Heidelberg Institute of Public Health Who We Are Demonstrated by Our Work in 2010/2011

UniversitätsKlinikum Heidelberg

On the occasion of our 50th jubilee Heidelberg Institute of Public Health Who we are demonstrated by our work in 2010/2011

Welcome Welcome

to our institute, it’s staff, students and institute as the hub. The grant also provided The master level training program was partners worldwide. The Heidelberg Institute two chairs, one in parasitology and one in expanded, modularized and integrated of Public Health (HIPH) celebrates its 50th tropical hygiene and public health along into the European teaching network tropEd. jubilee anniversary this year. As the biennial with two young research groups. It now consists of a base module of three report covers only the period of 2010/11, let months and fourteen short courses from me take this opportunity to briefly sketch In 1997, Rainer Sauerborn was hired from human rights to climate change and health. our history. Harvard University to become his succes- These short courses can be selected as sor. Under his leadership, the institute was stand-alone units or as part of a master’s Founded in 1962 by my predecessor Helmut awarded a "Special Research Center (SFB): degree both at University of Heidelberg or Jusatz as the "health wing" of the South Asia Control of Tropical Infectious Diseases" any of the other 29 tropEd teaching institu- Institute of the University of Heidelberg, it funded by the German Research Foundation tions across Europe. had a focus on medical geography. Hans (DFG). It was in a way an extension and Jochen Diesfeld who followed Jusatz in 1978 intensification of the previous research We have founded a consultancy group brought his expertise in tropical medicine focus. It included the research groups from EVAluation & PLANning (EVAPLAN), which and his interest in public health in low- the European Molecular Biology Lab (EMBL), is quite successful in running both large income countries to the table and renamed and the German Cancer Research Center implementation projects for various bi- and the institute as "Department of Tropical (DKFZ), both situated in Heidelberg. After multilateral donors, and individual consul- Hygiene and Public Health". In 1990, he three successful three-year evaluations, the ting mission both to governments and to aid set up the first non-consecutive Master of SFB concluded in 2011. organizations. Science in a medical field in Germany. Until today, it has remained with many improve- In formal teaching, Heiko Becher, epidemio- Research expanded on an ever improving ments and additions, our flagship offer in logist and deputy of the institute, set up a track record of acquiring research grants postgraduate training. doctoral school in epidemiology in 2002, from the European Union, the DFG, the again with the institute as the hub of a uni- Volkswagenstiftung, the Humboldt Founda- A large federally funded research focus on versity-wide cooperation which included also tion, the French Climate Research Program, tropical medicine brought the natural (bio- the German Cancer Research Center. An in- the National Institutes of Health (NIH) and chemistry, molecular biology) and clinical ternational doctoral school (Graduiertenkol- several private international foundations. (paediatrics) sciences of the university, leg) in global health, coordinated by Rainer A grant proposal to the Gates foundation clinicians and public health specialists Sauerborn, is currently set up. In this joint has been recently submitted with the IND- together and paved the foundation of a doctoral programme the Karolinska Institute EPTH network. long-term interdisciplinary cooperation (Stockholm) and Umeå University in Sweden around the topic of tropical medicine join the institute to establish an international and public health in Heidelberg, with the PhD programme in global health.

4 The institute is well connected in professio- Mission nal networks in Europe, Africa and Asia with To contribute to improved health in a number of "preferred partners", they are populations through research and elaborated on from page 92 onwards. teaching, both at home and in low- and middle-income countries. In the 50 years of its existence, the institute has contributed to the various paradigm Vision shifts from tropical medicine, as a sub-spe- As an academic institution, be at the fore- cialty of diseases specific to the tropics, to front of public health research through "tropical hygiene", seen as a public health fair and equitable partnerships across focus on these countries looking particu- the globe. larly at prevention and classical hygiene. The next paradigm arising in the 80's was Values "international health", referring to health Excellence. Respect. Integrity. and health care in low- and middle-income Equitable partnerships. countries. We live currently in the era of "global health", which deals with diseases, risk factors, health relevant behaviours, and policies going beyond national borders, and requiring the coordinated effort of policy, science and communities. Rainer Sauerborn Chair and Director

5 6 "Only when we know where we are coming from, can we decide where we want to go"

7 8 The Heidelberg Institute of Public Health Thematic Groups The Collaborative Research Centre (SFB 544) Teaching Service and Consulting International Collaborations National Collaborations Funding Institute’s Life

9 10 The Heidelberg Institute of Public Health sociologists, mathematicians, geographers, Who we are management specialists, and biologists work closely together with public health and clinical physicians.

Our staff is working within seven thematic units: 1. Epidemiology and biostatistics, including maternal and child health epidemiology The Institute of Public Health (former Our mission is to contribute to the improve- and non-communicable diseases and Department of Tropical Hygiene and Public ment of health through research, teaching aging populations Health) was founded in 1962 and has stea- and direct services (consulting) in low- and 2. Disease control in disadvantaged dily grown since. It is part of the medical middle-income countries and at home. To populations faculty of the University of Heidelberg and fulfil this mission, we attach great impor- 3. Climate change and health receives public core funding. However, over tance to linking our activities in two ways: 4. Reproductive health and HIV/AIDS half of the funds are competitively acquired on the one hand, we want to make sure that 5. International health economics and for both research and teaching activities. our staff teaches, evaluates development financing projects in the health sector of low- and 6. Global health policy and health systems The institute currently boasts a staff of middle-income countries and participates in 7. Health service and quality management about 60 from over 30 countries and inclu- research so that their insight and experi- des the chair, one additional full professor ence from different activities are enhancing Each unit develops their core area integ- (C3), five assistant professors (scientists each other. As an example, research results rating research, teaching and service. In with ‘habilitation’), one Mercator professor, are fed immediately into lectures; and addition, we have a teaching unit to coor- research associates, support staff and a insights from policy evaluation help us in dinate and support the institute’s teaching varying number of visiting scholars, post- the design of our own research projects. On activities. The management support staff doctoral fellows and doctoral students. the other hand, we seek to look at health coordinate administrative and financial and health systems from an international tasks. perspective, linking experience in the North and South. An executive board comprised of the unit heads and the head of the administrative An example is our study of different ways support is chaired by the director and is res- to organize health insurance, spanning ponsible for strategy and decision-making. from our own Bismarckian social security to community-based insurance in Burkina  www.ukl-hd.de/PH Faso. A third linkage we cherish at the institute is the linkage between the different disciplines. Health economists, epidemiologists, anthropologists, political scientists,

12 International Health Health Services and Economics and Financing Quality Management

Disease Control Reproductive Health in Disadvantaged Populations and HIV/AIDS Executive Board Teaching Unit Administrative Support Climate Change Global Health Policy and Health and Health Systems

Epidemiology and Biostatistics

Maternal and Non-communicable Diseases Child Health Epidemiology and Aging Populations

13 The Institute as a Hub The Heidelberg Initiative for Global Health (HIGH)

In recent years, many countries have and future think tank for all global public upgraded their research and management health related activities at the University of capacity in global health. In Germany, this Heidelberg and its associated institutions process is still in an early stage. The Uni- and partners locally, nationally and inter- versity of Heidelberg has established itself nationally. This new initiative was planned as a centre of excellence in a wide range of and developed in 2011 and launched in relevant disciplines (e.g. life sciences, poli- 2012 and covers life sciences, clinical tical sciences, geo sciences, international medicine, public health, anthropology, law, development studies), and can draw environmental sciences, law and econo- on expertise from eminent collaborating mics. It pursues the following objectives: institutions such as the German Cancer Research Centre and Max Planck Institutes. 1. To map, link interests, activities and fos- Thus, it has a unique potential and a res- ter synergies related to global health. ponsibility to take a lead in research and 2. To join forces for research and teaching evidence generation for action to promote in global health through coordination, "Health for All". The institute as well as the concept development, joint applications medical faculty and the university have a and joint projects. long track record of tackling global health 3. To promote equitable and enabling issues and challenges. This includes joint international academic partnerships for research programmes such as the Research global health issues. Focus Control of Tropical Infectious Disea- 4. To strengthen the capacity of University ses (SFB 544), joint doctoral programmes of Heidelberg, its networks and its part- as well as the many international collabo- ners, to address global health challenges rative projects, portrayed in this report. ranging from disease control, to universal access to health care, health equity, Building on these assets and taking into environment, governance and health- account the trans-disciplinary nature of related human rights. global health, we initiated the Heidelberg Initiative for Global Health (HIGH) as a hub

14 Our operational priorities include: Our thematic priorities include: ›› Research: Building ongoing projects ›› Developing models, tools and strategies and collaborations, and developing new for the prevention and control of disea- projects around the proposed thematic ses, which disproportionally affect disad- priorities. vantaged populations (product develop- ›› Teaching for medical students: Public ment – clinical interventions – modelling health and health economics techniques - implementation research). ›› Global health teaching: Heidelberg can ›› Health and the natural and social environ- build on the postgraduate teaching in ment (climate change, migration). In this the MSc International Health, the Master area, we closely collaborate with another in Medical Anthropology in South Asia, new interdisciplinary platform, the Heidel- various short courses, and diploma berg Center for the Environment (HCE). courses for those planning to work in ›› Increasing equity, including gender, low- and middle-income countries. In coverage and cost-effectiveness of health 2010 an elective course in global health systems. was established for medical students and ›› Health policy, governance and health short courses have been opened to medi- diplomacy (analysis of current policies cal students. A student society for global on global health, such as the Millennium health has also been established. Development Goals (MDGs), human rights ›› Consulting and participation in internatio- and health, funding for global health). nal expert groups: Synthesising evidence and providing advice to policy makers and development agencies nationally and internationally working in the field of global health. ›› Fostering equitable partnerships: Deve- loping models of best practice for fair partnerships and capacity building in low-income countries (e.g. cooperation with the Nouna Research Centre, as well as networking internationally (European Academic Global Health Alliance) on best practice and guidelines, such as the 11 principles for trans-boundary research partnerships, as developed by the Swiss Commission for Research Partnerships (update 2012).

15 Collaborations Worldwide 6

30 29 1. Afghanistan, Mazar-e-Sharif: tries in Africa and Asia), Accra; Health Civil Balkh Hospital Research Centre, Navrongo; Kumasi 2. Bangladesh, Dhaka: BRAC University Centre for Collaborative Research; 3. Belgium: Institute of Tropical Medicine, Kintampo Health Research Centre Antwerp; Gent University 16. Guinea Bisseau: Bandim Health Project 4. Brasil, Fortaleza: University Fortaleza 17. Indonesia, Yogyakarta: Gadjah Mada 5. Burkina Faso: Centre de University Recherche en Santé de Nouna (CSRN); 18. Israel, Jerusalem: Statistical Bureau Faculté de Mediciné, Ouagadougou 19. Malawi: Central Hospital and Light- 6. Canada, Montreal: McGill University house Trust, Kamuzu; College of 7. China, Shanghai: Fundan University, Medicine and Reach Trust, Lilongwe Zhejiang University School of Medicine, 20. Netherlands, Amsterdam Hangzhou Center for Global Health and Inequality 8. China, Wuhan: Tongji Medical College 21. Pakistan, Punjab: Ministry of Health 4 Huazhong University of Science and 22. Singapore: National University Hospital Technology 23. Sweden, Stockholm: Karolinska Institute 9. Denmark, Kopenhagen: Statens Serum 24. Sweden, Umeå: Umeå University Institute 25. Switzerland: WHO, Geneva; Swiss Tro- 10. Ethiopia, Gondar: University of Gondar pical and Public Health Institute, Basel 11. France: International Agency for 26. Tanzania: Muhimbili University of Research on Cancer (IARC), Lyon; Health and Allied Sciences (MUHAS), University of Toulouse Dar es Saalam; Mbeya Medical 12. Gabon: Medical Research Unit (MRU) Research Programme from the Albert Schweitzer Hospital, 27. Thailand, Bangkok: Thai Red Cross Society Lambaréné 28. United Kingdom, London: London 13. Gambia, Fajara: MRC laboratories School of Hygiene & Tropical Medicine; 14. Germany: (see chapter National University College London (UCL) Collaborations) 29. USA, Cambridge: Havard University 15. Ghana: INDEPTH Network (18 coun- 30. USA, Utah: University of Utah

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17 18 Thematic Groups Postdocs: PD Dr. Heribert Ramroth (deputy head) Epidemiology and Dr. Sabine Gabrysch Dr. Volker Winkler Dr. Gisela Kynast-Wolf Biostatistics Dr. Anton Safer

Doctoral students: Andreas Deckert Ema Kuhrs Epidemiology has a relatively short tradition The unit "Epidemiology and biostatistics" Eva Lorenz in Germany. Thirty years ago few research headed by Prof. Heiko Becher, is the only Robin Nesbitt departments with a focus on epidemiology formal "section" within the institute. Major Irene Santi existed at German universities. Although milestones in its development were two Heiko Zimmermann the University of Heidelberg was not one projects within the collaborative research of them at the time, some epidemiological grant SFB 544 "Control of tropical infectious IT support: activities nonetheless took place within diseases" from 1999 to 2011, and a PhD Oumar Mamadou Dia the clinical departments or within other programme (Graduiertenkolleg 793) on institutes. In 1998, a new position for a full "Epidemiology of communicable and chronic, Associate members: professor in epidemiology and biostatistics non-communicable diseases and their inter- Prof. Olaf Müller was created at the medical faculty of the relationships", funded from 2002 to 2011. Dr. Valérie Louis University of Heidelberg, assigned to the Dr. Florian Neuhann Institute of Public Health, at that time under The unit started with just four members, and Nobila Ouedraogo its former name "Department of Tropical has now grown to a considerable size. A majo- Hygiene and Public Health". rity of its staff is funded through research In addition, some doctoral students and grants which has increased substantially over undergraduate students are involved ad hoc  www.ukl-hd.de/epistat the last years, with a total funding amount of on small-scale assistant contracts. 6,13 million Euro from 2006 to 2012. The unit covers a range of different research Head: areas which include studies in infectious Prof. Dr. Heiko Becher disease epidemiology, with a focus on malaria and tuberculosis, studies of chronic Administrator: diseases (e.g. cancer, stroke), studies in Elke Braun-van der Hoeven social epidemiology in migrants, maternal and child health epidemiology, descriptive Data manager: studies with a focus on Africa, biostatistical Gabriele Stieglbauer research projects and others.

The unit is also actively involved in teaching.

20 The epidemiology module of the "Quer- A sample of major research projects are Our research projects in this area focus on schnittsbereich" epidemiology, medical briefly outlined in the following. three main aspects. The first is a better biometry and medical informatics for medical understanding of the temporal and spatial students is organized by the Prof. Becher, distribution of overall mortality in gene- and various members of the unit together Infectious disease epidemiology ral and malaria mortality in particular in with colleagues from the DKFZ (German Can- and health reporting in low- and countries with high malaria transmission. cer Research Centre) are involved in teaching middle-income countries The second is to contribute to the planning in them. The epidemiology module in the and analysis of large intervention trials, Master of Science in International Health Project team: for example to investigate the effects of course as well as other courses within the Heiko Becher, Heribert Ramroth, Gisela insecticide-treated bednets, or to compare institute are also taught by unit staff. Kynast-Wolf, Anja Schoeps, Eveline Otte im different vaccination schemes and their Kampe, Eva Lorenz, Gabriele Stieglbauer, Olaf effect on overall mortality. Our long standing Furthermore, training courses for doctoral Müller, Nobila Ouedraogo, Volker Winkler collaborations with the Centre de Recherche students in epidemiology have been develo- en Santé de Nouna (CRSN), Burkina Faso, ped and taught within the PhD programme External Collaborators: and with the international network for the "Graduiertenkolleg 793". This is outlined Dr. Ali Sié and CRSN staff, Nouna, Burkina demographic evaluation of populations in the teaching chapter on page 74 of the Faso; Dr. Osman Sankoh and INDEPTH, and their health in developing countries report. Unit members are also involved in Accra, Ghana; Prof. Peter Byass and colle- (INDEPTH) in Accra, Ghana, enable us to use various other teaching activities. agues, Umeå, Sweden large and high-quality databases for this

The unit offers epidemiological support to all members of the medical faculty. This Mortality rates by malaria for children less than five years of age by year, Nouna HDSS has led to various collaborations in a range (crosses: original rates, blue: average, red: model) of different areas, such as oral health and cardiology. According to physical coded verbal autopsy

Members of the unit are involved in numerous other academic activities within and outside the faculty. Prof. Becher has been recently nominated by the epidemiological societies in Germany as a representative for epidemiology in the German Research Foun- dation (DFG) and was elected for his second period which runs from 2012 to 2016. Pre- viously, he has also been President of the German Society of Epidemiology.

The unit has been successful in terms of publications and several grant applications.

21 research. Since ascertainment of cause of young researchers, and educating decision External Collaboration: death is a particularly difficult problem in makers on social determinants of health. Ari Paltiel, Jerusalem, Israel; The National low- and middle-income countries, we use Cohort, Germany and compare different approaches to assign The project "Estimating lung cancer death the most likely cause of deat. in countries with incomplete or less reliable For about ten years, our unit has been death statistics" is funded by the German investigating the mortality patterns of The first series of projects are: Research Foundation and led by Volker migrants from the former Soviet Union. ›› Pattern of cause-specific childhood Winkler. We have developed models which We have set up two large register based mortality in a malaria endemic area of allow estimation of lung cancer deaths cohort studies of about 50,000 individuals Burkina Faso indirectly, using smoking prevalence data, in total and have investigated the mortality ›› Seasonal patterns in overall and malaria effect estimates from other studies and pattern, which showed several remarkable mortality population figures. characteristics. The low mortality from car- ›› Ascertainment of cause of death via diovascular disease in particular gave rise verbal autopsy: Physician coding versus to several further studies, such as a nested computer assisted interpreting of verbal Migrant studies / case-control study within this cohort where autopsies (INTER-VA) social epidemiology individual information was collected by In these projects, data from the Nouna personal interview, and a prospective HDSS are the basis. Project team: cohort study in the area of Augsburg for Heiko Becher, Volker Winkler, Ema Kuhrs, which cohort recruitment is currently The second series of projects are collabora- Heiko Zimmermann, Andreas Deckert, ongoing. Our unit is also involved since the tive projects with the group of Olaf Müller, Tabeth Mashayamombe, Anna Keib initial planning phases for one of the largest the CRSN, and several partners in Africa and Europe. Members of the unit epidemiology and biostatistics ›› Effects of insecticide-treated bednets during early infancy ›› OPTIMUNIZE - Optimising the impact and cost-effectiveness of child health intervention programmes of vaccines and micronutrients in low-income countries.

Other projects: INTREC is an EU-funded project entitled "Building sustainable capacity for research for health in low- and its determinants in low- and middle-income countries". Running drom 2012 to 2017, it aims at developing sustainable capacity by providing state-of-the-art region-specific training for

22 Projects in migration/ cohort studies worldwide, the "National Biostatistical methods in social epidemiology Cohort" which plans to recruit 200,000 epidemiology individuals, starting 2013 (see also page ›› Changing risk factor patterns for 107). In the BMBF funded feasibility studies, Project team: cardiovascular and cerebrovascular our unit investigated strategies to recruit Heiko Becher, Eva Lorenz, Volker Winkler diseases (CVD) in a large cohort of migrants. In addition, the unit is involved in migrants in Augsburg several other sub-projects. External collaborations: ›› Mortality of ethnic German immigrants Prof. Sauerbrei, Freiburg; Prof Royston, Lon- from the former Soviet Union in don, Prof. Siemiaticky and Prof. Abrahamo- Germany – The AMOR study Stroke epidemiology wizc, Montreal; Prof. Kauermann, München ›› Cancer incidence and mortality of German immigrants in the Saarland Project team: Developing appropriate statistical methods (AMOR-Saar) Heiko Becher, Anton Safer, Gabriele Stiegl- for complex epidemiological data is impor- ›› Nested Case-control study on cardio- bauer tant. We focus on two areas. Dose-response vascular risk factors among Aussiedler modelling is of particular importance if the ›› Mortality of migrants from the former External Collaborations: relationship between the dose of an agent Soviet Union to Germany and Israel – Prof. Armin Grau and Dr. Frederik Palm, and the disease risk is to be estimated. a comparative study Ludwigshafen; PD Dr. Caspar Grond- Often the distributions of these exposures ›› The National Cohort – migrant Ginsbach, Heidelberg are complex, and involve a part of the popu- research, feasibility studies and lation which is unexposed, and another part cohort recruitment For several years, the unit has been col- which has a specific, continuously distribu- laborating with the group of Prof. Armin ted exposure. Estimating a dose-response Grau, Ludwigshafen, in the field of stroke function is more complex in such a situation epidemiology. Most recently, we have fini- and we have developed a method which shed data ascertainment for a case-control can be applied. In this project, funded study with 475 cases and 810 controls. The by the German Research Foundation, we primary aim of the study is to investigate investigate further statistical properties and inflammation, genetic factors and social develop multivariable extension: determinants as risk factors for ischemic stroke and their interaction. In addition, ›› Analysis of dose-response relationships we analyse, together with the colleagues in in epidemiology with spike at zero Ludwigshafen, data from the ongoing stroke ›› Person-year estimation with incomplete registry. follow-up Mortality from cardiovascular diseases in ›› Using penalized spline to model age- and Europe: a striking example of the diffe- season-of-birth-dependent effects of rences in health and risk factors between childhood mortality risk factors in rural countries of migrant origin and destination Burkina Faso (dark blue: high risk, light blue: low risk).

