WDI RA To Return To Med School
WDI Healthcare research associate Monique Smith recently returned from a two-month-long healthcare study in the Indian states of Uttar Pradesh and Bihar. Smith, a research associate at WDI since September, will soon return to Harvard Medical School to continue her studies.
Smith's work in India has yielded interesting insights into how centralized and decentralized decision-making helps, and sometimes hampers, the health systems.
For the India project, the WDI Healthcare Research initiative, together with its partners at ACCESS Health, is studying the impact of decentralized and flexible financing under the National Rural Health Mission (NRHM). NRHM is an ambitious, large-scale funded Indian health program for improving health care delivery across rural India.
Smith and the WDI research team are synthesizing the research findings from her trip. WDI will then share its analysis with policy stakeholders in India and abroad.
The Government of India launched the NRHM in 2005 in order to improve public health services in rural parts of the country. A key component in the design of the NRHM was the Flexipool, a relatively “fungible” untied money pool allocated to each state. This pool allows more bottom-up planning and allocation, and a strengthening of ingenuity at the decentralized level.
To assess how well program resources are being spent via the Flexipool and the impact of such a financing arrangement, WDI collected primary data from a carefully selected sample of 25 facilities, including district health units when available, in the two Indian states.
These interviews helped WDI better understand whether “information blind spots” or “incentive problems” led to suboptimal allocations.
WDI also is doing some “scenario modeling” as part of the project. WDI researchers will run multiple scenarios of resource allocation for each facility, and compare those results against the actual resource allocation. Outcome measures will be extrapolated using simple models.
Smith, who specializes in allocative efficiency of health care programs at the national and facility level, said she appreciates all she experienced at WDI.
“As I look forward to returning to the clinical setting to refine my skills in providing patient care, I am grateful for the opportunity that I have had to practically engage with aspects of policy and financing of health systems,” she said. “My time at WDI has given me the opportunity to bridge academic research and curiosity with applied efforts to impact the health of individuals and populations. I truly value this lens and know that it will continue to inform my increasingly holistic vision of the field of medicine.”
Prior to joining WDI, Smith consulted on a diverse set of public health and policy issues ranging from the population and treatment dynamics of HIV/AIDS in Jamaica to traceability in global opioid supply chains and the development of health outcome measures for cost effectiveness analysis. Most recently, she has worked as a consultant at the GAVI Alliance developing a set of tools for performance and vaccine grant management.
Smith received a master’s degree in Health Policy, Planning, and Financing jointly from the London School of Hygiene & Tropical Medicine and the London School of Economics & Political Science and a bachelor’s degree in Anthropology from Harvard College. She is expected to receive her medical degree from Harvard Medical School in 2014.