the fire is on. And we should keep the flame burning to make this pilot experience a success, but first and foremost, to draw the lessons on such an experience.

Whether we want it or not, we will have to adapt our teaching methods to the changing environment, and the earlier we pilot these changes, the better. So let’s hope we will learn from this!

Yellow Fever outbreak mission, Angola, May 10-21

by Veerle Vanlerberghe

In late April B-fast contacted ITM to identify outbreak/arbovirosis experts for a potential mission to investigate the yellow fever (YF) outbreak in Angola within the framework of the European Medical Corpse Public Health team.

Once the Minister of Health of Angola accepted our mission, we were told to obtain our visas as soon as possible to be able to leave a few days later. I joined a team of eight people: two epidemiologists/outbreak experts from ECDC (European Centre for Disease Control), an epidemiologist from Germany, a clinician from Portugal, a local ECHO expert and two EC staff for administrative, organizational and logistical support.

with the MOH team Kapalanga

with the MOH team

The mission aimed at reviewing the Angolan epidemiological situation and the control measures implemented, in order to advise the Angolan health authorities, to assess the risk of YF importation in the EU and the risk for EU residents, and to provide advice to the EC. The mission has been organised in agreement with the Government of Angola and in close coordination with World Health Organization (WHO). It was prepared and deployed in the framework of the European Union Civil Protection Mechanism (EUCPM), making first time use of the recently launched European Medical Corps (EMC).

The full technical report will be available soon, but in the meantime ECDC updated their risk assessment report based on het missions’ findings.

The epidemic, which started on December 5th, 2015 is declining, but not yet under control and is still expanding over the country. Up till the end of May, out of 2420 suspect YF cases 736 were laboratory confirmed, of which 88 were fatal (Case Fatality Rate: 12%). The lack of control on the outbreak is partly due to the control measures (vaccination and vector control) being only implemented after case detection and confirmation of local transmission (rule of ICG in view of the scarcity of vaccines available worldwide). Halting expansion can only be reached by preventive vaccination in urban areas with high population density, intensive human movement and in areas where the vector is present. The lack of background information on the Aedes mosquito infestation levels and on the most productive breeding sites in Angola is hampering the planning for such vaccination campaigns and for efficient pro-active vector control. The restricted availability of YF vaccines makes it impossible to expand vaccination coverage (for instance to have a buffer-belt around transmission spots) in order to prevent the spreading of the disease.

nets for 'huge mosquitoes'

nets for ‘huge mosquitoes’

The proportion of the Angolan population vaccinated is rapidly increasing. The current mass vaccination campaign is supposed to be finalised by the end of May. When that will be accomplished, about 11.2 million individuals will have been vaccinated in approximately four months. However, there are some challenges: vaccination coverage is not consistently high in areas where vaccination campaigns took place, adult males (i.e. the main YF affected population group) are difficult to reach during vaccination campaigns, and census data, on which the calculation of vaccination coverages is based, may suffer a degree of imprecision in rapidly growing urban areas of Luanda and other large towns. Geographical pockets (where transmission is still happening) exist despite acceptable overall coverage rates.


Being on such a short mission with the EMC was a nice personal experience, I particularly enjoyed the field trip to Huila province. I could see the huge changes between my previous stay in Angola (1996-1997) and now, especially on the availability and quality of health infrastructures. I also met a former CIPS student, Dr. Filomeno Fortes who is now the head of the National Public Health Department (DNSP/MINSA).

For the latest update on the Yellow fever outbreak, see WHO/AFRO page.