23 to differentiate between educational and lities influence use of delivery care, antena- Research group: occupational effects for this cancer. This tal care, maternal and newborn mortality in Non-communicable diseases seems to be especially important for better Sub-Saharan African countries. & aging populations distinguishing between various confoun- ding variables. Recent survival analyses In Zambia and Malawi, we could take advan- Project team: considering the effect of lifestyle factors are tage of existing geo-referenced national Heribert Ramroth (head), Heiko Becher, Irene planned to be applied to a cohort of head health facility census data and household Santi, Elisabeth Rudolph, Sami Chenouda and neck cancer patients collected by the data from demographic and health surveys, INHANCE working group in cooperation with linking these in a Geographic Information External Collaboration: the International Agency for Research on System (GIS). In Burkina Faso and in Ghana, International Agency for Research on Cancer Cancer (IARC), France. we use data from our partner institutions’ (IARC), Lyon France; International Head And demographic surveillance systems. In Neck Cancer Consortium (INHANCE), Utah USA Ghana, together with our collaborators, we Research group: Maternal and surveyed 86 health facilities in 2010 and are The research group focuses on behavioural child health epidemiology currently studying the influence of distance and occupational risk factors for laryngeal and quality of maternal and newborn care at cancer, as well as survival rates. Starting Project team: delivery facilities on maternal mortality as point for this project was a case-control Sabine Gabrysch (head), Robin Nesbitt, well as on delivery care-seeking in emer- study, while analyses focusing on survi- Heiko Becher, Terhi Lohela, Nicholas Kyei, gency situations and for planned facility val resulted from a subsequent enlarged Anja Schoeps deliveries. cohort study. Two university hospitals and three medical hospitals of three different External collaborators: We have furthermore reviewed current German federal states participated in this Oona Campbell, Betty Kirkwood, Alex Manu, health-system output indicators and bench- study, resulting in a final sample of 257 Lisa Hurt and others at the London School marks proposed by the WHO and other UN cases and 769 controls, 1:3 frequency- of Hygiene and Tropical Medicine; Kintampo agencies and made suggestions on how to matched for sex and age. The subsequent Health Research Centre in Ghana; Centre de make them consistent and more practically cohort study included all patients from the Recherche en Santé Nouna in Burkina Faso; useful. case-control study but was increased to Philipp Zanger at the Institute of Tropical include all cases in the same study region Medicine Tübingen, amongst others. From 2013 on for six years, the BMBF will as in the case-control study up to the end fund a junior scientist group in epidemiolo- of the year 2004. To date, patients from Funding: gy at the institute, which will be led by four clinics could be recruited, resulting Rahel Goitein-Straus fellowship from the Dr. Sabine Gabrysch. The group will conduct in a final cohort of 594 laryngeal cancer Medical Faculty of Heidelberg University, a cluster-randomised trial of an integrated patients. Postdoctoral fellowship of the Baden-Würt- agricultural project with women’s groups temberg Foundation. aimed at reducing undernutrition in young Perspectives of the group: children. The study team is currently applying a We investigate how geographic accessibility recently developed occupational index of health facilities and quality of care at faci-

24 Project HIPH Staff Partners in External Partners Funding Duration * Doctoral students HIPH ** Bachelor/Master students Infectious disease epidemiology Pattern of cause-specific childhood Heiko Becher, Gisela Olaf Müller Ali Sié, CRSN, Nouna, DFG 2008-2012 mortality in a malaria endemic area of Kynast, Heribert Burkina Faso (SFB 544), Burkina Faso Ramroth, Gabriele Project Z2 Stieglbauer Seasonal patterns in overall and malaria Heiko Becher, Eveline Olaf Müller Ali Sié, CRSN, Nouna, DFG (SFB 544), 2008- mortality Otte in Kampe**, Burkina Faso Project Z2, ongoing Heribert Ramroth, Core funding Gabriele Stieglbauer Modeling of malaria Heiko Becher Martin Eichner, Institute GRK 793 2005-2011 Thomas Jänisch of Medical Biometry, Kerstin Rosenberger * Tübingen, Germany Effects of insecticide-treated bednets Heiko Becher Olaf Müller Ali Sié, CRSN, Nouna, DFG (SFB 544), 2002-2012 during early infancy (PI) Burkina Faso core funding The role of antimicrobial peptides in Sabine Gabrysch Philipp Zanger, Institute 2009-2010 human skin infections of Tropical Medicine, Tübingen, Germany Optimunizing the impact an cost-effec- Heiko Becher Olaf Müller Peter Aaby, Guinea Bis- EU 2011-2015 tiveness of child health intervention Anja Schoeps** Nobila seau and the OPTIMUNI- (OPTIMUNIZE) Ouedraogo* ZE consortium Cancer epidemiology Smoking and lung cancer in Africa Heiko Becher Nawi Ng, Centre for Glo- DFG 2008-2012 Volker Winkler bal Health Reasearch, Umeå, Sweden Occupational and other risk factors for Heiko Becher Andreas Dietz, Unive- BMBF and 2000 - laryngeal cancer Heribert Ramroth rity Hospital, Leipzig, core funding ongoing Germany; INHANCE consortium; IARC France; Wolfgang Ahrens, BIPS, Bemen, Germany Survival of laryngeal cancer Heribert Ramroth Andreas Dietz, Unive- GRK 793 2006 - Heiko Becher rity Hospital, Leipzig, Hopp-Stiftung ongoing Irene Santi * Germany; INHANCE con- Elisabeth Rudolph * sortium; IARC France; Sami Chenoudi * Wolfgang Ahrens, BIPS, Bemen, Germany

25 Project HIPH Staff Partners in External Partners Funding Duration * Doctoral students HIPH ** Bachelor/Master students Migrant studies / Social epidemiology Changing risk factor patterns for cardio- Heiko Becher Christa Meisinger, DFG / GRK 793 2009 - vascular and cerebrovascular diseases Andreas Deckert * Institute of Epidemiolo- 2013 (CVD) in a large cohort of migrants in gy, Helmholtz Zentrum Augsburg München, Germany Mortality of ethnic German immigrants Volker Winkler Oliver Razum, University GRK 793 2002 - from the former Soviet Union in Germa- Ema Kuhrs * of Bielefeld, Germany ongoing ny – The AMOR study Heiko Becher Cancer incidence and mortality of Volker Winkler Christa Stegmeier, Can- Core funding ongoing German immigrants in the Saarland Heiko Becher cer Register Saarland, (AMOR-Saar) Germany Nested case-control study on cardiovas- Heiko Becher GRK 793 2009 - cular risk factors among Aussiedler Ema Kuhrs * 2012 Mortality of migrants from the former Heiko Becher Ari Paltiel, Bureau of ongoing Soviet Union to Germany and Israel – the Statistics Jerusalem, a comparative study Israel Biostatistics Analysis of dose-response relationships Heiko Becher Willi Sauerbrei, Universi- DFG 2011-2014 in epidemiology with spike at zero Eva Lorenz * ty of Freiburg, Germany; (SPATZ) Patrick Royston, UCL, London, UK Person-year estimation with incomplete Heiko Becher Core funding ongoing follow-up Volker Winkler Cardiovascular disease epidemiology Case-control study on inflammatory, Heiko Becher Olaf Müller Armin Grau, Frederik DFG 2007-2012 genetic and social determinants of Anton Safer Palm and others, Lud- ischamic stroke (GENESIS) wigshafen, Germany Maternal and child health epidemiology Risk factors of infant and child mortality Heiko Becher Ali Sié, CRSN, Nouna, Core funding 2006 - in Burkina Faso Gisela Kynast Burkina Faso Faso and University ongoing Gabriele Stieglbauer Hospital

26 Project HIPH Staff Partners in External Partners Funding Duration * Doctoral students HIPH ** Bachelor/Master students Spatial clustering of childhood mortality Heiko Becher Olaf Müller Osman Sankoh, IND- Core funding 2006 - Gisela Kynast EPTH, Accra, Ghana; and University ongoing Gabriele Stieglbauer Ali Sié, CRSN, Nouna, Hospital Burkina Faso Indicators and benchmarks for tracking Sabine Gabrysch Oona Campbell, LSHTM, 2009-2011 progress towards safe motherhood London, UK; Philipp Zanger, Institute of Tropical Medicine, Tübingen, Germany Distance to delivery care, service use Sabine Gabrysch, Oona Campbell, LSHTM, Rahel Goitein- 2009-2012 and neonatal mortality in Zambia and Terhi Lohela** London, UK Straus Malawi Fellowship Quality of antenatal care in Zambia, and Sabine Gabrysch, Oona Campbell, LSHTM, Rahel Goitein- 2011-2012 influence of quality of care and distance Nicholas Kyei** London, UK Straus on antenatal care use Fellowship Geographic access, quality of care and Sabine Gabrysch, Betty Kirkwood, Alex Baden-Württem- 2010 - delivery care-seeking in Ghana, impact Robin Nesbitt * Manu, Lisa Hurt, and berg Foundation ongoing on maternal an perinatal mortality others, LSHTM, London, UK Childhood mortality and distance to Heiko Becher Olaf Müller Ali Sié, CRSN, Nouna, Core funding 2010 - 2011 health centers in Burkina Faso Anja Schoeps** Burkina Faso Sabine Gabrysch Other projects Ascertaining the cause of death using Heribert Ramroth Peter Byass, Ed Fot- 2008-2012 verbal autopsy data: the probabilistic Eva Lorenz* rell, Umeå University, InterVA. Mark Ssennono* Sweden Heiko Becher Johanna Rankin** National Cohort feasibility-studies Heiko Becher See BMBF 2011-2013 Heiko Zimmermann  www.nationale- Ema Kuhrs * kohorte.de Heribert Ramroth Gabriele Stieglbauer Comparative study on head lice treat- Heiko Becher Jörg Heukelbach, Federal GRK 793 2008-2011 ment in Fortaleza, Brazil Susanne Sonnberg * University of Fortaleza, Core funding Brasil

27 a research project on different operatio- Disease Control in nal facets of a routine PMTCT (preventing mother-to-child transmission) program in Nouna, Burkina Faso (principal investigator Disadvantaged (PI) Hans-Georg Kräusslich; co-investigators Malabika Sarker and Olaf Müller). The multi-country European Union (EU) project Populations "Effect of antiretrovirals for HIV on African health systems, maternal and child health" This multidisciplinary working group Group leader: ARVMAC focussed on the quality of ART consists of specialists working in different Prof. Dr. Olaf Müller and PMTCT service provision in Uganda, areas relevant to disease control in low- and Tanzania and Burkina Faso (HIPH principal middle-income countries (e.g. parasitology, Members: Investigator Malabika Sarker, co-investiga- epidemiology, paediatrics, reproductive Claudia Beiersmann tors Florian Neuhann and Olaf Müller). Since health, anthropology, health economics, Dr. Manuela De Allegri* 2006, ARVMAC engaged in conducting disease surveillance). Dr. Sabine Gabrysch* research on cross-country comparison using Prof. Dr. Albrecht Jahn* three demographic surveillance systems All group members work on projects in Dr. Valérie Louis* (DSS). The project ended in 2011. Additional partnership with colleagues from a number Robin Nesbitt* research is ongoing in the areas of retention of countries mainly situated in the south Dr. Florian Neuhann* in care, treatment interruption, and emer- (e.g. Burkina Faso, Uganda, Tanzania, Martin Nyaaba Adokiya ging resistance to ART in Malawi, funded by Malawi, China, Bangladesh). Nobila Ouedraogo the Hector Foundation (PI Florian Neuhann). Prof. Dr. Andreas Ruppel The aim of the group is to collaborate on Prof. Dr. Malabika Sarker  www.arvmac.eu relevant projects to improve health through Dr. Aurélia Souares* applied disease control measures in disad- Dr. Yesim Tozan vantaged populations of respective partner Prof. Dr. Annelies Wilder-Smith* Malaria research countries. Currently, the main topics of the working group are HIV/AIDS, malaria, den- *Associated members Most of the malaria research projects were gue and maternal and child health. carried out in the research zone of the Cen- tre de Recherche en Santé de Nouna (CRSN) HIV research in Burkina Faso. Malaria is holoendemic but highly seasonal in this area. Our HIV research group addresses quality of care related to antiretroviral treatment (ART) Research activities started in 1999 with a provision for adult and pregnant women WHO-supported randomised controlled trial and ART adherence and retention in care. (RCT) on the effects of zinc supplementation Since 2002 and until 2011 DFG has funded in malaria control (PI Olaf Müller), followed

28 tropics and sub-tropics, but climate change and travel patterns have also contributed to the introduction of dengue fever even in Europe.

Our dengue working group consists of physicians, epidemiologists and environmental scientists. The group is part of the EU Den- gueTools project. DengueTools endeavours to achieve better diagnosis, surveillance, prevention, prediction and/or prevention of the spread of dengue fever to previously non-endemic regions (including Europe) in the context of climate change. The project Doctoral student Germain Mandi examining a child with malaria enrolled in a RCT on the efficacy of methylene is funded under the health theme of the 7th blue-based combination therapy in Nouna, Burkina Faso framework programme of the European Com- mission, grant agreement number: 282589 by a DFG-supported RCT on the long-term drug regimen until registration (PI Olaf DengueTools. effects of insecticide-treated mosquito nets Müller). Moreover, studies have started or (ITN) on malaria morbidity and all-cause are planned which aim to assess the effects  www.denguetools.net mortality (PI Olaf Müller), a DFG-supported of methylene blue-based combination the- study on operational aspects of ITN pro- rapy on the gametocytes in falciparum mala- grammes in Africa (PI Olaf Müller), a DFG- ria and on the hypnocytes in vivax malaria. Maternal & child health (MCH) supported study on the efficacy and effec- A new solid methylene blue formulation for tiveness of alternative first-line treatment children has just been developed in collabo- The MCH projects consist of: regimens compared to artemisinin-based ration with the University of Düsseldorf ›› Research on public health aspects of combination therapy (ACT) in Burkina Faso (PI Olaf Müller). routine childhood vaccinations in Sub- (PI Olaf Müller). Most of these projects were Saharan Africa (SSA) part of the DFG-funded SFB 544 which also ›› Research on the epidemiology and concluded in 2011. A partly industry-funded Dengue prevention of childhood malnutrition in clinical research project on the develop- Burkina Faso ment of methylene blue-based combination Dengue fever is a mosquito-borne viral ›› Research on infectious disease elimi- therapy as an alternative treatment regimen disease estimated to cause about 50-100 nation and eradication strategies in SSA for falciparum malaria in Africa is ongoing. million infections worldwide every year, of ›› Research on the effectiveness of care which 25,000 are fatal. Global incidence in pregnancy and child birth with an The goal of this project is the establishment has risen rapidly in recent decades: some emphasis on antenatal screening, referral of a product development partnership for 2.5 billion people, two fifths of the world‘s systems, community-based safe mother- the development of an alternative malaria population, are now at risk, mainly in the hood, and related health systems issues,

29 it requires a functional health system ranging from the community to local first level facilities and up to the referral hospital.

These levels need to be linked through a referral system, supportive supervision and a bi-directional flow of information. Thus, our research projects in Tanzania and Burkina Faso pursue a systems approach, based on a defined and tested health service model (PI Albrecht Jahn).

Doctoral student Maike Tipke investigating the quality of malaria drugs sold on a market in Nouna, Burkina Faso Health information on reproductive health issues is often incomplete and not standar- dized, hampering planning for appropriate such as quality of care and access in Tan- Disease elimination and eradication remain services as well as limiting the possibilities zania, Burkina Faso, Ghana and Germany globally debated topics. The working group to learn from the cross-country comparative ›› Research on the population-based is addressing aspects of malaria elimination analysis. We are the German partners in assessment and monitoring of repro- in Asia, dracunculosis elimination in Ghana the EU-funded REPROSTAT project, which ductive morbidity, mortality and use and polio elimination in Nigeria (PI Olaf aims at standardizing reproductive health of health services in Europe Müller). reporting in Europe and address specific neglected areas such as adolescent repro- Childhood vaccinations are an important Childhood malnutrition remains a major ductive health, abortion, and teenage tool for reducing morbidity and mortality public health problem in SSA, causing up to pregnancies (PI Albrecht Jahn). in developing countries. In recent years, half of the under-five mortality. A longitudi- a number of new and costly vaccinations nal study on the development of childhood have been included or are proposed to be malnutrition and its determinants took Perspectives of the group: included into the Extended Programme of place in the research zone of the Centre de Immunization (EPI) schemes, but it is cur- Recherche en Santé de Nouna (CRSN) in The members of the working groups plan rently not clear how this can be effectively Nouna health district in north-western Bur- to continue working closely together in the implemented and sustained. Moreover, kina Faso (PI Olaf Müller, doctoral student field of applied disease control research routine vaccinations can be associated with Claudia Beiersmann). aiming at improving the health of neglected some rare, unspecific and unintentional populations, but will concentrate fully on effects. A large EU-funded multi-country Care in pregnancy and child birth is closely infectious diseases in the future. research project is currently under way to linked to the Millennium Development look at these issues in a number of African Goals (MDG 4 and 5). Effective care cannot countries (HIPH PIs Olaf Müller & Heiko be achieved with a silver bullet approach Becher, doctoral student Nobila Ouedraogo). based on one specific intervention. Rather,

30 Projects 2010/2011:

Acronym Full title Partners HIPH Staff Funding Main results and outlook *doctoral agency and students timeline D4 Efficacy, safety HIPH; CRSN; Ministry of Health Olaf Müller DFG ITNs are safe in all age groups and in all and public health Burkina Faso Albrecht Jahn SFB 544 endemic areas; compliance remains a aspects of ITNs Manuela De (1999-2011) challenge during the hot and dry season in Africa Allegri in West Africa; universal coverage is the Valérie Louis best public health strategy; replacement Joelle Bals* sytems for old ITNs remain a challenge Maike Tipke* Tabea Schroer* A8 Development of HIPH; Institute for Biometrics Olaf Müller DFG MB is safe and effective in African methylene blue and Informatics, Heidelberg; Bernd Marks (SFB 544) malaria patients; it acts slow against the (MB) -based ma- University of Düsseldorf; Maike Tipke* (2005-2011) parasites and thus needs to be com- laria treatment University of Ulm; CRSN; bined with appropriate partner drugs; combination Centre National de Recherche it is currently the most effective drug therapy et de Formation sur le Paludis- against the gametocytes of P. falcipa- me (CNRFP) rum; adding MB to existing ACTs could be a good strategy GK 793 Malnutrition in CRSN Olaf Müller DFG Malnutrition has only marginally decli- young children of Claudia Beiers- (2008-2011) ned in rural Burkina Faso over the past Burkina Faso mann* decades and remains a major neglected area in international public health Optimu- Unspecific ef- HIPH; States Serum Institute, Heiko Becher EU The project aims to analyse routine data nise fects of child- Denmark LSHTM, UK; CRSN Olaf Müller (2011-2015) from three DSS sites in SSA; in addition hood immun- Burkina Faso, Navrongo Nobila Oued- it aims at conducting a RCT on an al- isations in SSA raogo* ternative measles vaccine regimen. AIDS in AIDS in Malawi HIPH; Light house, Malawi Florian Neu- Hector Foun- Treatment interruption of ART is associa- Malawi hann, Heribert dation ted with restistance development in Ramroth, Flo- (2008-2014) 25 % of cases. rian Scheibe*, Julia Lübbert* Dengue- Strategies and University of Umeå, Sweden; Valérie Louis EU FP7 To develop novel tools and strategies to Tools tools for the LSHTM; University of Singapore; Yesim Tozan (2011-2015) control dengue surveillance and University of Malaysia; Ministry Annelies control of dengue of Health, Sri Lanka; University of Wilder-Smith Sao Paolo; Mahidol University, Thailand; TwistDx, Cambridge; Oxitec, Oxford; Institute Pasteur, Paris; Swiss Tropical Institute, Basel 31 includes time series analysis on data from Climate Change 11 INDEPTH research centres from Sub- Saharan Africa and Asia. Age- and cause- and spatially-specific deaths were analyzed and Health against temperature, humidity and rainfall data of the day of death and lagged by days to three months. The results have been submitted as a special volume of "Global Health Action". There will be no diseases exclusively speci- Group leader: fic of climate change, rather climate change Prof. Rainer Sauerborn PALUCLIM (Impacts of climate factors on modifies and amplifies existing health risks the production of malaria vectors) in a great array of climate-sensitive disea- Members: The aim is to guide larvicidal antimalarial ses. This will particularly affect low- and Dr. Valérie Louis intervention to ecosystems of high transmis- middle-income countries, raising serious Dr. Sabine Gabrysch* sion risk using satellite proxies, which have issues of inequity. There is good evidence Dr. Yazoumé Yé previously been validated on the ground that the health impacts will be in the areas Dr. Shelby Yamamoto through entomological data (both larva and of malnutrition, infectious diseases, diarrhea, adult mosquitoes). The project is in colla- and cardiovascular diseases. Particularly *Associated members boration with the University of Toulouse, vulnerable groups are likely to be infants, the French Space Research Centre, Météo young children and the elderly. There is a Doctoral students: France and the CRSN Nouna. large need for detailed, population-based Aditi Chebbi studies of health impact by linking disease Aminul Haq Aging and Climate change: datasets with meteorological informationl. Alina Vandenbergh This is a joint Umeå-HIPH group, where Climate theses need to be longitudinal Peter Dambach the post doc, Dr. Barbara Schumann, from covering at least 10 years. Our close Revati Phalkey Umeå at the Center for Aging and Living collaboration with the INDEPTH network Conditions (ALC) and two doctoral students gives us access to such datasets, both Humboldt scholar: are affiliated with the Heidelberg NAR (Net- retrospectively and prospectively. Impacts Maduni Madanayake work of Aging Research), of which our insti- can be avoided through what the climate tute is a member. The two doctoral theses, community calls "adaptation" interventions supervised by Rainer Sauerborn, will focus and policies. These may be within the Research projects run in on the impact of climate change on morbi- health sector or outside. Adaptation within the group dity and mortality of the elderly in Sub- the sector include surveillance systems for Saharan Africa and changes in prescribing climate-sensitive diseases, early warning CLIMIMO (Climate change, migration and practices for multi-morbid elderly patients systems, e.g. for vector-borne diseases, mortality) during heat waves in Germany. enhanced control efforts on geographic or This is a cooperation with 11 INDEPTH sites socioeconomic target groups. and Umeå University, Sweden. Research

32 Perspectives of the group:

A strategic workshop in May 2012 founded a consortium of our group with Umeå university, the French Space Research Center, Toulouse University, the French Meterological Service and Nouna IND- EPTH center. Apart from pursuing our current agenda, we want to develop jointly the following areas:

1. Malnutrition triggered by climate change

2. The impact of climate driven hydrometeorological diasters

CLIMIMO first project workshop in Nouna, 11/2011 3. Early-warning systems for malaria and dengue Peter Dambach struggling to find the ground truth of satellite data of malaria breeding sites

33 Dengue risk by identified socio-economic Annual rainfall of Gampola region, factors in Gampola region, Sri Lanka Sri Lanka, in millimetre 2010 with isolines

Dengue cases in 2010 Dengue cases from January to May 2011 3229 Major Road Low

Minor road Moderate 1808 High

34 Update: new junior research Two doctoral scholarships were awarded group "Climate change and by the NAR on: aging in a global perspective" Climate change and aging in Germany Background Topic: Climate-related perceptions and Climate change is one of the largest poten- behavior of the elderly and their tial threats to global health. While it is doctors and nurses in the Rhine-Neckar widely accepted that vulnerabilities to the Region health impact of climate change will vary according to gender, socio-economic status, Climate change and aging in low- and education, social networks and immobility, middle-income countries the specific vulnerability of the elderly has Topic: The impact of climate on the health received very little scientific attention so far. of the ageing population in Nouna, Burkina Some studies from UK and Sweden indicate Faso. that the elderly might not only be more vulnerable, particularly to heat, air pollution and climate-sensitive infectious diseases, but they may also have a larger climate footprint, thus at the same time dispropor- tionately contributing to and suffering from climate change. Studies have also shown that the elderly male population are more reluctant to consider climate-induced hazards a threat to their own health.

Set-up In addition to the topic, the set up of this junior group is quite innovative: it spans two universities with their research capacity on aging and climate:

›› University of Heidelberg (Institute of Public Health, Network of Aging Research NAR) ›› Umeå Universitet, Sweden (Centre for Glo- bal Health Research and Centre for Aging and Living Conditions)

35 Effects of antiretrovirals for HIV Reproductive Health on African health systems, maternal and child health and HIV/AIDS (ARVMAC) Project team: Prof. Malabika Sarker (head), Hilde Gold- Feuchtmüller, Saskia Nahrgang, Dr. Florian Neuhann, Prof. Olaf Müller, Florian Scheibe, Recent years have seen progress in maternal Group leader: Paul Conrad and child health with decreasing maternal and Dr. Florian Neuhann under 5 mortality, however this progress does ARVMAC was a large EU FP6 funded project not apply everywhere in the world and im- Group members: conducted by a large consortium in which provement around maternal health and child Dr. Sabine Gabrysch* the HIPH took a work package on quality of health will remain a priority for global health Prof. Albrecht Jahn* care in antenatal care, including prevention even in the post MDG era. Within our institute Prof. Olaf Müller* of mother to child transmission of HIV (HIPH, we address this topic in close relation to HIV Prof. Malabika Sarker* Malabika Sarker) and for antiretroviral thera- not least because some countries in particu- PD Dr. Heribert Ramroth* py (HIPH Florian Neuhann). Several other lar in Sub-Saharan Africa with high maternal Sandra Barteit researchers of the Institute have been mortality face generalized HIV epidemics Phillip Hoepfner involved in and contributed to the project simultaneously. Further the sexual transmis- (Manuela De Allegri, Albrecht Jahn, Olaf sion of HIV and mother to child transmission *Associated members Müller) and results have been analyzed for also link these health topics. The reproductive doctoral theses, master theses and publica- health and HIV/AIDS thematic group works Doctoral students: tions. in close cooperation with other groups in Florian Scheibe particular the disease control in disadvantaged Julia Lübbert  www.arvmac.eu populations group and the health service & Nicola Glaser quality management. Saskia Nahrgang Antje Theurer Sub-Section HIV: The focus of projects in HIV lies on treatment of HIV and opportunistic infections and complications, quality of health services structures and processes, retention in HIV care, competence of patients and adherence to treatment. All projects include elements of capacity building in partner countries and for young researchers in North and South.

36 Malawi German networking for capacity building in treatment, training and research at Kamuzu central hospital (MAGNET)

Project team: Dr.Florian Neuhann (head), Antje Theurer, Philip Hoepffner, Sandra Barteit, PD Dr. Heribert Ramroth, Hilde Gold-Feuchtmüller

Partners: Kamuzu Central Hospital, Medical Depart- ment, University Clinic Infectiology Cologne and Bonn,

Funding : GIZ/ESTHER, Centre for international Mig- ration and development (CIM), extension Florian Neuhann teaching EpiInfo in Lilongwe, Malawi. possible Waiting list number handed out at Lighthouse Clinic reception

In the framework of the European ESTHER Initative ( Ensemble pour une Solidarité Therapeutique Hospitalière en Reseau) since 2008 the institute is engaged – together with infectious disease departments in Cologne and Bonn – in a partnership with medical department of the Kamuzu Central Hospital in Lilongwe Malawi called MAGNET (Malawi German Networking for capacity building in treatment, training and research at Kamuzu Central Hospital).

The overall objective of this partnership is to improve the quality of patient care and the teaching and training for the final year medical students. A German medical doctor is placed at the department, teaching ward rounds are conducted by visiting faculty,

37 an e-learning platform has been developed and operational research conducted e.g. to perform a situational analysis of the quality of care and to investigate the causes of fever among patients admitted to the department. Results of both studies have been presented at international conferences and are in the process of publication. Since 2012 a second ESTHER partnership was funded by ESTHER between the Lighthouse, the Infectious Disease Clinic of Cologne and the HIPH.

 www.esther-magnet.org

Addressing the challenges of service quality: innovations in patient care and service efficiency in a large public ART clinic in a resource limited setting

Project team: Dr. Florian Neuhann (head), Julia Lübbert, Florian Neuhann with Director Dr. Sam Phiri and members of the management team of Lighthouse Nicola Glaser , PD Dr. Heribert Ramroth, Hilde Gold-Feuchtmüller

The Hector Foundation in Germany funds projects for a study period of five years, there are some sub-projects still ongoing. Project partner is the Lighthouse Trust in Lilongwe, Malawi, which runs two large centres for comprehensive HIV prevention, treatment and care services. The program aims to analyse and consequently inform public treatment programs with regards to quality and efficiency.

38 The back to care viral load study (B2CVL) Other projects look in a qualitative looked at and evaluated the current approach into the reasons of patients to practice of the Malawian HIV treatment interrupt antiretroviral treatment and the programme to restart patients who inter- perception and expectations of patients on rupted of their antiretroviral treatment on quality and efficiency of the services at the their previous first line regimen (PI Florian Lighthouse. Neuhann, HIPH, Sam Phiri, Lighthouse, investigators Julia Luebbert, doctoral student Between January and March 2012 a cross- Heidelberg, Hannock Tweya, Lighthouse, sectional study on the prevalence of renal Paul Schnitzler, Virology Heidelberg, impairments among HIV positive and HIV Heribert Ramroth HIPH). The aim of this negative clients of the lighthouse has been study was to determine the prevalence conducted and is now being analyzed (RE- of virological failure and patterns of drug SULT - renal survey Lighthouse; cross-sec- resistance among patients with treatment tional survey of renal function in HIV-positive interruption and to evaluate the current and HIV-negative clients of the Lighthouse practice of resuming firstline ART. The pro- counselling and testing center in Lilongwe, ject was successfully completed, presented Malawi). and published. (Clin Inf Diss 2012)  www.lighthouse.org

Acronym Title Key words Partners HIPH Funding Timeline Perspective investigator MAGNET Malawi German networking for Capacity buil- University Florian GIZ/ESTHER 2008-2012 Extension capacity building in treatment, ding, quality of Cologne, Neuhann possible training and research at Kamuzu improvement, Kamuzu Central Hospital training, high Central HIV prevalence Hospital RESULT Cross-sectional survey of renal HIV, renal Florian Hector Stiftung function in HIV-positive and function Neuhann HIV-negative clients of the Light- house counseling and testing center in Lilongwe, Malawi ARVMAC Effetcs of antiretrovirals for HIV Quality ART, Florian EU 2007-2010 Analysis still on African health systems, ART delivery in Neuhann ongoing maternal and child health urban and rural health systems in Africa

39 coverage on a global level. In line with the International Health global health financing agenda, the group’s current work focuses primarily on impact Economics and Financing evaluations related to: ›› alternative systems to raise funds for health care ›› health care financing interventions which target traditionally disadvantaged groups The research group in international health Group leader: and vulnerable populations with the aim economics and health financing aims at Dr. Manuela De Allegri of increasing access to health services being at the fore-front of health economics ›› innovative strategies to ensure an equi- and health financing research and teaching Formal members table and efficient mix of quality health on a global level. The group came into Gerald Leppert services to those in need. existence about fifteen years ago, as one of Stephan Brenner the first academic groups in Germany with Olivier Kalmus Specific areas of expertise and research a focus on the application of health econo- Qun Wang include: mics to health systems research in low- and Gilbert Abiiro middle-income countries. Over the years, Hoa Nguyen Social health insurance, private insurance, the group has experienced natural changes and micro health insurance: The group in leadership, but has maintained its role Associated partners works with experimental and semi-experi- of contributing to global health systems Prof. Dr. Hengjin Dong mental research designs to accompany the research through the understanding of how Dr. Yesim Tozan development and to produce evidence on scarce resources can be used efficiently to the impact of insurance mechanisms in low- produce valuable and equitable health outco- Associated PhD students and middle-income countries. mes world-wide. Hans-Christian Stahl Shafiu Mohammed Provider payment and health services  www.ukl-hd.de/ph/HealthEconomics Yan Ding purchasing: The group has competencies in Yan Fei performance-based financing and relevant Budi Aji assessments of quality of care, primarily in Happiness P. Saronga low- and middle-income countries. Germain Savadogo Jake Robyn User fee abolition: The group works on issues relevant to the abolition of user Over the years, the group has come to focus fees in West African countries, conducting primarily on research themes pertinent both applied research on the impact of to health financing and more specifically single interventions (in collaboration with to the achievement of universal health the disease control group at the HIPH) and

40 broader policy analysis to unravel factors shaping the relevant policy shifts.

Economic evaluation and health technology assessment: The group is proficient in the theory and practice of analytical approaches to cost analysis, economic evaluation, and health technology assessment both of specific treatments and of complex public health interventions. Specific competencies include economic evaluation of malaria, dengue, and cutaneous leishmaniasis interventions.

Equity analysis: The group has extensive expertise in the assessment of the equity Using the meta-plan method to facilitate workshops on micro health insurance in low-income settings impact of diverse public health policies, primarily in relation to access to care and Manuela holding a workshop on health financing in Malawi financial protection from the cost of illness.

Mixed methods research: The group com- bines expertise in econometric analysis with expertise in qualitative research methods to promote the application of mixed research methods in health economics and financing. The group has held relevant courses and workshops in several countries around the world.

Partnership with evaplan

The group has established a strategic partnership on social protection and health financing with colleagues from evaplan (see page 86 ff), a consultancy agency affiliated with the HIPH.

41 Joining academia and consultancy aims at An integrated surveillance system for At the same time, the group is looking into contributing to the development of effective infectious disease in rural China: genera- strengthening its presence in Africa. In parti- social protection policies by combining aca- ting evidence for early detection of disease cular, the group has set up collaboration demic excellence with state-of-the-art global outbreaks in resource-poor settings (ISSC) with colleagues from the University of Mont- practice. Within the framework of such part- Funded by the European Union FP7 Program real to join forces in the evaluation of health nership, group members actively contribute 2010-2013 financing reforms in West Africa. In addition, to project development, offering training and Co-investigator: Hengjin Dong building on the recognition that health is consulting services across their range of core central to economic development, the group competencies. At the same time, colleagues Innovative tools and strategies for surveil- has engaged in cooperation with develop- from evaplan have the opportunity to contri- lance and control of dengue ment economists both at the University of bute their practical knowledge to the teach- Funded by the European Union FP7 Program Passau and at the University of Mannheim ing and research activities of the group. 2011-2015 to explore the link between health inter- Co-investigator: Yesim Tozan ventions and economic development. The group currently further intensifies its recent Current projects cooperation with research partners in Perspectives of the group Malawi, particularly the College of Medicine The potential of microfinance institutions to of the University of Malawi and the Research advance progress towards universal health The group is currently working to expand its for Equity and Community Health Trust coverage through micro health insurance: work in Asia, mostly in collaboration with (REACH Trust). A mixed methods study in Malawi two institutions bound to HIPH by a memo- Funded by the DFG (German Research Socie- randum of understanding: James P Grant Last but not least, the near future will see ty) 2011 to 2013 BRAC School of Public Health in Bangladesh the group progressively more engaged in Principal investigator (PI): Manuela De Allegri and Zhejiang University in Hangzhou, China. "exporting" its mixed-methods approach to In addition, the group is currently part of the study of the economics of global health. Agenda - setting criteria for the abolition of a recently established network, co-funded Training in mixed-methods will take place user fees health policies in West Africa among others by DFG and ESRC, which both through formal teaching abroad and Funded by the Canadian Health Research gathers researchers from the University of through direct mentoring of junior resear- Institute 2011 to 2012 Heidelberg, from the University of Edin- chers with the aim of establishing capacity Co-investigator: Manuela De Allegri burgh, and from Jawaharlal Nehru University to replicate the unique course currently on and from Sree Chitra Tirunal Institute for offer at HIPH in a number of other settings. Assessing the impact of using performance- Medical Sciences and Technology in India to based financing to improve the quality of foster discussion and research development obstetric and neonatal care in Malawi on the topics of transcultural health, Asian Funded by TRAction (United States Agency medicine, innovations in medicine, and for International Development, USAID) an non-communicable diseases. the Norwegian Government 2012 to 2014 PI: Manuela De Allegri

42 Gerald and Olivier with research partners in Malawi

Dengue project team members at a meeting in Sri Lanka (fourth from the left: project leader Annelies Wilder-Smith)

43 goal (MDG) concept and related con- Global Health Policy sequences for post-MDG development goals beyond 2015, 3. models for global partnerships in and Health Systems research and development, and 4. governance, leadership and priority setting in global health based on a human rights approach.

"Global health is collaborative transnational Global health is still a concept under Group leader: research and action for promoting health development. Academic institutions across Prof. Albrecht Jahn for all". Beaglehole’s and Bonita’s (2010) the world are working on it and reorient short answer emphasises the key elements their agendas towards a global health Members: as health equity, healthy environment, perspective and move to a transdisciplinary Prof. Olaf Müller* universal access to health care, and action- approach within and beyond the health Dr. Manuela De Allegri* orientation. The challenges to health for all sector, including other disciplines such as Dr. Rafael Bauschke** are many. While the global dimension of geography, political sciences, anthropo- Caroline Zöllner, MSc pandemics is self-evident, the solutions to logy, law and trade. We started this working Abdulai Abubakari, MSc many other health issues, such as mitiga- group in 2011 along with the initiation of tion of health effects of climate change, the Heidelberg Initiative for Global Health *Associated members migrant health, malnutrition, violence and (HIGH), as a university-wide transdiscipli- **Associated member, based at the injuries, as well as unequal and poor access nary platform for global health, which was Institute of political sciences to health care and medicines, are equally lauched in 2012. It comprises partners from dependent on a coordinated global effort the University Hospital, the University and and global solidarity as enshrined in the its Center for the Environment, as well as Projects: human right to health. associated institutions, such as the German Cancer Research Center. Go4Health: Formulating new goals for global health, and proposing new gover- Within this transdisciplinary context and nance for global health that will allow the partnership, the working group monitors achievement of these goals and analyses major global health policy This is a EU-FP7-project starting in September issues and processes, with a focus on 2012 and addressing the following objectives: 1. the implementation of WHO’s global strategy and plan of action on public health, General objective: innovation and intellectual property To propose New health development goals (GSPOA), (NHDG), embedded in a global social contract. 2. the analysis of the strengths and limitations of the millennium development

44 Specific objectives: Academic Global Health Alliance, the German The Go4Health consortium 1. To critically analyse the MDG approach, Agency for International Cooperation (GIZ), comprises 14 international its achievements and shortcomings, Global Health Europe, and international partners from academia including the present incentive systems academic partner institutions in Tanzania, (public health and law), for MDG-related health innovation. Burkina Faso, Bangladesh, and Peru. and civil society: 2. To formulate a set of goods and services that corresponds with essential health ›› Institute of Tropical Medicine, Belgium needs (EHNs), which should be guaran- ›› Heidelberg Institute of Public Health teed to every human being as entitle- ›› SECTION27, South Africa ments under the human right to health. ›› O’Neill Institute for National and Glo- 3. To affirm and further elucidate the nati- bal Health Law, Georgetown University onal responsibility for providing these Law Center goods and services, and to clarify the ›› University of Oxford international responsibility in relation to ›› Medico International the national responsibility. ›› Center for Health, Human Rights and 4. To critically analyse and propose chan- Development, Uganda ges to the present global. Governance of ›› University of Nairobi Health (GGoH), such that it holds govern- ›› BRAC University, James P. Grant School ments and others more accountable for of Public Health, Bangladesh their responsibilities, enhancing the like- ›› Centro de Estudios para la Equidad y lihood that the goals will be achieved. Gobernanza en los Sistemas de Salud, Guatemala Another important activity is the follow up ›› Norwegian Centre for Human Rights of WHO’s consultative expert working group ›› London School of Hygiene and Tropical (CEWG) on research and development: Medicine financing and coordination. This report was ›› University of Queensland; Australia presented to the World Health Assembly ›› University of Toronto, Dalla Lana 2012 and made a range of recommenda- School of Public Health tions on how to best support research and innovations for diseases that primarily affect low- and middle-income countries. Having been involved in the CEWG, we support the current consultations and work on the proposal for a WHO convention.

We also provide consultancy service for development agencies and Ministries of Health. Current collaborations include the European

45 the know-do gap) funded as part of the Health Service and 7th framework programme of the Euro- pean Union (grant agreement 22982) is a collaboration between the Centre de Quality Management Recherche en Santé de Nouna (Burkina Faso), Ghent University (Belgium), Univer- sity of Heidelberg (Germany), Karolinska Institute (Sweden), Muhimbili University of Health and Allied Sciences (Tanzania), and The Heidelberg health service and quali- Coordinating team: Navrongo Health Research Centre (Ghana). ty management group is a collaboration PD Dr. med. Michael Marx The overall objective of this research is to between evaplan GmbH and the Institute of Helen Prytherch improve the motivation and performance of Public Health at the University of Heidelberg. Dr. Aurélia Souares health workers and ultimately the quality of As such it brings together consultants, prenatal and maternal care services. The trainers and researchers working to improve Participants intervention packages include the deve- the quality of health care in developing Prof. Albrecht Jahn* lopment and implementation of a system countries and Germany. Dr. med. Svetla Loukanova of performance based incentives and a Dr. med. Rainer Külker computer-assisted clinical decision support Sylvia Sax system (CDSS) based on WHO guidelines. Christine Thayer The interventions will be implemented from Angelika Pochanke, evaplan GmbH the beginning of 2012 and will be evaluated Prof. Annelies Wilder-Smith* in a pre-post controlled study design in rural Norma Lange-Tagaza Burkina Faso, Ghana and Tanzania between Sylvia Runge-Ranziger 2009-2014. The project includes over 30 Irmgard Marx scientists and nine PhD students. Prof. Dr. Joachim Szecsenyi The hypothesis of the overall QUALMAT *Associated members project is that there are deficits in the performance of maternal and neonatal health care providers that result in insufficient Ongoing projects – examples outputs (eg. insufficient quality of patient care) that go beyond the limitations that can QUALMAT project be readily explained by a lack of resources Project Coordinator: Rainer Sauerborn and combine with other malfunctions in the Project Manager: Svetla Loukanova health system to hinder progress towards health outcomes including the targets of The QUALMAT research project (Quality MDG 5. Motivation is believed to hold the of maternal and prenatal care: bridging key to provider performance and improved

46 quality of care. Firstly, qualitative work was conducted to explore the determinants and influences upon maternal and neonatal health (MNH) provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania. Secondly, a scale has been developed to assess MNH provider motivation, willingness to perform and work behaviour. Baseline data has been collected in all three countries. As the main QUALMAT interventions are introduced the scale will be used at intervals to monitor for possible change.

 www.qualmat.net

Supporting quality improvement in health systems in Bangladesh (Photo S. Sax) Development and implementation of a comprehensive integrated quality management Training on the computer-assisted clinical decision support system of QUALMAT system for reproductive health services, Kenya (2011-2013), evaplan GmbH evaplan GmbH and the Institut für Ange- wandte Qualitätsförderung und Forschung im Gesundheitswesen (AQUA Institute) are implementing this project as an established consortium in collaboration with a local partner, the Institute of Health Policy Manage- ment & Research (IHPMR) in Nairobi. evaplan has the lead and carries overall responsibility. The aim is to improve the quality of services in the area of reproductive health, including gender-based violence (GBV) by means of an integrated quality management system.

The AQUA Institute has already developed a scientifically proven quality management (QM) instrument called the European Practi- ce Assessment which rests on the visotool® software. It allows for benchmarking, can

47 QUALMAT meeting in Burkina Faso in 2011

be used in out-patients and in-patients set- taken to incorporate ongoing QM processes Instrument, to accompany the implemen- tings and adapted to different clinical areas, in Kenya. Facility needs assessment will tation, providing coaching of staff and for example to focus on family planning also be undertaken to inform the adaptati- to establish a pool of trainer of trainers and reproductive health services. Taking on process and ensure the QM instrument at IHPMR. The private sector will also be advantage of evaplan and IHPMRs local meets local needs and is truly tailor-made. involved as future potential clients for the knowledge of the Kenyan health system and The consensus building approach will also adapted QM instrument. It is intended that the Kenyan quality assurance model, a well involve relevant provincial, district and marketing will be undertaken throughout established methodology will be used to hospital management as their buy-in is Kenya and the East-African region in due engage stakeholders in a participatory pro- essential to the success of QM change pro- course. These measures will all help to cess to select the standards and indicators cesses, particularly those that involve the secure the sustainability of the intervention that the QM instrument needs to be based introduction of information and communica- beyond the initial time-span of support from upon in order to be integrated in the Kenyan tion technologies (ICTs). GIZ. Internal GIZ knowledge management, health system. operational research and broader project Capacity building at the health facility level dissemination services are also provided. Prior experience in adapting this QM inst- is provided by the IHPMR and a team of The AQUA Institute is interested to support rument to other settings has shown that it international consultants. The international IHPMR staff and facility level partners to allows for utmost flexibility. Care is being experts' foci are the adaptation of the QM prepare scientific publications.

48 Impact of community-based health insu- quality of care of primary health care facili- Other quality management rance and other financing mechanisms on ties contracted with the Nouna CBI scheme. activities at evaplan: quality of care in Sub-Saharan Africa Project team: Aurélia Souares, Jake Robyn, Health care financing reforms should en- ›› 2010-2011 capacity building for effec- Rainer Sauerborn hance a more equitable access to care (free tive health project: evaplan and AOK External Collaboration: Ali Sié, Germain health care, health insurance) and improve Consult jointly implement a one year Savadogo, Centre de Recherche en Santé de performances in health service delivery blended learning course on QM for Nouna, Burkina Faso (performance-based funding). But their inte- senior health professionals from Kenya, gration into national health systems might Tanzania, Cambodia, Vietnam on behalf Community-based health insurance (CBI), be a challenge for the system’s stability, for GIZ (formerly InWEnt). one form of community financing, has been health care quality and the sustainability of ›› 2010 evaplan implemented a regional seen as an attractive solution to the challen- targeted health programs. symposium entitled "Measuring and ge of generating financial resources for the improving quality in maternal health formal health sector in low- and middle-in- Research project developed are aiming at care: chances and challenges for cen- come countries. In particular, they are seen analyzing this impact on quality of health tral Asia" (Uzbekistan, Tajikistan and as a potential instrument to improve access care. Kyrgyzstan) on behalf of GIZ. to health care by reducing financial barriers ›› Expanded quality management using to health services, empowering enrollees, Salzburg global seminar information power (EQUIP) research and improving the quality of care provided. Michael Marx and Sylvia Sax joined Dr. project funded by the EU 7th framework In recent years, the development of CBI pro- Rashad Massoud and other quality experts programme to improve maternal and grams in Sub-Saharan Africa has garnered in the planning committee for a global new-born health in Tanzania and Ugan- substantial interest by both researchers seminar held at the Schloss Leopoldskron da: evaplan is responsible for the work and policymakers alike. In early 2004, a CBI in Salzburg, Austria from April 22 - 27, 2012. package on Quality Management scheme (Assurance Maladie à Base Commu- The seminar focused on health care impro-  www.equip-project.eu nautaire - AMBC) was introduced in Nouna vement in low- and middle-income coun- ›› 2009 evaplan and the AQUA Institute district, Burkina Faso. As the perception of tries and the target group was high level in Göttingen undertook a consultancy quality is a major factor for the predicted policy makers and practitioners from these to strengthen the process of accredita- retention of patients in modern health care countries. The aim of the seminar was to tion in the health sector in Kenya. systems and also seems to be an important examine global accomplishments and failu- ›› QM-consultancies (including con- factor of enrolment and retention of those res in quality improvement, their reasons ceptual work, implementation and enrolled in health insurance, the different and challenges of taking successful efforts training courses) conducted on behalf factors related to patients’ perception of forward in our increasingly complex health of GIZ in India, Bangladesh, Pakistan quality of care are an important problem to systems over the next five to ten years. A and Yemen. be tackled. We used observation, in-depth framework paper has been submitted to the interview and exit questionnaire to assess British Medical Journal. potential differences, between CBI enrollees and the general population not enrolled in the scheme, in the objective and perceived

49 De Allegri M, Ridde V, Louis VR, Sarker M, Ti- Publications éndrebéogo J, Yé M, Müller O, Jahn A (2010) Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso. Health Policy. 99(3):210-8.

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51 Sonnberg S, Oliveira FA, Araújo de Melo IL, Winkler V, Ott JJ, Becher H (2010) Reliability Becher H, Winkler V (2011) Epidemiology of de Melo Soares MM, Becher H, Heukelbach of coding causes of death with ICD-10 in Prostate Cancer: The case of Ethnic German J. (2010) Ex Vivo Development of Eggs from Germany. Int J Public Health. 55(1):43-8. Migrants from the Former Soviet Union, In: Head Lice (Pediculus humanus capitis). The Prostate Cancer - Original Scientific Reports Open Dermatology Journal. 4:82-9. Yamamoto S, Louis VR, Sié A, Sauerborn and Case Studies. Spiess PE, Moffitt HL R (2010) Household risk factors for clinical (Eds). pp 1-20. ISBN: 978-953-307-342-2 Souares A, Savadogo G, Dong H, Parmar D, malaria in a semi-urban area of Burkina Sié A, Sauerborn R (2010) Using commu- Faso: a case-control study. Trans R Soc Trop Béguin A, Hales S, Rocklöv J, Åström C, nity wealth ranking to identify the poor for Med Hyg. 104(1):61-5. Louis V, Sauerborn R (2011) The opposing subsidies: a case study of community-based effects of climate change and socio-econo- health insurance in Nouna, Burkina Faso. Yamamoto S, Souares A, Sié A, Sauerborn mic development on the global distribution Health Soc Care Community. 18(4):363-8. R (2010) Does recent contact with a health of malaria. Global Environmental Change. care provider make a difference in malaria 21:1209-1214. Tang JW, Tambyah PA, Wilder-Smith A, knowledge? J Trop Pediatr. 56(6):414-20. Puong KY, Shaw R, Barr IG, Chan KP (2010) Beiersmann C, Bountogo M, Tiendrébeogo Cross-reactive antibodies to influenza Zanger P, Holzer J, Schleucher R, Scherbaum J, De Allegri M, Louis VR, Coulibaly B, Yé (H1N1) 2009 virus, Singapore. Emerg Infect H, Schittek B, Gabrysch S (2010) Severity of M, Mueller O (2011) Falciparum malaria in Dis. 16(5):874-6 Staphylococcus aureus infection of the skin young children of rural Burkina Faso: com- is associated with inducibility of human parison of survey data in 1999 with 2009. Wilder-Smith A (2010) Meningococcal beta-defensin 3 but not human beta-defensi Malar J. 11(10):296. disease in travelers: a rare but devastating 2. Infect Immun. 78(7):3112-7. disease. J Travel Med. 17 Suppl:1-2. Chen LH, Hill DR, Wilder-Smith A (2011) Wilder-Smith A, Earnest A, OoiEe, Gubler D Vaccination of travelers: how far have we (2010) Lack of association between dengue 2011 come and where are we going? Expert Rev and haze. Epidemiol Infect. 7:1-6 Vaccines. 10(11):1609-20. Bahgat MM, Saad AH, El-Shahawi GA , Gad Wilder-Smith A, Halstead S. Japanese ence- AM, Ramzy RM, Ruppel A, Abdel-Latif M Chuang SC, Agudo A, Ahrens W, Anantha- phalitis: update on vaccines and vaccine re- (2011) Cross-reaction of antigen prepara- raman D, Benhamou S, Boccia S, Chen C, commendations (2010) Curr Opin Infect Dis. tions from adult and larval stages of the Conway DI, Fabianova E, HayesRB, Healy CM, parasite Setaria equina with sera from Holcatova I, Kjaerheim K, Lagiou P, Lazarus Wilder-Smith A, Ooi EE, Vasudevan S, Gubler D. humans infected with Wuchereria bancrof- P, Macfarlane TV, Mahimkar MB, Mates D, Update on Dengue: Epidemiology, virus evolu- ti. Eastern Mediterranean Health Journal. Matsuo K, Merletti F, Metspalu A, Morgen- tion, antiviral drugs and vaccine development 17, 679-686. stern H,Muscat J, Cadoni G, Olshan AF, Pur- (2010) Curr Infect Dis Rep. 12(3):157-64. due M, Ramroth H, Rudnai P, Schwartz SM, Becher H, Winkler V (2011): Lung cancer Simonato L, Smith EM,Sturgis EM, Szeszenia- Winkler V, Becher H (2010) Global Cancer mortality in Sub-Saharan Africa (letter). Int J Dabrowska N, Talamini R, Thomson P, Wei cases and Lung cancer in Sub-Saharan Cancer. 129:1537-40. Q, Zaridze D, Zhang ZF, Znaor A, Brennan P, Africa. BMJ rapid response. Boffetta B, Hashibe M (2011) Sequence Vari-

52 ants and the Risk of Head and Neck Cancer: in Forschung und Entwicklung. Shaker Zambia: A Study of Linked National Data Pooled Analysis in the INHANCE Consortium. Verlag. pp.79-90. in a Geographic Information System. PLoS Front. Oncol. 1(13): 1-15. Medicine. 8(1):e1000394. Deckert A, Zimmermann H (2011) Anwen- De Allegri M, Ridde V, Louis VR, Sarker M, Ti- dung von (Perl) Regular Expressions für die Gabrysch S, Simushi V, Campbell OMR endrebéogo J, Yé M, Müller O, Jahn A (2011) Mustersuche in Strings. KSFE 2011 - Procee- (2011) Availability and distribution of, and Determinants of utilisation of maternal care dings der 15. Konferenz der SAS-Anwender geographic access to emergency obstetric services after the reduction of userfees: a in Forschung und Entwicklung. Shaker care in Zambia. International Journal of case study from rural Burkina Faso. Health Verlag. pp.121-129. Gynecology & Obstetrics. 114:174-179. Policy. 99(3):210-8. Earnest A, Tan SB, Wilder-Smith A (2011) Gabrysch S, Zanger P, Seneviratne HR, De Allegri M, Schwarzbach M, Loerbroks A, Meteorological factors and El Niño Southern Mbewe R, Campbell OMR (2011) Tracking Ronellenfitsch U (2011) Which factors are Oscillation are independently associated with progress towards safe motherhood: meeting important for the successful development dengue infections. Epidemiol Infect. 12:1-8. the benchmark yet missing the goal? An ap- and implementation of clinical pathways? A peal for better use of health-system output qualitative study. BMJ Qual Saf. 20(3):203-8. Ehrle N, Sarker M (2011) Emergency contra- indicators with evidence from Zambia and ceptive pills: knowledge and attitudes of Sri Lanka. Tropical Medicine and Internatio- De Allegri M, Tiendrebéogo J, Louis VR, Yé pharmacy personnel in Managua, Nicaragua. nal Health. 16(5):627-639. M, Müller O (2011) Measuring the AMFm. Int Perspect Sex Reprod Health. 37(2):67-74. Lancet. 377(9768):810. Gigic B, Deckert A (2011) Einführung in Flores-Figueroa J, Okhuysen PC, von Son- effizientes Programmieren mit PROCIML am Deckert A (2011) Matching von Fällen und nenburg F, Dupont HL, Libman MD, Keystone Beispiel einer Simulation. KSFE 2011 - Pro- Kontrollen: Propensity Score vs. PROC SQL. JS, Hale DC, Burchard G, Han PV, Wilder- ceedings der 15. Konferenz der SAS-Anwen- KSFE 2011 - Proceedings der 15. Konferenz Smith A, Freedman DO (2011) Patterns of Ill- der in Forschung und Entwicklung. Shaker der SAS-Anwender in Forschung und Ent- ness in Travelers Visiting Mexico and Central Verlag. pp.177-186. wicklung. Shaker Verlag. pp.105-119. America: The GeoSentinel Experience. Clin Infect Dis. 53(6):523-531. Harrison LH, Pelton SI, Wilder-Smith A, Holst Deckert A (2011) Umkodieren von ICD-9-Da- J, Safadi MA, Vazquez JA, Taha MK, Laforce ten zu ICD-10 in SAS mittels einer relati- Forßbohm M, Kropp R, Loytved G, Neher A, FM, von Gottberg A, Borrow R, Plotkin SA onalen Datenbank und PROC SQL. KSFE Simma M, Rabbow M, Becher H (2011) Tod Global meningococcal initiative (2010): 2011 - Proceedings der 15. Konferenz der an behandlungsbedürftiger Tuberkulose recommendations for reducing the global SAS-Anwender in Forschung und Entwick- oder an Begleitkrankheiten? Ein Beitrag zur burden of meningococcal disease. Vaccine. lung. Shaker Verlag. pp.131-139. Letalität und Mortalität der Tuberkulose in 29(18):3363-71 Deutschland. Pneumologie. 65:607-614. Deckert A, Bruckner T (2011) Ausgewählte Beispiele zu komplexen Graphiken und ihre Gabrysch S, Cousens S, Cox J, Campbell Realisierung in SAS. KSFE 2011 - Procee- OMR (2011) The Influence of Distance and dings der 15. Konferenz der SAS-Anwender Level of Care on Delivery Place in Rural

53 Heukelbach J, Sonnberg S, Becher H, Mello of sexual and reproductive health within Ramroth H, Ahrens W, Dietz A, Becher H I, Speare R, Oliveira FA (2011) Ovicidal the European Union. Eur J Contracept Re- (2011) Occupational asbestos exposure as efficacy of high concentration dimeticone: prod Health Care. 1:1-70. a risk factor for laryngeal carcinoma in a a new era of head lice treatment. J Am Acad population based case control study from Dermatol. 64(4):e61-2. Ortseifen C, Ramroth H, Weires M, Minken- German. Am J Ind Med. 54(7):510-4. berg R (Eds.) (2011) KFSE 2011 – Voneinan- Jentes ES, Poumerol G, Gershman M, Hill D, der Lernen. Proceedings der 15. Konferenz Ramroth H, Dietz A, Becher H (2011) Intensi- Lemarchand JO Lewis R, Oliva O, Staples E, der SAS-Anwender in Forschung und ty and inhalation of smoking in the aetio- Tomori O, Wilder-Smith A, Monath T (2011) Entwicklung. Shaker Verlag. pp 463. ISBN logy of laryngeal cancer. Int J Environ Res The Revised Global Yellow Fever Risk Map 978-3-8440-0379-6. Public Health. 8(4):976-84. and Recommendations for Vaccination 2010: An international collaborative effort. Ouedraogo N, Müller O, Jahn A, Gerhardus A Ramroth H, Schoeps A, Rudolph E, Dyckhoff Lancet Infect Dis. 11(8):622-632. (2011) Human papillomavirus vaccination in G, Plinkert P, Lippert B, Feist K, Delank KW, Africa. The Lancet. 378:315-16. Scheuermann K, Baier G, Ott I, Chenouda S, Lover AA, Sutton BA, Asy AJ, Wilder-Smith A Becher H, Dietz A (2011) Factors predicting (2011) An exploratory study of treated-bed Palm F, Urbanek C, Wolf J, Buggle F, survival after diagnosis of laryngeal cancer. nets in Timor-Leste: patterns of intended Kleemann T, Hennerici MG, Inselmann G, Oral Oncol. 47:1154-8. and alternative usage. Malar J. 10:199. Hagar M, Safer A, Becher H, Grau AJ. (2011) Etiology, Risk Factors and Sex Differences in Rocklöv J, Wilder-Smith A (2011) Climate Mohammed S, Sambo M N, Dong H (2011) Ischemic Stroke in the Ludwigshafen Stroke change and vector-borne infections: Com- Understanding client satisfaction with a Study, a Population-Based Stroke Registry. ment on "Modeling the impact of global health insurance scheme in Nigeria: factors Cerebrovasc Dis. 33:69-75. warming on vector-borne infections" Phys and enrollees experiences. Health Research Life Rev. 8(2):204-5. Policy and Systems. 9:20. Paton NI, Lee L, Ooi EE, Xu Y, Cheung YB, Archuleta S, Wong G, Wilder-Smith A (2011) Rudolph E, Dyckhoff G, Becher H, Dietz A, Müller O (2011) Malaria in Africa: Challenges The CHloroquine for Influenza Prevention Ramroth H (2011) Effects of tumour stage, for Control and Elimination in the 21st Cen- (CHIP) Trial: a randomised, double-blind, co-morbidity and therapy on survival of tury. Peter Lang Verlag, Frankfurt. pp. 1-193. placebo controlled trial of chloroquine for laryngeal cancer patients - a systematic the prevention of influenza. Lancet Infect review and a meta-analysis. Eur Arch Otorhi- Neuhann, F (2011) Universal Access – Uto- Dis. 11(9):677-83 nolaryngol. 268(2):165-79. pie oder realisierbare Chance? Ebenen des Handelns und die Probleme der Umsetzung. Phalkey R, Reinhardt JD, Marx M (2011) Schoeps A, Gabrysch S, Niamba L, Sié Spektrum Virologie. 2(6):3-12. Injury epidemiology after the 2001 Gujarat A, Becher H (2011) The Effect of Distance earthquake in India: a retrospective analysis to Health Care Facilities on Childhood Oliveira da Silva M, Jahn A, Olsen J, Karro of injuries treated at a rural hospital in the Mortality in rural Burkina Faso. Am J Epid. H, Temmerman M, Gissler M, Bloemen- Kutch district immediately after the disaster. 173:492–498. kamp K, Hannaford K, Fronteira I (2011). Glob Health Action. 4:7196. The Reproductive Health Report: The state

54 Shafik A, Criel B (2011) Remind me again: on patterns and reported health status in Fund grant for tuberculosis control at the why are we here? Bull World Health Organ. ethnic German migrants (Aussiedler) in Ger- district level in rural Cameroon. IntJ Tuberc 89(9):622. many: a cross-sectional study. BMC Public Lung Dis. 15(3):352-7. Health. 11:509. Tambyah PA, Wilder-Smith A, Pavlova BG, Zimmermann H, Deckert A (2011) SAS und Barrett PN, Oh HM, Hui DS, Yuen KY, Fritsch Wilder-Smith A, Lover AA, Kittayapong P, LaTeX: Erste Ansätze für eine gute "Zusam- S, Aichinger G, Loew-Baselli A, van der Burnham G (2011) Impregnated school menarbeit". KSFE 2011 - Proceedings der 15. Velden M, Maritsch F, Kistner O, Ehrlich HJ uniforms reduce the incidence of dengue Konferenz der SAS-Anwender in Forschung (2011) Safety and immunogenicity of two infections in school children. Med Hypothe- und Entwicklung. Shaker Verlag. pp.433-447. different doses of a Vero cell-derived, whole ses. 76(6):861-2. virus clade 2 H5N1 (A/Indonesia/05/2005) Zanger P, Kötter I, Kremsner PG, Gabrysch influenza vaccine.Vaccine. Windisch R, Waiswa P, Neuhann F, Scheibe S. (2011): Tumor necrosis factor alpha F, de Savigny D (2011) Scaling up antiretro- antagonist drugs and leishmaniasis in Thiede M, Müller O, Panea R, Tozan Y viral therapy in Uganda: using supply chain Europe. Clinical Microbiology and Infection, (2011) Effectiveness and Cost-Effectiveness management to appraise health systems 18(7):670-676 study of the Affordable Medicines Facility- strengthening. Globalization and Health. 7:25. malaria: Feasibility Report.² The Global Fund to Fight AIDS, Tuberculosis and Mala- Winkler V, Ng N, Tesfaye F, Becher H (2011) ria: Geneva. pp.1-53. Predicting lung cancer deaths from smoking prevalence data. Lung Cancer. 74:170-7. Tozan Y, Negin J, Ogola Wariero J (2011) Im- proving rural health and eliminating extreme Yé M, Diboulo E, Niamba L, Sié A, Coulibaly poverty: A case study on the Millennium B, Bagagnan C, Dembélé J, Ramroth H (2011) Villages Project. In: Erik Blas, Johannes An improved method for physician-certified Sommerfeld and Anand Sivasankara Kurup verbal autopsy reduces the rate of discre- Number of publications (Eds). Social determinants approaches to pu- pancy: experiences in the Nouna Health and (peer-reviewed) blic health: from concept to practice. World Demographic Surveillance Site (NHDSS), Health Organization. Geneva. pp.91-104. Burkina Faso. Popul Health Metr. 9:34. 60 50 Umar N, Mohammed S (2011) Insured per- Yumo HA , Kuaban C , Neuhann F (2011) WHO 51 46 sons’ dilemma about other family members: recommended collaborative TB/HIV activities: 40 39 a perspective on the national health insu- evaluation of implementation and perfor- 30 33 rance scheme in Nigeria. Journal of Public mance in a rural district hospital in Cameroon. 28 20 Health in Africa. 2:e31. The Pan African Medical Journal. 10:30. 10 Volodina A, Bertsche T, Kostev K, Winkler V, Yumo HA, Mbanya D, Kuaban C, Neuhann 0 Haefeli WE, Becher H (2011) Drug utilizati- F (2011) Outcome assessment of a Global 2007 2008 2009 2010 2011

55 56 The Collaborative Research Centre (SFB 544) dissertations and contributed to the training SFB 544 (1999-2011) of many young scientists. The Collaborative Research Centre 544 As an illustrative example for the development of new drugs and vaccines against (Control of Tropical Infectious Diseases) tropical infectious diseases, a recombinant malaria vaccine was develop against a parasitic target structure, the merozoite surface protein (MSP-1) protein by the group of Her- This large and successful research program The "Sonderforschungsbereich" (collabora- mann Bujard. Heiner Schirmer re-discovered has been running since the year 1999 and tive special research grant) entitled "Control methylene blue as a potent antimalarial and ended in mid-2011. The HIPH has been of tropical infectious diseases "of the German characterized it structurally and functionally. among the founding members of this pro- Science Foundation (DFG) comprised In combination with other antimalarials, gram and has regularly contributed to the between 15 and 20 research groups and the latter drug has been tested in clinical high quality of this collaborative research. was acquired in 1999 with Rainer Sauerborn trials, led by Olaf Müller. Since children’s as the founding speaker and re-evaluated urine will turn green during the treatment every three years. The research project and accompanying study of collaborating lasted 12 years. It was led by Hans-Georg anthro-pologists explored whether this Kräusslich (Dept. of Virology) in the last nine would be a barrier for drug use and reported years of its existence. The SFB comprised at that it was actually not. Drugs and vaccines its start six groups of the Institute of Public are only useful tools when and if they reach Health, two from biochemistry, one form the women, children and men for which they parasitology and virology respectively, two have been designed. In Africa, only between from the Central Institute for Molecular bio- 10% and 40% of those suffering from malaria logy research groups of the EMBL (Kafatos), seek modern health care and have access to the Biochemistry Department (Schirmer drugs. The main barrier is the high costs for and Krauth-Siegel), the Department of obtaining care and buying drugs. Within the Economics (Schmidt), and the Departments SFB and in collaboration with the Ministry of Parasitology (Lanzer). The underlying of health, a group of the HIPH achieved an concept of the research project was to evidence-based design of a community- look at new interventions and potential based health insurance scheme. barriers for the control of infectious tropical diseases from the bench to the bed and to The SFB received core funding form the the community, from "gene to society". The Ministry of Science of the State of Baden- collaborative grant became a condensation Württemberg for our main research partner, kernel for interdisciplinary research within the "Centre de Recherche en Santé de the University of Heidelberg and produced a Nouna", in Burkina Faso. This allowed the large number of scientific papers, doctoral construction of on site state-of-the-art labs,

58 a computer center and the establishment of a population-based demographic surveillance system in the Nouna district, which today includes over 150,000 individuals (see chapter on CRSN on page 92).

During the last phase of the SFB 544 program, four research projects and one central project were implemented by HIPH. These were:

1. A8 Project (PIs Olaf Müller, Peter Meis- sner): Evaluation of alternative malaria first-line combination therapies in young children of Nouna/Burkina Faso

2. D1 Project (PI Heiko Becher): An extended evaluation of malaria morbidity and Making people count: Population-based research as part of the special research center SFB 544 “Control of tropical infectious diseases” SFB project Z1 (Heiko Becher). mortality estimates in selected countries in Sub-Saharan Africa

3. D2 Project (PI Rainer Sauerborn): Community-based insurance – the effect of targeted subsidies and other policies on different scenarios for long-term sustainability

4. D4 Project (PI Olaf Müller, Albrecht Jahn): Community-effectiveness of the distribution of insecticide-treated bed nets through antenatal care services in malaria control in rural Burkina Faso

5. Z2 Project (PI Heiko Becher): Data management and data analysis of the da- tabase from the CRSN in Nouna, Burkina Faso, and statistical collaboration with research groups within the SFB

59 60 Teaching Teaching is a core value in our institute. The teaching unit oversees all the undergraduate and postgraduate teaching at our institute. For many years, Professor Andreas Ruppel as Director of Teaching, and Dr. Rainer Kuelker, Master's course coordinator, led the teaching unit with great dedication and vision.

In June 2011, Mercator Professor Annelies Wilder-Smith took over the leadership of the teaching unit, supported by Dr. Olaf Horstick as teaching coordinator, Mrs. Pauline Grys as short course coordinator, Mrs. Katharina Sommer as course manager, and Anke Nitschke-Edert as DAAD coordinator. Annelies Wilder-Smith, director of teaching

 www.ukl-hd.de/ph/teaching Some tropEd students

62 Introduction to new teaching faculty Master course administration and coordination Annelies Wilder-Smith moved to Heidel- Katharina Sommer berg in early 2011 after almost 20 years in Asia. She is a public health physician and tropical medicine specialist with many years of working experience in low- Short course coordinator and middle-income countries. She was Pauline Grys the coordinator of global health teaching at the National University of Singapore, the director of Asia’s largest travel medicine clinic in Singapore, and specialises in clinical and epidemiological research DAAD related to emerging infectious diseases. Anke Nitschke

Olaf Horstick is a specialist in public Teaching Director health medicine with main interests in A. Wilder-Smith public health in low- and middle-income Teaching Coordinator Medical students countries. Over his 20 years of experi- teaching Olaf Horstick ence in global health in many different (Public Health) countries and different fields of public Michael Marx health, his work has been predomi- nantly in neglected tropical diseases. In this context Olaf has been at WHO Preparatory course for 6 years, working chiefly on dengue. in Development As of last year, Olaf works part-time for Cooperation GIZ, coordinating several health-related Florian Neuhann cooperation projects between Brazil and other Latin American countries. His special interests include primary care development, health sector reform, Required elective programme management and control of Global Health neglected communicable diseases. Sabine Gabrysch

63 Undergraduate Global health required elective Following an initiative from Heidelberg Teaching for medical students medical students and members of the Institute of Public Health, a new elective course ("Wahlfach") for medical students on global health was launched in the winter term 2010/11, coordinated by Dr. Sabine Gabrysch. Various members of the Insti- Undergraduate teaching is a core activity of try; more than 60% expressed an interest in tute teach on the course which runs every our institute. We offer teaching in various more teaching on global health. term over two weekends and provides an formats to medical students in the fields of overview of global health issues, including public health and health economics. Global Dr. Sabine Gabrysch has successfully sessions on health systems in low-income health teaching to medical students is a introduced the elective course "global countries, the MDGs and on social, ecolo- new activity since 2010. health". In addition to this course we have gical and political determinants of health now opened some of our short courses (see such as climate change and gender issues. Global health is the health of populations chapter postgraduate) for a limited number Medical students enthusiastically took up in a global context and transcends the of medical students. If more than 4 courses this chance to learn about global issues and perspectives and concerns of individual na- are successfully completed, the student can some got engaged in organising the course. tions. The shortest and possibly best defini- obtain a certificate in global health. Further- tion is "collaborative trans-national research more, we are engaging with the students to In May 2011 teachers and students orga- and action for promoting health for all." develop a global health society, under the nising global health courses in German The reasons for giving more attention to leadership of Prof. Albrecht Jahn and Dr. universities gathered in Marburg and foun- global health education at German medical Olaf Horstick. ded the Global Health Alliance to exchange universities go well beyond the needs of the experiences and teaching material and to low- and middle-income countries. Several enable more German universities to offer studies have found that student exposure such courses. Furthermore, there are links to global health problems can affect career to teaching coordinators of global health choices in favour of disciplines and job set- courses in other European countries, in tings that serve disadvantaged populations, particular the UK and Italy. both overseas and in their home countries.

There is a rapid rise in student interest Coordinator: in overseas experiences. We did a survey Dr. Sabine Gabrysch amongst medical students at the University of Heidelberg: About 20-25% of the German medical students intend to do a medical elective in a low- and middle-income coun-

64 Epidemiology in HeiCuMed Teaching staff (Institute of Public Health): care, health and environment, models for Manuela De Allegri, Dr. Olaf Horstick, Gerald research and innovation for neglected The new "Approbationsordnung" includes Leppert, PD Dr. Michael Marx, Roland Panea diseases, human rights based approaches epidemiology as part of the so-called Quer- (evaplan GmbH), Prof. Dr. Rainer Sauerborn, to health and effectiveness and sustainabi- schnittsfach "Epidemiology, medical biomet- Prof. Dr. Annelies Wilder-Smith, Hans-Chris- lity of disease specific control programs. ry and medical informatics" as a compulsory tian Stahl subject within the "HeiCuMed" curriculum At the same time the society aims to inform for medical students. Professor Heiko Becher Partner Institutes/Co-organizer: and link students to ongoing research has been appointed by the medical faculty Department of General Medicine and projects and to involve and mainstream as the responsible scientist for organisation Health Care Research, Department of Heidelberg’s international students and and teaching of the epidemiology modu- Sports Medicine researchers, along with their personal le. Teaching takes part in small groups of experiences, into our global health related about 35 students. The students learn basic Course content (covered by the HIPH): teaching in research. Finally, the society concepts in epidemiology, including relevant ›› Public Health: Introduction to health wants to raise awareness on ethical issues measures, study designs, and principles systems; principles and structure of the and the University’s societal responsibility to analyse observational studies. Practical German health system; global perspec- related to Global Health. exercises are incorporated in the course for tive in health and prevention a better comprehension of the theoretical ›› Health Economics: Definition and assess- principles. Teaching materials are regularly ment of condition, requirements and DAAD Ärzteprogramm updated and the lectures are supplemented needs, methods of economic evaluation, by examples from recently published studies. guidelines and principles for health Medical students from low- and middle- financing, health insurance income countries are not sufficiently Together with colleagues from the German prepared by the German medical curriculum Cancer Research Centre, the following mem- Module in-charge/Coordinator to confront health problems in their home bers of the unit contribute to the teaching in PD Dr. med. Michael Marx countries. The DAAD supports us since this course which is conducted in German: many years to teach thematic blocks during Prof. Dr. Heiko Becher, Prof. Dr. Olaf Müller, weekends to foreign students from Africa, PD Dr. Heribert Ramroth, Dr. Sabine Gabrysch, Society for global health Asia and Latin America. We organized 6 to 8 Dr. Volker Winkler weekends per year, each with about 25 par- This academic society offers medical stu- ticipants coming from various German Uni- dents and students from other faculties the versities. We have been pleased throughout Public health in HeiCuMed opportunity to deepen their understanding by the commitment of the students and and engage in debate on global health issu- their strong interest in rearing themeselve to Prevention, health promotion / health es beyond the scope of their core curricula work in their home countries on return. The economics and disciplines. It involves a high level of weekends are dedicated to subjects from Language: German interactive teaching and self-organization, fields such as HIV/AIDS, sexual and repro- Number of Students in 2010/2011: and links students to global challenges such ductive health, neglected tropical diseases, 320 (95% German, 5% international) as how to achieve universal access to health health systems and health policy, tropical

65 paediatrics, non-communicable diseases, drug management, control programs. Financial support by DAAD is essential for this program and we are grateful that – after restructuring its program lines – these weekends continue as a special offer to prepare medical students to some challenges which they may face after they return to their home countries.

 www.ukl-hd.de/ph/aerzteprogramm

Pädagogische Hochschule teaching

Since 2008, the Institute of Public Health covers the topic epidemiology in the "Pädago- gische Hochschule" Heidelberg for students who would like to achieve a bachelor in "Gesundheitswissenschaften". The students learn basic concepts in epidemiology, including relevant measures, study designs, and principles to analyse observational studies. The following members of the unit contribute to the teaching within the reporting period: Prof. Dr. Olaf Müller, PD Dr. Heribert Ramroth, Dr. Volker Winkler, Prof. Dr. Heiko Becher.

The teaching language is German.

66 assignments, presentations based on their Postgraduate own working experience, case studies and group discussion.

Structure The course has three distinct parts, each accounting for 20 ECTS (European Credit Transfer System). In this system, credit points are given on the basis of student Postgraduate teaching in international Master's programme in investment time, i.e., how much time a health has a long-standing tradition at our International Health (M.Sc. IH) student "invests" in a given topic (including institute. About 20 years ago the English lecture time, group work and individual Master's course was started, initially with Course focus learning time). The three parts of the M.Sc. a focus of training future leaders from low- Focuses on health problems in low- and IH are: and middle-income countries. More than 35 middle-income countries. It includes the years ago, Professor Diesfeld founded the promotion of health, prevention and treat- ›› A three-month core module, providing "Entwicklungshilfekurs", a course to prepare ment of disease, palliative care and rehabi- a basic overview on essential topics in mainly German doctors and non-doctors for litation. Studies of health systems, health international health. their service in resource limited settings. economics, health policy, and management ›› Advanced modules, offering more in- Our institute is also one of the hosting of health services are central. A cursory depth learning on selected topics. institutions for the tropEd network (see view of diverse aspects of health in many ›› A thesis module, allowing for guided page 79). low- and middle-income countries shows individual research work with a personally a need for improved health policy, more flexible choice. The 13th 'Humanitärer Kongress-Theorie und efficient organisation and management at Praxis der Humanitären Hilfe' with the theme: all levels of health systems, and sustainable The course covers the diverse aspects of 'Ideals, reality and compromises: do we meet financing. In order to make health services international health and may be taken humanitarian needs?' was held in October accessible to the people who need them either as part time study within the tropEd 2011 in Berlin, Germany, where we presen- most, reforms are urgently needed both at network or as a compact one-year residenti- ted our teaching. Furthermore, our ideas on the policy-making level and on the delivery al programme at Heidelberg. global health teaching were presented at side. The M.Sc. IH was developed with these the World Health Summit in Berlin, October factors in mind. DAAD scholarships are available for the 2011, and at the 7th European conference residential programme. on tropical medicine and international health Teaching Approach in Barcelona, October 2011. Currently we Participatory teaching and learning methods Quality Assurance offer the following postgraduate courses: are the underlying didactic concepts of the The programme is accredited at the national Master's programme in International Health, course. Participants are expected to take level. All taught parts (core course, advan- Advanced short courses, and preparatory an active part throughout the course, e.g. ced modules) are additionally accredited in courses for working in developing countries. small group work, individual study time and the tropEd network. An international stan-

67 dard is further ensured by faculty members of other Institutes of public health acting as lecturers and external examiners.

A maximum of 25 students are accepted into the programme, which guarantees an intensive personal contact with lecturers and academic supervisors throughout the programme.

Target group The M.Sc. IH is intended for physicians and other health-related academic professionals with at least two years’ work experience. Its focus is to provide students with a solid foundation in international public health principles and competency with the tools and methods necessary to initiate program- Successful graduates in 2010 mes that would improve health services in an efficient, sustainable and equitable way. Successful graduates in 2011

Career Perspective Graduates are expected to take up policy, planning, management or teaching positions in, for example, international organisations, ministries of health, national health programmes, non-government organisations and universities.

Course language English

Entry requirements Degree in medicine or any other equivalent academic degree (minimum of 4 years bachelor or master’s degree, conform to the standard of University of Heidelberg

68 regulations) plus at least two years’ profes- Content of the Master's sional experience in a public health related programme in International position. Health ›› Consultancy skills in international English language proficiency: if an ›› Introduction: creating a learning Cooperation in health: evaluation of applicant’s first language is not English, community (excursion on weekend) health facilities, projects and he/she is requested to provide evidence of ›› Health systems and international health programmes his/her English language proficiency with a concerns ›› Thesis preparation ii TOEFL or IELTS test. ›› Determinants of health ›› Excursion ›› Research foundations (epidemiology, ›› Elective: public health and disasters (TOEFL required minimum score: 237 compu- biostatistics, qualitative methods) ›› Elective: proposal writing as a consul- ter based, 92-93 internet based, 580 paper ›› Health policy, health economics, tancy skill based, IELTS required minimum: band 6.5) evaluation ›› Elective: climate change and health ›› Health planning, health ›› Thesis writing / field work Age limit for DAAD scholarship: 36 at time management, quality management ›› Introduction: creating a learning of application and the respective academic ›› Thesis preparation i community degrees should normally not be older than ›› Reproductive health services and hiv/ ›› Introduction to international health 6 years. aids: new evidence and strategy and health systems ›› Disease control: strategies and policies ›› Determinants of health Degree awarded ›› Financing health care – principles of ›› Research foundations Master of Science in International Health insurance ›› Health policy, health economics, (M.Sc. IH) ›› Leadership and change management evaluation ›› Improving the quality of health care Course begins services 1 October each year

Course duration 12 months

Duration of German language course prior to beginning of programme (only for holders of a DAAD scholarship) 2 months

69 Application deadline a download on our website (see below). University deadline: 30 April for the same Applications for DAAD scholarship must year’s course be completed separately using the DAAD application form. DAAD scholarships are available for the residential programme with the following Tuition fee: 14,095 Euro for the residential deadlines for each year’s course: programme (special arrangements apply to 31 July at the German Embassy; DAAD scholarship holders). 31 August at DAAD in Bonn; 15 October at the M.Sc. IH course administ- For further information ration at Heidelberg. Heidelberg Institute of Public Health M.Sc.IH – course administration Different deadlines may apply for other Phone: +49-(0)6221-564905 scholarship funding agencies. Fax: +49-(0)6221-564918 e-mail: [email protected] Remarks Candidates are required to submit the  www.ukl-hd.de/ph/MSCIH M.Sc.IH course application form which is available from the course secretariat or as

Master theses 2010 - 2011 Name Country Profession Thesis 2010 / 2011 Dr. Phyu Mar Soe Myanmar Assistant Lecturer MB, BS Mothers’ self-treatment practices for under-five children with acute respiratory infections/pneumonia in Dembia district, Amhara region, Ethiopia Thi Hoa Nguyen Vietnam Project Officer for health and Community preferences for a social health insurance HIV/AIDS benefit package - an exploratory study among the uninsured in Bac Giang, Vietnam Dr. Juan Alfonso Leonardia Philippines Medical Doctor, Pharmacist, An assessment of factors influencing the retention of Local Reform Implementation physicians under the national rural physician deployment Coordinator program in the Philippines Nuri Nazmun Nahar Bangladesh Dentist Oral hygiene knowledge and practice among school going adolescents (13-18 years) in Kumasi, Ghana

70 Name Country Profession Thesis Dr. Nicholas Nana Adjei Kyei Ghana Medical Officer, MB, CHB The influence of distance and quality of care on antenatal service utilization in rural Zambia Shushan Kebedom Tedla Eritrea Hospital Pharmacist Insecticide-treated mosquito net utilization among pregnant women in Dembia District, Amhara Region, Ethiopia Dr. Fekri Ali Salem Dureab Yemen Community Medicine, CBRHP The effects of community-based reproductive health wor- Technical Officer kers on the utilization of family planning services in Yeme Dr. Mayu Okano Japan Medical Doctor tropEd-track, thesis pending Margret Fockenberg Germany Medical Doctor and Advisor The know-do-gap in performance: dimension and causes of professional misconduct in a rural district hospital in Tanzania Dr. Terhi Lohela Finland Medical Doctor Influence of distance to delivery facility on neonatal mortality in rural Malawi Mario André Maximilian Brazil Dentist, Teaching Forensic The implementation of the "Sistema Único de Saúde" and its Couto Ferrari Medicine impact on the quality of life and oral health status in Brazil Thomas Moore USA Planner for US-European Com- tropEd-track, thesis pending mand, Avian/Pandemic Influenza Miriam Wilms Germany Medicine Degree tropEd-track, thesis pending Dr. Günther Slesak Germany Medical Doctor, Project Manager tropEd-track, thesis pending Marie-Carmel Gedeon Canada Physiotherapist tropEd-track, thesis pending Felicia Chang Trinidad & Biologist Travel restrictions for HIV positive travellers Canada 2011 / 2012 Afua Aduako Asante-Poku Ghana MSc International Health Ma- Household expenditure for diabetes in Sub-Saharan nagement, Eonomics and Policy, Africa - a systematic literature review Researcher Iris de Miranda Brazil BSc Psychology tropEd-track, thesis pending Ana Ligia Gutiérrez Solís Mexico Surgeon Dentist Interventions against fluorosis and the effect on prevalence in Mexico Naqibullah Hamdard Afghanistan Medical Doctor, Programme Health organizations culture, set of beliefs and attitudes Manager for Provincial Health associated with use of health data in decision making Systems

71 Name Country Profession Thesis Angella Basemera Karamagi Uganda Medical Doctor, Medical Officer E-learning as a tool for partial compensation of lack of with Children's AIDS Fund clinical teachers in Kamuzu Central Hospital Malawi Stephen Kow Baako Amoah Ghana BSc In Community Nutrition, Tracking progress towards the underlying policy objecti- Program Officer ves of the Millennium Declaration in Ghana Neo Mogogi Mohutsiwa-Dibe Botsuana BSc Dental Science, Dentist Mobile health (m-health) in Africa - what works, what doesn't and why? Natasha Evelyn Anne New MBChB, House Officer Knowledge, acceptability and behavior towards impregna- Murray Zealand ted school uniforms for dengue control in chachoengsao province of Thailand: a mixed methods approach Nsorma Gertrude Nyaaba Ghana BA Integrated Development Stu- Factors that affect Health Extension Workers satisfaction dies, Assistant Research Officer with training and supervision in Dera Woreda, Ethiopia in Health Research Zhomart Orman Kazakhstan Medical Doctor Healthcare facility perception on the influence of the new upgraded accreditation processes on the quality of health services within the facility Daniel Ssentamu Uganda MBBS, Regional Health Service Value of membership in Community Health Insurance in Manager/ Consultant Nakaseke District, Uganda: Reasons to enroll or not to enroll John Langidare Tanaki Tanzania BSc Public Administration, Hos- Can incentive payments increase the uptake of maternal Laiser pital Administrator care services in Dodoma Region, Tanzania? Meilayasina Tarigan Indonesia BSc in Chemistry, Monitoring Impact of model household training by health extension and Evaluation coordinator workers to immunization coverage, nutritional status, and insecticide treated nets utilization in Dera district - Ethiopia Shaveta Walia India MBBS, Medical Officer Social media: a new promising tool for disaster management Manting Wang China MSc Social Medicine and Health Analysis of health education for schistosomiasis control Management, Administrator in China: a literature review Nay Yee Wyine Myanmar MBBS, Demonstrator Comparison of integrated management of childhood illness (imci) guidelines adapted with dengue fever and various dengue fever guidelines and in South East Asian countries Julia Franziska Yassin Germany MBBS, Senior House Officer tropEd-track, thesis pending Obstetrics and Gynecology

72 Short courses in International Short course participants' origin Short courses 2010/11 Health 2010/11 ›› Consultancy skills in international The Institute of Public Health has been 5 cooperation in health: evaluation of offering a growing number of short courses 18 health facilities, projects & programmes since 1999. ›› Disease control: strategies and policies ›› Economic principles of social security 58 In 2006 a number of courses have been 123 ›› Health and climate change: impact included into our Master of Science in and adaptation strategies International Health as either mandatory or ›› Health and human rights elective advanced modules. 68 ›› Facility management ›› Financing health care and insurance Lecturers in the courses generally have ›› Financial management and controlling both field experience and an academic in health insurance background in the course topic. Besides our Europe North America ›› Improving the quality of healthcare own international staff, we invite external ›› Leadership and change management lecturers from various sectors: e.g. non- Asia & South Middle & South ›› Macro-political aspects of social East Asia America governmental organizations (NGO), interna- security systems tional organisations, governmental sector, Africa ›› Mixed methods in international research and training programmes, etc. health research ›› Public health and disasters Participants are usually from a variety of Distribution tropEd / non-tropEd ›› Proposal writing as a consultancy skill countries, as well as professional and participants 2010/11 ›› Quality management in international educational backgrounds. As all courses are health accredited within the educational network ›› Reproductive health services and tropEd, and those students are an important hiv/aids: new evidence and strategy target group. Yet, we also have about 50 % ›› Schistosomiasis control: of external participants who do the courses an interdisciplinary approach as individual further training. 122 New in 2011  www.ukl-hd.de/ph/shortcourses 150 ›› Decision making in public health: evidence, politics or diplomacy ›› Participatory learning and action: tools for community development ›› Public health and Anthropology

tropEd non-tropEd  www.ukl-hd/ph/shortcourses

73 Graduiertenkolleg 793 (GRK 793)

The PhD programme "Graduiertenkolleg 793: Epidemiology of communicable and chronic, non-communicable diseases and their interrelationships" has been the only PhD programme for epidemiology in Ger- many until now. It ran from April 1st, 2002 to March 31, 2011 with a stipend extension period until March 31, 2012. Heiko Becher has been the chairman of the program. Other supervisors and lecturers from the Institute of Public Health were Olaf Müller, Rainer Sauerborn, Heribert Ramroth and, as former members, Thomas Jänisch and Members of the Graduiertenkolleg at a two-day retreat 2010 Oliver Razum. The administration of the program has been organized by Ms Elke Braun-van der Hoeven. The main aim of the program was postgraduate education of young graduates in the field of epidemiology through largely independent research in an epidemiological study, general advanced Number of doctoral students and marks of the GRK 793 education in main fields of epidemiologic research, and reinforcement of existing Note PhD theses research groups and genuine contributions male female total to epidemiologic research. Fellows Cum laude 1 2 3 Magna cum laude 5 20 20 Until April 2012, 92 doctoral theses were completed or almost completed. Of these, Summa cum laude 2 8 10 17 were or are affiliated with the Institute of Final mark pending 1 9 10 Public Health. The table on the right shows total 9 39 43 some data. Many of the theses were marked associated Cum laude 2 1 3 with "summa cum laude", and a large number PhD students of scientific prizes were awarded to mem- Magna cum laude 9 14 23 bers of the program (see list on page 76). Summa cum laude 0 3 3 With few exceptions, all theses were written Final mark pending 2 8 10 in English. The teaching program including total 13 26 39 all seminars and lecturers were also given in

74 English. Members in the GRK were recrui- GRK 793 members Dr. Michael Pawlita (DKFZ), Division of ted from all over the world, with students Genome Modification and Carcinogenesis coming from the following countries: Europe Prof. Dr. rer. nat. Heiko Becher (Chairman), (Germany, Spain, Poland, Georgia, Italy, Heidelberg Institute of Public Health Prof. Dr. Marcella Rietschel, Central Romania, Russia, Hungary), Africa (Burkina Institute of Mental Health, Mannheim Faso, Cameroon, Uganda), Asia (China, Prof. Dr. med. Hermann Brenner, (Deputy Mongolia, The Philippines, Nepal, Pales- Chairman; DKFZ), Division of Clinical Epi- Prof. Dr. med. Dietrich Rothenbacher, tine, Israel), America (USA, Canada) and demiology and Aging Research (DKFZ), Division of Clinical Epidemiology Australia. and Aging Research Prof. Dr. sc. hum. Jenny Chang-Claude The scientific output was impressive. Until (Council member; DKFZ), Division of Prof. Dr. rer. nat. Karen Steindorf (DKFZ), April 2012, the students published 320 peer Cancer Epidemiology Research Group Environmental reviewed papers in total, many of these in Epidemiology the very best journals. Several papers are Prof. Dr. sc. math. Jürgen Wahrendorf, not yet submitted, therefore this number (Council member; DKFZ), Research Group Prof. Dr. med. Til Stürmer, University of will increase further. All students presented Environmental Epidemiology North Carolina at Chapel Hill their work on international conferences. PD Dr. med. Volker Arndt (DKFZ), Prof. Dr. med. Thomas Diepgen, University We are also proud that all alumni of the Division of Clinical Epidemiology and Hospital – Department of Social Medicine, program who got attractive positions, many Aging Research Heidelberg of them to continue with a scientific career, and others in the industry or in international Prof. Dr. med. Walter Haefeli, Clinical Dr. rer. medic. Christiane Gasse, Aarhus organisations such as the WHO. Pharmacology and Pharmacoepi- Universitet, Clinical Epidemiology, NBG demiology, Heidelberg  http://grk.dermis.net PD Dr. Jakob Linseisen, Institute of Epi- Dr. Thomas Jänisch, University Hospital – demiology, Helmholtz Centre München Section Tropical Medicine, Heidelberg (HMGU)

Prof. Dr. Rudolf Kaaks (DKFZ), Division of Prof. Dr. Oliver Razum, University of Biele- Cancer Epidemiology feld, School of Public Health

Prof. Dr. med. Olaf Müller, Heidelberg Prof. Dr. Rainer Sauerborn, Heidelberg Institute of Public Health Institute of Public Health

PD Dr. Alexandra Nieters (DKFZ), Division Dr. Brigitte Schlehofer (DKFZ), Research of Cancer Epidemiology Group Environmental Epidemiology

75 Awards for students from the PhD programme GRK 793 (members of the institute)

›› September 2007 - Jördis Jennifer Ott and Volker Winkler (3rd price, 250 €) won young scientist prizes at the meeting of the German Society for Epidemiology, Augsburg.

›› September 2009 - Volker Winkler (3rd price) won a Stephan-Weiland-Price for young scientists at the annual meeting of the German Society of Epidemiology (DGEpi) in Münster.

›› February 2011 - Andreas Deckert won the 1st price of the best paper award Heiko Becher thanks Elke Braun-van der Hoeven for her excellent administrative support in the GRK 793 (final for his presentation at the 15th con- symposium June 2011) ference of SAS users in research and development (KSFE) in Heidelberg. GRK 793 members at the final symposium in June 2011 ›› September 2011 – Heiko Zimmermann won the poster price at the joint annual meeting of the German Society of Epi- demiology (DGEpi) and the meeting of the GMDS in Mainz.

76 Contribution to the Master's programme in Medical Biometry and Biostatistics

The Institute of Medical Biometry and Informatics in Heidelberg (IMBI) offers a postgraduate Master's programme in Medi- cal Biometry and Statistics. The curriculum covers the wide field of biostatistics and its application in medical research as well as lectures to deepen knowledge in specific statistical methods and in medical topics. Within the core curriculum, epidemiology as a single module is taught. This block course is coordinated and lectured by Prof. Heiko Becher. Andreas Deckert is the coordinator Participants of the preparatory course for professionals in 2011 of the basic module biometry and is also an active lecturer within this module. Several generations of German professionals in international health have started their Preparatory course for careers after participating in the course. The professionals in health sector curricula of course were adapted over time to development cooperation reflect changes in needs and demands as e.g to address the HIV epidemic with a specific Since 1974, the institute conducted certi- course module. The funding through the ficate training courses to prepare profes- German Ministry of Economic Development sionals to work in health sector projects and Cooperation in collaboration with the in international development cooperation faith based development agency ended in founded by Prof Diesfeld. This course 2011. The institute however has decided to actually formed the basis to later start the continue its involvement in this area and si- Master's programme in International Health gned a memorandum of understanding with in Heidelberg. Over the last 7 years the the Medical Mission Institutes in Tübingen course was coordinated by Florian Neuhann and Würzburg to offer courses under the and administratively managed by Hilde Gold umbrella of an Academy of Global Health and Feuchtmüller since 1994. The courses were Development from 2013. highly acclaimed for the early introduction of multi-professional training and innovative teaching methodologies.

77 Lecturers and facilitators for ECTE come Teaching Collaborations from: ›› Institute of Public Health, Heidelberg University, Germany ›› Barcelona Institute for Global Health (ISGlobal), Spain ›› Barcelona Centre for International Health Research (CRESIB), Spain ›› Institute of Tropical Medicine and International collaborations are the hallmark European Course in Tropical International Health, Berlin, Germany of our institute. Strengthening international Epidemiology (ECTE) ›› Department of Public Health, Prince collaborations and fostering new collabo- Leopold Institute for Tropical Medicine, rations is our vision and a core value. We The European Course in Tropical Epidemio- Antwerp, Belgium. are pleased to report on our longstanding logy ECTE is 3-week intensive basic course ›› Nordic School of Public Health, Goteborg, collaborations, in particular with Nouna, on epidemiology and biostatistics. The Sweden. Burkina Faso, as well as newer collabora- course is intended for physicians, nurses, ›› Swiss Tropical and Public Health Institute, tions in Africa, Asia and beyond. Interna- biologists, anthropologists, health pro- Basel, Switzerland tional collaborations are important as they gram managers, health administrators and ›› Liverpool School of Tropical Medicine, open more opportunities for collaborative other professionals working in the health Liverpool, UK research and projects. With such collabo- sector in tropical countries or with an inte- ›› Centre for Tropical Diseases Sacro Cuore rations we can tap into the expertise and rest in public health in tropical countries. Don G. Calabria Hospital, Negrar, Verona, experience of academic staff at universities Italy and research centers worldwide. Everyo- Emphasis is on methodology and the ›› Mario Negri Research Institute, Milano - ne benefits. Countries from the South will practical application of epidemiological S. Maria Imbaro, Italy benefit from further capacity building and tools in low- and middle-income countries. ›› London School of Hygiene and Tropical scientific exchange programs. We in ECTE is a collaborative venture of various Medicine, UK Heidelberg have the opportunity to learn European centres of tropical medicine and more about the reality of public health in public health and is held annually at a Heidelberg was the host for this course in low- and middle-income countries, thus different venue. 2009 with Professor Becher as course direc- opening possibilities to improve and adapt tor followed by Gothenborg (Sweden) and existing training and research activities with Berlin, Germany. In 2012, the course takes a practical view of work in resource poor place in Barcelona, Spain. settings. International collaborations also enhance research funding, enrich training  www.ecte.org and teaching in global health, and open opportunities for German and overseas PhD students for exciting research projects.

78 Short courses tropEd – The tropEd member institutions meet three for their field studies, which always resulted network for education in times a year at various locations within in a successful master thesis. Within the international health the network to accredit courses, discuss "Ärzte-Programm" we also organize yearly membership statuses, quality assurance, "expert seminars" in selected countries tropEd is a network of institutions for higher student issues, etc. In January 2010, as the for DAAD-Alumni. These aim at refreshing education in international health, consisting meeting was hosted in Heidelberg which local medical professionals in areas of their of more than 30 European and 8 non- was attended by 18 member institutions. choice. The topics of the workshops were in European institutions. The network provides Apart from working long hours, the network 2010 "cancer", "health sector reform" and postgraduate opportunities for education always tries to include also a social activity "Poverty reduction" (Addis Ababa, Ethiopia) and training. It focuses on improving the and despite the cold and icy paths, most and in 2011 "cancer" and "health sector management of health services for disad- people joined and enjoyed the castle tour. reform" (Hannoi, Vietnam). vantaged populations, thus contributing to sustainable development. The innovative  www.tropEd.org approach is based on mobility of people, Short courses: Bangladesh the exchange of experiences in different disciplines and the establishment of a com- Short courses: Ethiopia Quality Management (2010) mon standard in education and training. It BRAC University, Bangladesh prepares people to work more effectively We enjoy a long-standing, DAAD-supported Organizer: Sylvia Sax in a multicultural environment by exposing partnership with the Department of Public A short course based on the one offered in them to multiple perspectives as the tropEd health at Gondar University in Ethiopia. Heidelberg by the same coordinator. students have to take a number of advan- Our cooperation involves teaching and ced modules outside of their so-called research, and we have continuous exchange home institutions at partner institutions of of scientists amongst both institutions. As Short courses: Tunisia the network. part of the exchange program, each year we receive two participants from Gondar Climate change and health (2010) Heidelberg has been a member of tropEd University in short courses of their choice The short course on climate change and from the start. Currently, not only the short within our Master's programme in Interna- health was sponsored by the Tunisian courses (advanced modules) are accredited tional Health in Heidelberg. These visits Ministry of Health and GTZ (now GIZ), the within the network, but also the Master's aim to strengthen postgraduate teaching German Society for International Cooperati- programme which has been restructured in Gondar, which we support by staff from on. The request for this introductory course several years ago. It now consists of three Heidelberg. We jointly developed and to be held in French was initiated from the parts: a three month core course, advanced implemented in Gondar short courses Ministry of Health. Prof. Rainer Sauerborn modules, and a thesis. on "Consultancy skills" and "Qualitative and Dr. Valérie Louis, the coordinators of research methods" (2010), which are now the Heidelberg short course on climate The Institute of Public Health thus was able part of their Master's programme. In 2011, change and health, adapted the course to introduce a part time track while keeping we offered a course on "Publication and content and format to a five-day course in the full time residental students in Heidel- research skills". Our partners in Gondar French. They covered 80 % of the lectures. berg. regularly receive our MSc students (two or A francophone guest lecturer from Belgium three per year) and act as local supervisors was also invited.

79 The topics covered included the following: physical basis of climate change; climate scenarios and mitigation; health impact of climate change; climate-sensitive diseases; health system response, adaptation, mitigation in the health sector. Examples were drawn as often as possible from the geographical context. At the end of the course, the participants made an oral group presentation on a topic of their choice linking their professional expertise with the themes covered during the week. The course was evaluated and feedback from the participants was sought out.

The course was conducted by Prof Rainer Sauerborn and Dr. Valérie Louis Group discussion led by Malabika Sarker

Heribert Ramroth discusses analysis results with CRSN staff members during an intensive short course in Nouna Teaching in Malawi

Teaching constitutes one important ele- ment of the collaboration with the Hospital in Lilongwe Malawi and comprises of ›› Clinical teaching through bedside teaching ward rounds, lectures by visiting faculty, a structured training course in ultrasound diagnostic and the provision of an e-learning platform  www.esther-magnet.org ›› A training course "Introduction to epidemiology and use of the EpiInfo Software (PD Dr. Heribert Ramroth) ›› A combination of bedside teaching and lectured course in "Advanced HIV management" in cooperation with the Infectious Disease Clinic University Cologne

80 Teaching in Nouna, Burkina Faso Public Health, Juliet Kiguli). The EAR-HEALTH courses facilitated in 2010 and 2011 One major aim within the SFB 544 was to At each partner university we developed in detail were: build sustainable capacity in the Nouna and implemented – together with the local Research Centre (CRSN). Regular training organizers – each of the following courses: 2010 was provided in the field of statistical DP: 21.06.-03.07.2010, Dar es Salaam, methods and epidemiology for researchers ›› "Quality improvement and leadership in Tanzania, course coordinator Simon and collaborators. Topics in the reported health systems and services" (QI), Rainer Mamuya time frame were concepts in epidemiology, Kuelker including relevant measures, study designs ›› "Sexual and reproductive health & HIV/ RH: 10.05.-22.05.2010, Eldoret, Kenya, and principles to analyse observational AIDS" (RH), Malabika Sarker course coordinator Edwin Were studies. Survival techniques were taught, in- ›› "Health and displaced populations" (DP), cluding Cox Regression models and Kaplan Michael Marx QI: 22.02.-05.03.2010, Kampala, Ugan- Maier estimates, using EpiInfo and Stata® ›› "Train the teachers" workshops, Andreas da, course coordinator Roy Mayega software. Ruppel and Rainer Kuelker. Train the Teachers: Courses were conducted by Prof. Dr. Heiko In total, the courses and workshops were 22.02.-26.02.2010, organizers Duncan Becher, PD Dr. Heribert Ramroth and attended by over 300 participants from Ngare, David Ayuku, Charles Walekhwa, Gabriele Stieglbauer. various institutions. Andreas Ruppel, Rainer Kuelker. 08.03.-12.03.2010, Dar es Salaam, The project ended in August 2011 and Tanzania, organizers M.T. Leshabari, D.C. The institutional capacity received financial support from the ACP-EU Kakoko, Andreas Ruppel, Rainer Külker. building through an East African Cooperation Programme in Higher Educa- region postgraduate teaching tion (EDULINK: A programme of the ACP programme "Public Health" group of states, with the financial assis- 2011 (EAR-HEALTH) tance of the European Union). It is intended DP: 21.03.-01.04.2011, Kampala, Uganda, that the courses continue from 2012 without course coordinator Abdullah Ali Halage Within the EDULINK program we aimed to EU-support and under the leadership of the contribute to public health training in East East-African partners. RH: 23.05.-03.06.2011, Dar es Salaam, Africa. The Project EAR-HEALTH (2008-2011) Tanzania, course coordinator Rose was led by our institute (principal inves-  www.ear-health.org Mpembeni tigator Andreas Ruppel; project manager Pauline Grys) with partners in Kenya (Moi QI: 04.07.-15.07.2011, Eldoret Kenya, University School of Public Health, Duncan course coordinator Edwin Were Ngare, deceased, Edwin Were), Tanzania (MUHAS School of Public Health and Social Sciences, Melkizedeck Leshabari) and Uganda (Makerere University School of

81 The aim of the HIPH Seminar Series is: Lecture Series ›› To provide details of new or ongoing projects to the academic members of HIPH ›› To offer a platform for scientific exchange between the different groups of HIPH

EcoHealth seminar series

Widely regarded as a platform for distin- Lecture series epidemiology Organizers: guished speakers and engaging discus- Dr. Sabine Gabrysch sions on any topic related to global public Organizer: Dr. Thomas Jänisch health, we have organized various lecture Prof. Dr. Heiko Becher series. These lecture series are open to the Life-support systems are deteriorating on a public, and some are co-organized with A regular lecture series "Ringvorlesung global scale, we experience climate change, other institutes. In 2011, we organized Epidemiologie" is organised every term by biodiversity loss, soil erosion, ocean two lecture series in collaboration with the Heiko Becher (24th in the summer term pollution and other serious problems. The South Asia Institute: The first series was 2012). In this lecture, invited scientists give complex interdependence of humans, ani- on public health in South Asia and the a lecture on different topics, often from mals and their natural environments means second series was on current controversies areas which are not represented in Heidel- that human health affects and is affected in global health in the context of transcul- berg. The program is therefore always a mix- by these changes. Such complex challen- tural issues, organized by Professor William ture of very different areas, from infectious ges cannot be solved by reductionist and Sax from the South Asia Institute and Prof. diseases to genetics or new biostatistical unidisciplinary approaches, they require Annelies Wilder-Smith from the Institute of methods. ecological and social systems thinking. Public Health. Other lecture series are the EcoHealth, short for ecosystems approach regularly running lecture series in epide- to health, considers these inextricable miology, the HIPH seminar series and the Heidelberg Institute of Public linkages between ecosystems, society and ecohealth series. Health (HIPH) seminar series health of animals and human.

Organizer: Starting in the summer term 2011, Sabine Prof. Dr. med. Olaf Müller Gabrysch from the Institute of Public Health Dr. Valérie Louis and Thomas Jänisch from the Department of Infectiology, organised an EcoHealth semi- The HIPH seminar series is the successor of nar series with national and international the Abteilung für Tropenhygiene und Öffent- speakers and subsequently an EcoHealth liches Gesundheitswesen (ATHOEG) seminar journal club to bring together people from series, which was initiated by Olaf Müller different backgrounds to learn more about and Oliver Razum. the EcoHealth approach and to discuss

82 each other’s work and ideas with the aim to are adapted and transformed with increa- Lecturers in transcultural encourage joint EcoHealth projects. sing rapidity, but also that there are more controversies frequent situations where paradigms and  www.eco-health.de techniques from one milieu do not fit else- Prof. Kalinga Tudor Silva (Colombo): where. Controversies ensue for a number Health and the development industry of reasons; for example when "imported" Transcultural controversies paradigms and techniques are thought to Prof. Annelies Wilder-Smith (Heidel- be culturally inappropriate, scientifically berg): Emerging infectious diseases: Lecture Series 2011 unacceptable, or economically unfeasible. culture, environment and hysteria With accelerating globalization, scientific In this lecture series, prominent scientists and therapeutic paradigms are transferred from Heidelberg and abroad examine the Prof. William S. Sax (Heidelberg): Traditi- ever more quickly between cultures and role of globalization in creating – and sol- onal mental health therapies nations. This means not only that they ving – such controversies. Prof. Dr. Andreas Kruse (Heidelberg): Transcultural controversies in gerontology

Public health in South Asia Nazli Balkir (Heidelberg): Healing the Soul: spirituality and religion in psycho- Program of a joint seminar series of the South Asia Institute (SAI) and the Heidelberg therapy Institute of Public Health (HIPH) 2011 01/2011 Local and global health Bo Sax and Rainer Sauerborn, Dr. Stefan Ecks (Edinburgh): Mind food: Hans Rosling: TED seminar - film medicating moods in Calcutta projection 02/2011 Addressing corruption in the health sec- Dr. Cornelius Oepen, German Prof. Einar Wilder-Smith (Heidelberg): tor: Securing equitable access to health International Cooperation (GIZ), Transcultural aspects of epilepsy care for everyone Eschborn 03/2011 Health impact of and policy response Revati Phalkey, candidate to natural disasters in India - research Dr. sc. hum. results from a collaborative EU FP6 project 05/2011 Health impact scenarios for South Asia Rainer Sauerborn, HIPH 05/2011 Adaption strategies at the household, Urvashi Chandra, PhD, United community and government level in South Nations Office for Project Services Asia (UNOPS), Dehli; Aminul Haq 06/2011 The James Grand School of Public Health, Tim Evans, Dean, James Grant BRAC University, Dhaka, Bangladesh: School of Public Health, BRAC achievements and perspectives University, Dhaka, Bangladesh 07/2011 Lifestyle Diseases in South Asia Constanze Weigl, SAI; Florian Neuhann, HIPH

83 84 Service and Consulting evaplan – Your Partner Profile – areas of expertise evaplan undertakes advisory missions, engages in operational research, and in International Health implements projects and innovative training programmes, including study tours, in the field of international health.

evaplan’s professional staff has a broad evaplan is the consulting arm of the Since 2004, evaplan has worked for a range of backgrounds covering public Heidelberg Institute of Public Health and variety of bi- and multi-lateral agencies in health, epidemiology, sexual and repro- collaborates closely with other institutes and the following countries: Bangladesh, Burkina ductive health, HIV and AIDS, health departments of the university. It incorpo- Faso, Burundi, Cambodia, Cameroon, China, economics, social sciences and medical rates more than 20 years of professional Egypt, Ethiopia, Ghana, India, Indonesia, anthropology. All collaborators have first- experience from around the world. evaplan’s Kenya, Kirgizstan, Kosovo, Malawi, Morocco, hand experience of working in low-resource portfolio is largely based upon bi- and Nepal, Northern Sudan, Oman, Pakistan, contexts and travel frequently on assign- multilateral development cooperations, but the Philippines, Rwanda, Russia, South ments overseas. The evaplan team is mul- also includes assignments within the EU Africa, Tanzania, Turkey, Uganda, Ukraine, ticultural and multilingual. Senior staff is member states in the area of public health. Vietnam, Yemen, as well as in EU-Member also involved in teaching in various training states. programmes at the Heidelberg Institute of evaplan has a broad range of partners such Public Health, as well as in the tutoring of as universities, non-governmental organisa-  www.evaplan.org masters and doctoral students. tions and other consulting firms, spanning both the Northern and Southern Hemisphe- We are engaged in short- and long-term res. Furthermore, it is able to draw upon the projects with a focus on Sub-Saharan & large international network of academics, Northern Africa, the Middle East, Asia and policy makers and alumni that associate Europe. with the Heidelberg Institute of Public Health. evaplan has five main areas of expertise ›› Health systems strengthening ›› Sexual and reproductive health and rights ›› Response to hiv and aids ›› Comprehensive quality management ›› Social protection and health financing

86 Our principles and our approach includes conditional cash transfers and Health systems strengthening provisions for ageing populations. In line with the international strive for har- Given the various determinants of health we monising development efforts and ultimately Social protection in health are committed to cross-sectoral efforts to achieving greater efficiency in the delivery We promote universal health coverage by place health into a broader policy context. of aid our work is strictly aligned with the designing, scaling-up and linking social, Our work addresses the major weaknesses policy framework of partner countries and private and micro insurance mechanisms. of health systems, such as stewardship development partners. Our experience comprises the definition of and management issues, human resources, benefit packages and the design of models information, quality of service provision as The guiding principles of evaplan’s work for risk equalization. well as demand side issues such as people’s include: gender equality, realising human participation, knowledge and behaviour. rights and respect for cultural diversity. Our Reimbursement and provider payments approach is flexible and participatory. We We aim at setting the right incentives Main areas of support collaborate closely with local partners. within an efficient and coherent purchasing Sectoral coordination mechanisms framework and combine expert knowledge We provide advice for governments and Our core methodological competencies and skills in issues as diverse as pay for international organizations who strive to include the following performance, hospital financing – including improve health systems at national and diagnosis-related group (DRGs) – and sub-national levels. evaplan has conduc- ›› Technical support, result based pharmaceutical pricing. ted feasibility studies and evaluations of monitoring and impact evaluation health sector coordination mechanisms ›› Capacity building, teaching and Public financial management and good (e.g. SWAps) and of pooled sector financing. curriculum development governance Other recent relevant mandates include ›› Operational research Our portfolio encompasses the improve- studies on the impact of Global Health ›› Strategy and concept papers ment of public financial management at Initiatives on health systems. ›› Documentation of "good practice" and national, district and local level. We have a knowledge management track record in the promotion of good gover- Public private partnerships (PPPs) ›› Conceptualisation and implementation nance and in linking health sector strategic Our expertise includes designing, imple- of technical study tours plans to national accounting mechanisms. menting and evaluating PPPs in areas as diverse as quality management and e-health. Economic analyses and costing studies: Besides providing negotiation support for Social protection and health We conduct economic evaluations and setting up mutually beneficial PPPs we financing analyse the benefit incidence of health care ensure sustainability by anchoring these programmes. We also address the question initiatives in the health sector context. Social protection for the vulnerable of how health systems can best incorporate We conceptualise and strengthen mecha- innovations — from e-health to telemedicine Health planning, monitoring & evaluation nisms alleviating and mitigating the risks evaplan has guided participatory processes of falling into poverty due to ill health, disa- to elaborate national planning guidelines bility, old age and exclusion. Our expertise and formats for district, hospital develop-

87 ment and HIV/AIDS plans. Our services ran- professional exchange with bi- and multila- Outlook ge from the design of methods, techniques teral donors but also fosters the transfer of With its wide variety of services and exten- and tools for programme evaluations (inclu- knowledge among Southern countries. The sive experience from different continents, ding impact evaluation) to the implemen- group sees itself as a think tank translating the Heidelberg quality management working tation of programme progress reviews and evidence into policy making and practice. group seeks to build quality management results-based monitoring. Members of the group have extensive experi- capacity at all levels and to bridge the gap ence of supporting quality management po- between practical experience and academic Human resources for health licy development and implementation at all training and research. Besides facilitating The global health workforce crisis calls for levels of the health system. Clients include dialogue and exchange across countries, approaches that address political, economi- the European Union (EU), German Internatio- the group also provides services in the cal, psychological and sociological dimen- nal Cooperation (GIZ), Global Fund (GFATM), German health sector. sions. evaplan supports strategic planning World Bank, WHO, United Nations Population for human resources and undertakes opera- Fund (UNFPA) and USAID. tional research to explore country-specific Sexual and reproductive reasons for poor motivation, performance Examples of the work done by the group health & rights (SRHR) and and retention of health workers. We have include: HIV & AIDS experience of mapping tools to monitor ›› Support to the process of establishing health workers migration and of technically a national accreditation body in Kenya The importance of SRHR advising the design and implementation of in collaboration with the AQUA Institute SRHR is of crucial importance to broader incentive schemes. Support is given to inno- Göttingen efforts towards poverty reduction and susta- vative capacity building programmes for ›› Courses in quality of care at the University inable development, hence the addition of a health workers and at organisational level. of Heidelberg new target for "universal access to repro- ›› Blended learning courses in QM on behalf ductive health by 2015" to the Millennium of GIZ Development Goal of "Improving maternal Heidelberg quality ›› Research on implementation of quality health". management group management methods and tools in Pakis- tan, Kenya, Tanzania and Uganda We are committed to a rights-based ap- In 2008, the quality management group was proach that contributes to achieving equal established as joint effort of evaplan and the Outcomes access to information and services without Heidelberg Institute of Public Health. It brings The Heidelberg quality management group discrimination related to sex, social class, together a network of public health profes- has a strong track record on producing ethnicity or age. Our expertise includes con- sionals with multidisciplinary backgrounds strategy and concept papers for a variety of ceptual and strategic work on comprehensi- engaged in implementation, research and audiences and target groups. Additionally ve SRHR and respective technical support to teaching in the field of quality management. members of the group have significant programmes at country level. The group seeks to bring state of the art experience in drafting curricula, providing developments in the area of quality manage- training for participants from low- and HIV and AIDS ment to low- and middle-income countries. middle-income countries as well as conduc- evaplan has wide experience in the multi- To this end it not only engages constantly in a ting operational research. sectoral response to HIV and AIDS, both at

88 national level as well as in building local government capacity. This includes technical support, training, knowledge management, monitoring and evaluation in HIV and AIDS interventions. Furthermore, we have been involved in strengthening the role of businesses and the private sector through facilitating the development of workplace programmes.

Linkage and integration of SRHR and HIV and AIDS The need for linkage and integration of sexual and reproductive health and rights (SRHR) and HIV & AIDS in the framework of strengthened health systems is increasingly Mothers with their children at the CREN (health and nutrition center for undernourished children) in Nouna, recognized. We support efforts of promo- Burkina Faso (March 2010) ting the linkage of SRHR with HIV & AIDS for example through operational research, April 2011, best time for mangos in Burkina Faso conceptual work, training and capacity development.

Young people as a target group most in need Among the focal target groups in our work are young people who are very important both in vulnerability and numbers but lack access to information and services. We have a sound experience in numerous countries in the development of information and communication approaches and interventions that are gender-sensitive and tailored to young people’s needs. evaplan has also conducted operational research on young people’s sexual and reproductive health needs in various countries and cultural contexts.

89 90 International Collaborations CRSN Nouna Centre de Recherche en Santé de Nouna

We have the privilege to work with a large Over the past 20 years, the institute has a ship with Nouna, a cooperation treaty was number of partners and countries on a particularly close cooperation with the signed between the two medical faculties of project basis. However, some partners stand Centre de Recherche en Santé de Nouna in University of Heidelberg and Ouagadougou out through mutual long-term partnership Burkina Faso. This research center deve- University. In the future, the CRSN will arrangements, based on complementarity loped from a large public health research assume the role of a teaching and research in research and training. The partners project which started in 1989. In 1999 it collaborating centre of the medical faculty presented in this chapter in more detail are was fully integrated in the organogram of Ouagadougou. the Nouna Health Research Centre CRSN, the Ministry of Health directly affiliated the BRAC University with the collaboration with the Cabinet of the Minster of Health.  www.crsn-nouna.bf ICDDRB in Bangladesh, the Zhejiang Uni- This underlined the policy relevance that  www.hd-nouna.org versity in Hangzhou in China, the INDEPTH the center had gained in pioneering and network, partners in Malawi and the Tongji scientifically evaluating new policies, e.g. in Medical College. the area of health insurance or the improvement of quality of care. With the large and Among the European partners we have long-term collaborative grant on "Control of long-term collaborations with the Univer- tropical infectious diseases" other research sity of Umeå and the Karolinska Institute areas were built up: a parasitological and in Sweden, the London School of Hygiene biological lab, clinical trial capabilities, and and Tropical Medicine (LSHTM) in UK and most recently an environental/meteoro- the University Paul Sabatier and French logical information system. The core data Space Research Center (CNES) in Toulouse, base linking all these research areas was France. a dynamic population-register of deaths, births and migration, called "demographic surveillance system" (DSS). The CRSN Nou- na was a founding member and has been a leading partner in the Africa-Asia research network "INDEPTH" since its inception in 1999. Since 1986, preceding the partner-

92 Residents of Nouna in Burkina Faso

93 BRAC University

The James P Grant School of Public Health (JPGSPH) at BRAC University in Bangladesh is a leading school of public health. The Bulletin of the World Health Organization has recognized the school as one of the six schools in the world promoting and practicing innovative higher public health Group of women with children in Bangladesh education. In addition, JPGSPH has earned a standing amongst all schools of public health for its emphasis on community- mic meetings; and e) Student exchange. based experiential learning. Manuela De Allegri from Heidelberg Institute of Public Health and Malabika Sarker from The JPGSPH, BRAC University and the Insti- JPGSPH act as coordinating partners on tute of Public Health, University of Heidel- behalf of their respective institutions. berg, Germany, share the same mission of enhancing public health through capacity  www.bracu.ac.bd building; fostering graduate and post graduate education; contributing to the generation, dissemination, and promotion of the utilization of knowledge through research; and improving service delivery. Given the similarity of their missions, these two institutions have initiated a fruitful collaboration marked by the signing of a memorandum of understanding The areas of collaboration include: a) Academic cooperation; b) Joint research activities; c) Joint appointment of senior faculty and faculty exchange; d) Joint seminars, conferences and acade-

94 Zhejiang INDEPTH University, China

This is a new partnership with a long-term The INDEPTH network was created in 1999 quality control as well as the fostering of perspective. It was founded on a memo- as a federation of independent research collaborative research funds. The network randum of understanding signed in 2011 sites whose characteristic has been the tool has been extremely successful in fulfilling in which the two institutes of public health of demographic surveillance system (DSS). these roles and is major contributor now to sketch a research agenda on non-commu- This consists of a continuous monitoring of the live of the participating centres. It is a nicable diseases (NCDs), particularly on populations and their health with regular strong force in capacity building, providing diabetes and cardiovascular diseases. The house-to-house visits of a contiguous training, and workshops for proposal deve- center for NCD diseases of Zhejiang Univer- population of about a 100.000 people. lopment all across the sites. The Heidelberg sity will serve as a crystallization kernel for The INDEPTH network now has about 30 Institute of Public Health has been instru- joint research and teaching in this field. In collaborating research centres from 19 coun- mental in the setup and has been a partner a North-South collaboration effort, the HIPH tries in Africa and Asia. It is funded by the of the INDEPTH network ever since. will validate the current excellent disease Gates Foundation, the Swedish CIDAR and and vital event reporting system the Zheji- other foundations. Its main objective is the  www.indepth-network.org ang university built up both in an urban, a standardization of methods and definitions, rural and an island population. This valida- tion will be done together with the INDEPTH research network (on the right-hand side of the page), of which Zhejiang will become a member.

Senegal The Gambia Ethiopia Guinea-Bissau Uganda India Burkina Faso Kenya Bangladesh Ghana Tanzania Thailand Vietnam Malawi Indonesia Mosambique Papua New Guinea South Africa Cambodia

95 Partners in Malawi

Our collaboration with Malawian institutions unfolds along two parallel, yet highly com- plementary arms: one with a clinical focus and one with a focus on impact evaluation Experienced nurse at a Lighthouse review station in Malawi of complex health system interventions.

Kamuzu Central Hospital (KCH) and the with the Ministry of Health. LH is now one systems and financing, communicable and Lighthouse (LH) are central to our colla- of the largest providers of ART in Malawi, non-communicable diseases). Beyond the boration on clinical studies. The College reaching out to over 22,000 patients. single collaborative research projects, HIPH of Medicine (COM) and Reach Trust (RT) has made a long term commitment to foster are central to our collaboration on health Our cooperation with KCH and LH dates capacity building at COM through doctoral systems analysis. back to 2005. After initial informal exchange, training and faculty exchange, thanks to cooperation with the two institutions (see support from the Norwegian Government KCH is located in Lilongwe. It serves as a re- page 28) is now funded through GIZ as part and USAID. ferral centre for all the districts of the central of the European hospital part-nership net- region and is also a major referral hospital work ESTHER (Ensemble pour une solidarité The Reach Trust (RT) is an independent Mala- for the northern parts of Malawi. KCH, alrea- thérapeutique hospitalière en reseau) and wian health research charity based in Lilon- dy a teaching hospital for nurses, clinical further through a grant from the Hector gwe. RT is a leader in research operating officers, medical assistants, and medical foundation. Both partnerships aim at health at the intercept between clinical work and doctors, has recently been designated to system strengthening and quality improve- social sciences. RT and HIPH are currently become the second campus for the College ment. implementing the first longitudinal compre- of Medicine in Malawi. hensive household survey to monitor access The College of Medicine (COM) is located in to care and relative spending in Malawi. LH is also located in Lilongwe. Establis- Blantyre. Established in 1991, COM has distin- HIPH has made a long term commitment hed in 1997, the LH’s mission is to care for guished itself as an initiator of high class to foster capacity building at RT, mostly people living with HIV/AIDS by providing a health research. The collaboration is parti- through direct training of local junior continuum of quality services and support, cularly vibrant with the Department of Com- researchers. The collaboration between and by engaging to build capacity in the munity Health, given the common interests HIPH and RT is funded by a DFG grant. health sector, in direct close collaboration and expertise (reproductive health, health

96 University of Umeå

This young Northern-most Swedish univer- Wilder-Smith has been guest professor lea- sity won a structural Swedish grant to create ding the dengue project (b) since 2010. Stig the "Umeå Centre in Global Health Research" Wall and Peter Byass have been external (UCGHR) in 2008. The collaboration between examiners in our Master of Science course HIPH and the UCGHR has been particularly since 2007. Additionally, HeikoBecher and strong in four areas: Rainer Sauerborn are in the editorial board of the Global Health Action journal (chief a) "Climate change and health", with sever- editors Stig Wall and Peter Byass). al joint research project and two courses on the topic in Heidelberg and Umeå,  www.umu.se/english taught together b) Dengue control research, a large con- Staff members ofthe Umeå International School of Public Health with guest professor Heiko Becher after a sortium of 10 international scientific charity running event institutions. c) Partnership with INDEPTH network under- girded by a EU project to strengthen capacity-building across the INDEPTH sites (HeikoBecher) d) Journal in Global Health Action

Particularly fruitful are the double appoint- ments of professors in these areas: Rainer Sauerborn has been "guest professor of climate change and global health" (see item a) at Umeå university since 2009. Annelies

97 worked together in founding the European Karolinska Institute, Academic Global Health Alliance (EAGHA).

Both Swedish partners, Umeå University and Stockholm Karolinska Institute are running the "Swedish Research School in Global Health", a joint PhD programme. The HIPH is currently part- nering with this research school proposing a DFG funded "International Research Training Division of Global Health maternity care. Another focus was on early Group" (IRTG) on global health with both warning systems for infectious diseases Swedish partners, which we hope will lead to Since 1998 we have run five large EU-funded using lay people and their cell-phones as a joint Swedish-German PhD programme on research projects with Karolisnka Institute communication channels (with Prof. Vinod global health. (KI) as key partner. The focus has been on Diwan as lead partner). A large number of health system research and evidence-based mutual exchanges in external examiners for  http://ki.se policy development (with GöranTomson as doctoral theses complement this cooper- lead partner). The illustrative areas to study ation, as does the joint involvement in the this were malaria care and antenatal and INDEPTH network. KI and the HIPH have

98 LSHTM London School of Hygiene and Tropical Medicine

Since 1989, we have been working with developing and strengthening capacity at various departments of the LSHTM, parti- European universities in research on global cularly in two domains: health economics, aspects of health. particularly with regard to exploring innovative and locally adapted ways of health care Heidelberg and the LSHTM collaborated on financing. Recently we have collaborated the network Tropical Medicine Europe. We on health consequences of climate change were both founding members of the succes- an on maternal and child health. In Sir Prof. sor Institution, the European Academic Glo- Andy Haines, we have a strong partner for bal Health Alliance, chaired by Andy Haines.

99 UPS and CNES Paul Sabatier University and French Space Research Center, Toulouse

The Institute built a consortium which inclu- cooperation, we have access to satellite data (see projects CLIMIMO and PALUCLIM, des this multi-disciplinary science cluster to imaging ("remote sensing") and regional page 32). Prof. Jean-Pierre Lacaux has had improve our abilities to carry out environ- climate models. close links to the Nouna Health Research mental health research, particularly in the Center and serves on its international scien- area of regional weather/climate on malaria This enables us to study linkages e.g. with tific advisory board (page 92) and malnutrition in West Africa. Through our infectious disease models and real-time

100 Tongji Medical College Huazhong University of Science and Technology, Wuhan, PR China

The University of Heidelberg has a long- Medical College, he developed the Course Li Yonglong) covers the parasitic infection standing partnership with the Tongji Medi- "scientific presentation skills" for young schistosomiasis and included exchange in cal College. Prof. Ruppel is member of the Chinese scientists, which he taught several both directions of doctoral students university team which leads the exchange times, last in 2010 at the Tongji Hospital. (Pauline Grys, Wang Ting, Lei Jiahui) and of doctoral and other students with Wuhan. The scientific cooperation with the Depart- faculty (Prof. Ruppel and Prof. Li). Being a visiting professor of the Tongji ment of Parasitology (partner: Prof.

Participants in a lecture of Prof. Andreas Ruppel at the Tongji Medical College

101 102 National Collaborations Selected Partners 21 17 Schleswig- holstein 24 Mecklenburg- in Germany vorpommern 19

13 Bremen Brandenburg Our mission is to contribute to the improve- Niedersachsen ment of health through research, teaching 2 and direct services (patient care, consul- 20 5 26 Berlin ting) in low- and middle-income countries and at home. A number of our research 25 3 Sachsen- projects are therefore based in Germany, Anhalt and these are performed in collaboration Nordrhein-westfalen with many national partners. Among these 14 16 18 22 are the German Cancer Research Centre in 15 Heidelberg, the Institute for Mental Health Sachsen in Mannheim, Helmholtz Centers in Munich 9 Thüringen and Centers for infectious diseases, and a 4 HESSEN large number of University institutes.

Rheinland- 6 Pfalz

Saarland 234 12 10 8 Bayern

Baden- Württemberg 28 1 11 7

104 Selected collaborations in Collaborations within the Highlighted network collabora- Germany framework of the National Cohort tions within the framework of (see page 107) the multi-centre DZIF (German 1. KORA-Studienzentrum Augsburg Centre for Infection Research) 2. Charité - University Medical Center 2. Berlin: Max Delbrück Center for (see page 107) Berlin Molecular Medicine (MDC) Berlin-Buch; 3. University of Bielefeld Charité - University Medical Center; 19. Bernhard Nocht Institute for Tropical 4. Deutsche Gesellschaft für Internationale Robert Koch Institut (RKI) Medicine, Hamburg Zusammenarbeit (GIZ), Bonn 5. Helmholtz Centre for Infectious Diseases, 11. Department of Tropical Medicine at the 5. Helmholtz Centre for Infectious Diseases, Braunschweig Ludwig-Maximilians-University (LMU), Braunschweig 7. University Hospital Freiburg Munich 6. KfW Bankengruppe, Frankfurt 8. Heidelberg: DKFZ; University Hospital 28. Institute of Tropical Medicine, Eberhard 7. University of Freiburg 11. Helmholtz Centre Munich Karls University, Tübingen 8. Heidelberg: DKFZ; University Hospital 10. Central Institute of Mental Health (ZI), 9. Infectious Disease Department Cologne Mannheim 10. Central Institute of Mental Health (ZI), 12. Saarland Cancer Registry, Saarbrücken Mannheim 13. Bremen Institute of Epidemiology and 11. Helmholtz Centre Munich Prevention Research (BIPS) 12. Saarland Cancer Registry, Saarbrücken 14. University of Duisburg-Essen 15. Düsseldorf: German Diabetes Center; Leibniz Research Institute for Environmental Medicine (IUF) 16. University Hospital Essen 17. Ernst Moritz Arndt University, Greifswald 18. Martin-Luther-University of Halle 19. University Medical Center Hamburg- Eppendorf (UKE) 20. University of Veterinary Medicine Hannover, Foundation (TiHo) 21. Christian-Albrechts-University Kiel 22. University of Leipzig 23. Klinikum Ludwigshafen 24. University of Lübeck 25. University of Münster 26. Institute of Human Nutrition Potsdam-Rehbrücke (DIfE) 27. Regensburg University (RU)

105 In October 2011 a few infrastructural DZIF measures and projects have started and among them the "harmonization of research German Centre for Infection Research sites in infectious endemic countries". Our Institute is involved in a network of four German universities (Hamburg, Heidelberg, München and Tübingen) and four African research centres (Kumasi Centre for Colla- borative Research in Ghana, Mbeya Medical The DZIF is a multi-centre structure with 27 by "Thematic Translational Units" (TTUs). Research Programme in Tanzania, Albert contributing institutions located on seven To support the TTU and foster the strategic Schweitzer Hospital in Lambaréné, Gabon, sites (Bonn-Köln, Giessen-Marburg-Langen, coordination of concerted translational Centre de Recherche en Santé de Nouna in Hannover-Braunschweig, Hamburg-Lübeck- efforts translational infrastructures will be Burkina Faso). Borstel, Heidelberg, München, Tübingen). developed. The Federal Ministry of Education and This project has for objectives to prepare Research (BMBF) has founded it with the The DZIF has been founded in 2011 and the translational infrastructure "DZIF African overarching aim to make translation of basic started officially in January 2013. The Partners sites" and specifically to: research findings into new approaches and Institute of Public Health will be involved ›› establish the principles and to identify applications for the diagnosis, prevention in the TTU Malaria in the project "Impact of the remit of an international research and treatment of infectious diseases faster co-infections" and in the translational infra- framework and define the roles of all part- and more effective. The translational efforts structure "DZIF African partners sites"(see ner institutions in the spirit of a long-term focusing on distinct infectious disease- figure below). collaborative effort. related health problems will be coordinated ›› strengthen high quality infectious disease-related research both laborato- ry, clinical, epidemiological and public health in low-income countries. ›› provide training and scientific exchange Nouna for both, DZIF clinical scientists in these Burkina Lambarene Heidelberg Tübingen Gabon regions, as well as scientists from low- Faso income countries in DZIF institutions.

DZIF Partners  www.bmbf.de/de/16544.php sites

Kumasi Mbeya Hamburg München Ghana Tanzania

106 National Cohort DKFZ German Cancer Research Center

A network of German research institutes to derive valuable findings on how The collaboration with the German Cancer from the Helmholtz Association, the Leibniz ›› genetic factors, Research Center (DKFZ) is through a number Association, various universities and research ›› environmental conditions, of large projects: The PhD program epide- departments has taken the initiative for the ›› social milieu, and miology (Graduiertenkolleg, see page 74) creation of a large-scale, nation-wide, long- ›› lifestyle would not have existed without the contri- term prospective population study with the interact in the development of disease. bution of several departments of the DKFZ, aim of explaining the causes of widespread These findings, it is hoped, will greatly represented by the deputy speaker and diseases such as cardiovascular disease, facilitate the development of more effective members of the council (Profs. Hermann cancers, diabetes, dementia, and infectious prevention and treatment strategies for the Brenner, Jenny Chang-Claude and Jürgen diseases, identifying risk factors, high- most widespread diseases. It will also lead Wahrendorf) and other thesis supervisors. lighting effective forms of prevention, and to new approaches to the prevention of The case-control study on laryngeal cancer identifying options for the early detection of chronic diseases. (see page 24) was launched when the diseases. principal investigator, Professor Becher, was In the last year, feasibility studies have still at the DKFZ. The national cohort is a In this cohort study, 200,000 people aged been performed to test various aspects of new project, in which the DKFZ and the our between 20 and 69 from across Germany the planned study. Our institute under the Institute have joint responsibility for local will be medically examined and questioned leadership of Professor Becher was respon- recruitment (on the left side of this page). on their living habits (e.g. physical activity, sible for evaluating methods to recruit smoking, diet, occupation etc.). In additi- migrants for this cohort.  www.dkfz.de on, all participants in the study will supply blood samples which will be stored in a  www.nationale-kohorte.de central biobank for later research projects. In the course of their observation over a period of 10–20 years, some of the participants are bound to develop diseases, which we will then be able to correlate with the data collected. The study thus offers unique potential for a wide range of scientific inves- tigations. Researchers will therefore be able

107 108 Funding Core Funding

The core budget in 2010 was 889.800€ and Core funding 2010 / 2011 increased by 2.8% to 915.100€ in 2011. 42% of the employees are paid out of core Euro 889,8 € 915,1 € budget, 58% are paid by soft money. 900

Main funding organisations are: DFG, EU, 800 BMBF, GIZ, DAAD 700 600 500 810 832 400 300 200 100 79,8 83,1 0 2010 2011

consumables staff

110 Third Party Funding

Soft money 2010 1.927.170 €

DFG 1.012.788 € 52 % Foundation 30.000 € 2 %

EU 320.769 € 16 % WHO 13.158 € 1 %

GTZ/GIZ 176.083 € 9 % BMBF 48.954 € 3 %

Others 108.152 € 5 % DAAD 122.424 € 6 %

Participants 141.859 € 7 %

Soft money 2011 2.317.685 €

DFG 712.417 € 34 % Participants 127.445 € 6 %

EU 596.471 € 28 % Foundation 157.071 € 7 %

GIZ 128.557 € 6 % BMBF 149.858 € 7 %

Others 139.254 € 7 % DAAD 113.467 € 5 %

111 112 Institute’s Life Jubilee Conference

We strive to celebrate diversity of cul- In 2012, the Institute will celebrate its 50th coverage, climate change the continuing tures and thoughts among our staff and anniversary with a symposium "Global threat of infectious diseases and the rising students, commensurate with our global Health in the 21st Century" (September pandemic of non-communicable diseases orientation in research and teaching. 13-15). With its roots in the South Asia Insti- in an aging world. At the same time the Examples for social events include ethnic tute, its change to the Institute of Hygiene, institute will celebrate (with) its partners in cooking sessions, yoga groups, hiking/ the focus on global health with the integra- the North and the South. biking events, film clubs, parties, whether tion of clinical tropical medicine in the newly it be for celebrating birthdays, vital events, founded "Department of Infectious Disea-  www.klinikum.uni-heidelberg.de/Global- doctoral defences or christmas/season ses" the institute will attempt an outlook to Health-Symposium.124596.0.html parties to name just a few. the challenges lying ahead, from universal

Humboldt Fellow Maduni Madanayake (left side) meeting Federal President Gauck in Berlin.

114 of different cultural backgrounds Global Health Conference ›› Good governance, policy relevance, and corporate social responsibility

Heidelberg 2011 Thematic topics included the control of non- communicable diseases and communicable diseases, harmful use of alcohol, violence, smoking, environmental health and climate change, sanitation, health promotion and Second international conference on The discussion was organized along the health systems. At the crossroads of non- "Global health and preventive medicine", following broad issues communicable diseases and communicable 14. – 16./17. June 2011, Heidelberg diseases the new horizon of the debate on ›› Self-empowerment, lifestyle / life care health for all is moving towards the post- Under the patronage of the Federal and and education for good health and life MDG 2015 agenda. Thus the main conclu- State Ministries of Research, an internatio- long well-being sions of the conference was summarized in nal conference on global health & preven- ›› How to best promote health by addres- the Heidelberg Declaration. tive medicine was held in Heidelberg, sing the leading global risk factors Germany from 14. – 16. June 2011. ›› Partnerships for health across disciplines, institutions and traditional policy areas Prevention plays a key role in addressing ›› Alternative intercultural preventative global health challenges such as the medical approaches, to focus on the use control of pandemics, the rising tide of non-communicable diseases, and the Chamber music hall in the conference location, the Kongresshalle Heidelberg spread of violence and injuries. In order to be effective, preventive strategies need to include underlying causes of avoidable morbidity and mortality by promoting polices that foster a healthy environment, healthy life styles and equitable access to health care and information. So far, the global health debate has not paid the due attention to the potential of prevention and health promotion. Thus, this conference aimed addressing this gap by 3 days of presentations and intensive deliberations with more than 100 speakers and 500 participants from many disciplines and policy makers from 31 countries around the world.

115 before, reaching 530 registered conference KSFE Heidelberg 2011 participants. The main topic of the conference was "Learning from each other". The Conference of SAS-users in research conference covered tutorials on the usage of SAS®/Base, SAS® Graph, SAS® SQL , JMP and developement and many other specific talks on the SAS software.

 www.urz.uni-heidelberg.de/KSFE2011 Conference organizer: The German community of users of the PD Dr. Heribert Ramroth statistical programming package SAS meets Heidelberg contributed with this conference Dr. Carina Ortseifen (Heidelberg University) once a year to interchange knowledge and to the celebration of the 625th anniversary of SAS Institute Germany, Heidelberg to discuss new developments of the SAS the Ruperto Carola University of Heidelberg. software. In 2011, this conference was held in Heidelberg from 24th to 25th of February: KSFE 2011 – Konferenz der SAS-Anwender in Forschung und Entwicklung. The number of participants exceeded any number seen

The lecture hall at the opening event of the KSFE 2011 in Heidelberg

116 The current projects in The not-for-profit Burkina Faso include:

›› Installation of solar panels on rural association "Friends health centers and maternities (CSPS) in particular to provide light for deliveries taking place at night. Within the of Nouna" e.V. last 5 years, 6 CSPS have been equip- ped with solar installations. The idea to initiate a non-profit association after a falling tree had damaged the well ›› Set up and care of a food garden in giving humanitarian aid beyond causal external structure ensured further access to the health and nutrition center for research was developed following research safe water and use of the well. undernourished children (CREN) in activities at the "Centre de Recherche en Nouna. Santé de Nouna (CRSN)" in Nouna/Burkina Follow up of projects and maintenance of ›› Support for developing dormitory Faso in the context of the SFB 544 "Control current installations represents a priority for centers for school students away from of tropical infectious diseases" (see chapter the association. Activities in Germany focus home. 1). The association "Friends of Nouna" was on fundraising and actions to promote cul- founded in 2001 by members of the insti- tural exchange between Burkina Faso and tute. Prof. Becher was chairman until 2004 Germany. In recent years, this has included President: Dr. Valérie Louis followed by Dr. Ronellenfitsch until 2008; representation at the African market and Vice-president: Dr. Paul Conrad since then the position is held by Dr. Louis. at the christmas market in Heidelberg, an Treasurer: Dr. Aurélia Souares event to introduce African musical instru- Liaison officer: Nobila Ouédraogo The aims of the organisation are the pro- ments at a Kindergarten, and the production Webmaster: Olivier Kalmus motion of projects in the fields of training, and promotion of a CD recorded by local agri-cultural development and health in the traditional musicians in Nouna. The associ- province Kossi, situated in the North West of ation aims to continue its current work and Burkina Faso as well as the promotion and promote new projects and activities in the development of cultural exchange between future. Burkina Faso and Germany within the idea of international understanding. To contact us: [email protected] The first major project was building a well in the small village of Cissé. In this village, an  www.freunde-von-nouna.de extremely high child mortality was obser- ved, and the drinking water supply was particularly poor. Thanks to the generous help of sponsors the well was finished by the end of 2004. Reparations made in 2010

117 measures for saving energy have been taken Green Institute into consideration which can be influenced by staff members.

The idea was to calculate the Institute’s real rate of electricity consumption per employee. Until then there existed neither numbers nor a feeling of how much energy was consumed and at which costs - espe- The idea for the project "Green Institute" before seeking to reduce it. To obtain cially as the Institute does not have to pay has an unusual history, considering that it is exact numbers and develop convertible for electricity itself. Subsequently, measures an university or hospital "energy-saving-pro- measures, the "Green Institute" team for saving energy would be carried out and ject": the strong engagement of environ- sought new and supportive business the use of electricity would be measured mentally-conscious staff at the University of partners: the technical department of the to determinate the concrete potential for Heidelberg’s Institute of Public Health and University Hospital, the Energy Commissi- saving. the active support of the Institute’s director, oner of the University and the consulting Prof. Rainer Sauerborn, made it possible and coordination team Hoinka and At this point, it was very important for the for the "green seedling" to strike roots. By Dr. Banedji-Schafii. team to keep in mind every single of the now, it has already started to flourish and is pillars of sustainability, that is next to bearing first fruits. ecological and economical features also the Material and methods pillars of social sustainability and political First, the Institute introduced some small sustainability (see figure below). measures, which led to the reduction of The project group had knowledge about paper usage and also to the switch from the independent survey of the BUND (Bund white to recycled paper. Ways to reduce für Umwelt und Naturschutz Deutschland the amount of overseas travel were also – "Friends of the Earth Germany") which Sustainability initiated. Where possible, multimedia revealed that in clinics and hospitals nati- conferences and other alternative me- onwide energy costs of about 600 million thods are used to save time, money and Euros per year could potentially be saved. of course reduce the carbon footprint of Everyone was aware that, for example, the institute. Next the "Green Institute" through building measures on the facade, team looked into the possibilities of or renegotiating the contract with the cur- saving energy at the Institute itself. It be- rent or a new energy supplier, the University

came clear rather quickly that this project Hospital could save much energy, money ecology economy social politics had wide-reaching implications and that and CO2-Emissions. certain technical knowledge was needed in order to be able to measure as well as As these decisions are not in the hands of to evaluate the energy consumption the Institute of Public Health, only those

118 Five workging groups emerged: Scenario I: What measures were included?

I: Object-/building analyses Computers: II: Equipment analyses Unplugging computers after work (evening) and at the III: Users behavior weekends. Easily realizable by using power strips with IV: Organisation/management power buttons. V: PR/politics Printers: While working group I recorded the data of Unplugging printers over night and at the weekends. Easily the entire institute’s buildings and deter- realizable by using power strips with power buttons. Enabling mined model buildings and rooms for later automatically switching into power saving mode during daytime. measurements (see figure 2), working group II determined the exact number of Lighting: power-hungry devices in order to be able The installed lamps were already optimized (4x38W T5 lamps with to estimate the actual energy consumption electronic ballasts instead of 4x58-80W T8 lamps). Additional energy during a two-week-trial. can be saved by switching off the light when leaving the room or when no light is required at all. Working group III thought of means to spread awareness and motivation to take an With these measures up to 40% of energy can be saved. active role in the power saving project. The fourth working group attended to "organization and management" (including the issues of allocating the employees to their working ge behaviour before the topic was introduced estimated. With a small investment of about spaces, the purchase, maintenance and with the help of a pre and post test question- 280 Euros (scenario 1) the institute could repair of electronic devices, as well as the naire. During the workshop more measures save 3800 Euros and 14.520 kg CO2 within basic energy-saving setting on the com- and tools for saving energy were developed, three years. puters). The task of the public relations which were presented and discussed during working group was communication and a concluding session. Scenario 1 was chosen (mainly due to cost information, mainly to spread awareness reasons). The investments were made and and motivate people to participate in the From this pretest data it could be concluded measurements were done yet again. As can project. that most of the energy was used for laptops, be seen in figure 4, 30% of energy could be computers, and printers. Based on these saved with this scenario. This meant savings Institute staff and guests were invited to take findings, different scenarios were developed of up to 1780 Euros and 9.960 kg CO2, at a part in a seminar including a work-shop, which were supposed to evaluate small and amortization rate of three years. which introduced the project. Team members bigger investments (in for example power as well as external speakers presented diffe- strips or the purchase of new electronic The results of the user questionnaire were in- rent aspects of the project. Working group III equipment). As a result savings of up to 44% teresting: 90% of the participants stated that seized the opportunity to collect data of usa- for scenario 1 and 55% for scenario 2 were they would use means to save energy (as for

119 example turning off the lights when leaving a room), but 76% would still like to know more about energy-saving options.

As mentioned above in the introduction, this pilot project came to life on a very unusual way and will, in short-term, not achieve bigger savings for the entire university hospital. This is mostly due to financial and organizati- onal reasons, nonetheless is the first step in this direction.

Further, this project can be taken as an ex- Some members of the "Green Institute" team ample for other institutions such as schools and hospitals, as in institutions of this kind the saving potential is usually rather high. Therefore, the exchange and discussion Workplace room 13 (kWh/Person/a) of knowledge and ideas is the only way to spread awareness of the topic among Computer Screen Printer Light consumers in order to create incentives of 450.00 savings and thus create power efficiency on Results of measurement a larger scale. 400.00 in May 2011, > 30 % saving 350.00 300.00 250.00 200.00

kWh/Person/a 150.00 100.00 50.00 0.00 T-Labs HIPH November HIPH optimized HIPH May 2012 (reference project) 2010 with minor new equipment

With minor investment and "green" behaviour HIPH could save more than 30 % energy.

120 nications center. The server is based on The IT System a Fedora Linux operating system, using Samba shares to enable staff access and interconnections. Due to frequent absence at the Institute of staff members the need of flexible and secure exchange (in addition to e-mail communication) of scientific materials and key documents is required. A full data backup of shares is done every 3-4 months on external The information technology (IT) group of the maintenance, (re-)installations of operating USB hard disks. Incremental backups are institute consists of one doctoral student systems, different applications and drivers, independently carried out during a week. with a degree in medical informatics and a orders for new software and/or technical part time student assistant (HIWI). They are components, trouble shooting in cases of Overall, the institute has approximately 50 responsible for maintenance of both the viruses and malware intrusion. desktop computers and around 30 laptops/ server and corresponding infrastructure(s). netbooks. Most run with the operating The main tasks are broadly divided into The institute maintains its own Linux server system Windows XP, and some on Mac OS three areas: Software-, hardware-, operating which is currently a rack mount server with X. There are about 20 printers. Software is system and network infrastructure. These 3 gigabytes RAID 5 storage. The server is installed locally by the IT staff. It includes include: Server, local computer and printer located centrally in the university commu- Microsoft Office, Skype, Sophos, Endnote, PDF Programs, and additional statistical software like SAS or Stata, and specialized Prominent mucisians at a HIPH advent concert in 12/2011 software in some cases.

121 Staff

Members of the institute with a contract in 2010/2011

Professors Country of origin Sauerborn Rainer Climate change and health Germany Becher Heiko Epidemiology and biostatistics Germany Müller Olaf Disease control in disadvantaged populations Germany Jahn Albrecht Global health policy and health systems Germany Marx Michael Health service and quality management Germany Ruppel Andreas Teaching unit Germany Wilder-Smith Annelies Mercator Professor, Teaching unit Netherlands

Adjunct Professors Country of origin Dong Hengjin International health economics and financing China Sarker Malabika Reproductive health and HIV / AIDS Bangladesh

Postdocs / Scientists Country of origin De Allegri Manuela International health economics and financing Italy Gabrysch Sabine Epidemiology and biostatistics Germany Horstick Olaf Teaching unit Germany Külker Rainer Teaching unit Germany Kynast-Wolf Gisela Epidemiology and biostatistics Germany Leppert Gerald International health economics and financing Germany Louis Valérie Climate change and health France

122 Loukanova Svetla Climate change and health Bulgaria Neuhann Florian Reproductive health and HIV / AIDS Germany Ramroth Heribert Epidemiology and biostatistics Germany Safer Anton Epidemiology and biostatistics Austria Souares Aurélia Health service and quality management France Tozan Yesim Climate change and health Turkey Winkler Volker Epidemiology and biostatistics Germany Yamamoto Shelby Climate change and health Canada

Administration/Support Country of origin Bertram Claudia Teaching unit Germany Braun - van der Hoeven Elke Epidemiology and biostatistics Germany Dey Pinaki International health economics and financing India Gold-Feuchtmüller Hilde Disease control in disadvantaged populations / Germany Reproductive health and HIV / AIDS Häfner Angela Climate change and health Germany Niebel Sandra Climate change and health Germany Nitschke-Edert Anke Teaching unit Germany Schwarzmann Sabine Climate change and health Germany Sommer Katharina Climate change and health / Teaching unit Germany Stieglbauer Gabriele Epidemiology and biostatistics Gemany Petersen Natascha Teaching unit Germany Wolf Annette Epidemiology and biostatistics Germany

Guest Scientists Country of origin Banedj-Schafii Mandana Green institute Iran Civitelli Giulia Epidemiology and biostatistics Italy Jakubicka Thomas Health service and quality management Austria Madanayake Maduni Climate change and health Sri Lanka Meißner Peter Disease control in disadvantaged populations Germany Rankin Johanna Epidemiology and biostatistics Germany / USA

123 Sankoh Osman Epidemiology and biostatistics Sierra Leone Siling Katja Epidemiology and biostatistics Slovenia Yé Yazoumé Climate change and health Burkina Faso Zhen Yu International health economics and financing China

Doctoral Students Country of origin Adokiya Nyaaba Martin Disease control in disadvantaged populations Ghana Aji Budi Climate change and health Indonesia Beiersmann Claudia Disease control in disadvantaged populations Germany Codyre Patricia Climate change and health Ireland Dalaba Maxwell Climate change and health Ghana Dambach Peter Climate change and health Germany Deckert Andreas Epidemiology and biostatistics Germany Degougé Vivian Disease control in disadvantaged populations Camerun Ding Yan International health economics and financing China Farzana Yasmin Climate change and health Bangladesh Fei Yang International health economics and financing China Glaser Nicola Reproductive health and HIV / AIDS Germany Grys Pauline Disease control in disadvantaged populations Germany Haque Aminul Climate change and health Bangladesh Kalmus Olivier International health economics and financing Luxemburg Kuhrs Ema Epidemiology and biostatistics Georgia Lorenz Eva Epidemiology and biostatistics Germany Lübbert Julia Reproductive health and HIV / AIDS Germany Malik Ahmad Climate change and health Pakistan Mohammed Shafiu International health economics and financing Nigeria Nesbitt Robin Epidemiology and biostatistics Canada Ouédraogo Nobila Disease control in disadvantaged populations Burkina Parmar Divya Climate change and health India Phalkey Revati Health service and quality management India

124 Popilian Ramona Health service and quality management Romania Prytherch Helen Health service and quality management Great Britain Robyn Jake Climate change and health USA Rosenberger Kerstin Epidemiology and biostatistics Germany Santi Irene Epidemiology and biostatistics Italy Savadogo Germain Climate change and health Burkina Faso Shafik Amal Climate change and health Egypt Scheibe Florian Reproductive health and HIV / AIDS Germany Ssennono Mark Epidemiology and biostatistics Uganda Stahl Hans-Christian Climate change and health Germany Theurer Antje Reproductive health and HIV / AIDS Germany Yé Maurice Climate change and health Burkina Faso Yrjoe-Koskinen Jaakko Climate change and health Finnland Zimmermann Heiko Epidemiology and biostatistics Germany

Student Assistants Country of origin Asante Poku Afua International health economics and financing Ghana Ballhorn Annette Climate change and health Germany Barteit Sandra Reproductive health and HIV / AIDS Germany Dia Oumar Epidemiology and biostatistics Senegal Duffert Christin Teaching unit Germany Glaser Nicola Reproductive health and HIV / AIDS Germany Haase Maxi Teaching unit Germany Haßler Katja Climate change and health Germany Heimisch Melissa Climate change and health Germany Henkes Katrin Teaching Unit Germany Kama Cigdem Epidemiology and biostatistics Turkey Kroha Verena Teaching unit Germany Kyei Nicholas Epidemiology and biostatistics Ghana Lohela Terhi Epidemiology and biostatistics Finnland

125 Maurer Caterina Teaching Unit Germany Mazzurana Eva Teaching Unit Italy Mosenpour Amir Mohsen Teaching unit Iran Otte im Kampe Eveline Epidemiology and biostatistics Germany Petersen Margot Health service and quality management Germany Rankin Johanna Epidemiology and biostatistics USA Rothermund Nandita Teaching Unit Germany Schmid Simona Teaching unit Germany Schoeps Anja Epidemiology and biostatistics Germany Schröber Jakob Global health policy and health systems Germany Taubi Rasha Teaching unit Libanon Wolf Robert Epidemiology and biostatistics Germany Zöllner Caroline Disease control in disadvantaged populations Germany

Age structure of all staff at the end of 2011

15 Number of persons Number of 10

0 Age group 20-29 30-39 40-49 50-59 > 60

126 Doctoral Theses

Name Nationality Supervisor Started in Title of thesis Aji Budi Indonesian Rainer Sauerborn 2009 The effects of health insurance for poor people on fairness and equity in health care financing: An empirical illustration using out of pocket payments in Indonesia Patricia Codyre Irish Rainer Sauerborn 2008 Public health knowledge-based interventions for improving the quality of care in Subsahara Africa (computer-mediated communication systems a HCI solution) Dalaba Maxwell Burkinabé Rainer Sauerborn 2011 Cost effectivness of clinical decision support system (CDSS) in improving prenatal and maternal care in Ghana Peter Dambach German Rainer Sauerborn 2009 Modelling of persontime at risk of malaria in Nouna, Burkina Faso by remote sensing of distribution and quality of surface water Aminul Haque Bangladeshi Rainer Sauerborn 2010 Household‘s perception and copping strategies about the effect of climate change on health Ramona Popilian Romanian Rainer Sauerborn 2009 Analysis of financial and operational sustainability in a community based health insurance in rural Burkina Faso Yasmin Farzana Bangladeshi Rainer Sauerborn 2010 Mapping out the present scenario of prevention, early detection and treatment of diabetes at the first line health care centers and factors for the emerging epidemics of diabetes in Bangladesh Divya Parmar Indian Rainer Sauerborn 2009 Relationship between community-based health insurance and household economic indicators in Nouna, Burkina Faso Helen Prytherch British Rainer Sauerborn 2009 Definitions, determinants and measurements of health workers motiviation in low income settings Jake Robyn US Rainer Sauerborn 2009 Integrating innovative health care provider payments systems into extension of community-based health insurance in Burkina Faso

127 Name Nationality Supervisor Started in Title of thesis Germain Savadogo Burkinabé Rainer Sauerborn 2010 Utilization of an alternative method for measuring poverty: the community wealth ranking as an efficiant method to indentify the poorest in a community setting, Nouna health district, Burkina Faso Amal Shafik Eqyptian Rainer Sauerborn 2003 The impact of community health insurance on household health expenditures in Burkina Faso Maurice Ye Burkinabé Rainer Sauerborn 2009 Implementing a performance based incentive scheme taking into account health workers perspectives in Nouna health district (acceptability, feasibility and potential impact on maternal and child health care improvement) Jaakko Finnish Rainer Sauerborn 2006 Der Einfluss der Organisationskultur auf die Nutzung der Gesund- Yrjoe-Koskinen heitsberichterstattung durch die stattlichen Gesundheitsdienste im ländlichen Burkina Faso Hans-Christian Stahl German Rainer Sauerborn 2008 Economic evaluation of a novel therapeutic approach to the treatment of cutaneous leishmaniasis in Kabul, Afghanistan Yang Fei Chinese Hengjin Dong 2010 Feasibility evaluation of an integrated surveillance system for infectious diseases in rural China Yan Ding Chinese Hengjin Dong 2010 Economic evaluation of integrated surveillance system in rural China Mohammed Shafiu Nigerian Hengjin Dong 2008 Perceived-performance on the formal sector program of the health insurance scheme in Nigeria: An assessment of the insured, health care providers, and health maintenance organizations in Kaduna State, Nigeria Robin Nesbitt Canadian Heiko Becher / 2011 The influence of distance and quality of care on preventive versus Sabine Gabrysch emergency use of health facilities for delivery in the Brong Ahafo region of Ghana Elisabeth Rudolph German Heiko Becher / 2008 Überlebenszeitanlayse bei Larynxkarzinompatienten in Abhän- Heribert Ramroth gigkeit von Faktoren des Lebensstils und klinischen Merkmalen Irene Santi Italy Heiko Becher / 2011 Determining survival rates of laryngeal cancer patients taking Heribert Ramroth lifestyle factors into account Sami Chenouda German Heiko Becher / 2008 Einfluss von Komorbidität, Zweitkarzinomen und Rezidiven auf Heribert Ramroth die Überlebenszeit beim Larynxkarzinom Andreas Deckert German Heiko Becher 2008 Kohortenstudie zur Mortalität bei Spätaussiedlern im Raum Augs- burg: Genetische und lebensstilbedingte Faktoren

128 Name Nationality Supervisor Started in Title of thesis Kerstin Rosenberger German Heiko Becher 2007 Implementation and parameter estimation of an intra-host model describing human immune response in falciparum malaria Susanne Sonnberg German Heiko Becher 2008 Ovizide Wirksamkeit von Produkten zur Behandlung der Infestati- on mit der Kopflaus (Pediculus capitis) Ema Kuhrs Georgian Heiko Becher 2008 Risikofaktoren für kardiovaskuläre und zerebrovaskuläre Krank- heiten von Migranten aus Ländern der ehemaligen Sowjetunion in Deutschland Ari Paltiel Israeli Heiko Becher 2007 Mortality in Jewish migrants from Russia to Israel Heiko Zimmermann German Heiko Becher 2010 Oral health in migrants from the former Sowjet Union Eva Lorenz German Heiko Becher 2011 Generalisation of the fractional polynomial procedure for semi- continuous variables in epidemiology and clinical research Ingfu Wirjawan Indonesian/ Annelies Wilder- 2011 Research on emerging infectious diseases in South East Asia German Smith Antje Theuer German Gerd Fätkenheuer 2010 Causes of fever among in patient of Kamuzu Central Hospital (Cologne)/ Florian Neuhann Julia Lübbert German Paul Schnitzler / 2008 HIV resistance in treatment interruption Florian Neuhann Nicola Glaser German Olaf Müller / 2011 Chronic kidney disease in HIV and Non HIV patients Malawi Florian Neuhann Saskia Nahrgang German Olaf Müller / 2007 HIV/AIDS treatment quality in Burkina Faso Florian Neuhann Florian Scheibe German Olaf Müller / 2007 HIV/AIDS treatment quality in Uganda Florian Neuhann Paul Konrad German Olaf Müller 2007 Quality of maternal health in Burkina Faso Tabea Schroer German Olaf Müller 2008 Entomological efficacy of ITN in Burkina Faso Claudia Beiersmann German Olaf Müller 2008 Malnutrition in young children of Burkina Faso Bernd Marks German Olaf Müller 2008 Safety of methylene blue in African children with and without G6PD deficiency Joelle Bals German Olaf Müller 2009 Long-term effects of ITN in Africa Nobila Ouédraogo Burkinabé Olaf Müller 2009 Public health aspects of childhood vaccinations in Africa Martin Adokiya Ghana Olaf Müller 2011 Surveillance of infectious diseases in West Africa

129 Name Nationality Supervisor Started in Title of thesis Katharina Sušac German Michael Marx 2011 Water supply projects and their influence on diarrhoea prevalence in 0-5 year-olds in Burundi, East-Africa Sylvia Sax Canadian Michael Marx 2007 Adapting international healthcare accreditation in a developing country: when complex methods meet complex systems Silvia German Michael Marx 2008 Is dengue diesease surveillance able to predict or detect out- Runge-Ranzinger breaks and initiate timely response? Assessment of national dengue control programmes in Thailand and Cambodia Katharina Weigl German Michael Marx 2012 Quality approaches going beyond toolkits in Tanzania‘s healthcare system Revati Phalkey Indian Michael Marx 2008 Structure and performance of the integrated disease surveillance system in Maharashtra, India Patrik Tabatabai German Michael Marx 2010 The internal brain drain of health care professionals in the southern zone of Tanzania Florian Vogt German Michael Marx 2010 Health risk patterns among refugees and residential populations in South Sudan Tatjana Ohlig German Albrecht Jahn 2011 Long term consequences of antenatally detected and undetected intrauterine growth retardation Abubakari Abdulai Ghana Albrecht Jahn 2011 Malnutrition in school children in Ghana

130 Awards

Name Prizes awarded 2010/2011 Manuela De Allegri 2011: Best thesis supervisor Andreas Deckert Best paper award, KSFE 2011, 15th Conference of SAS users in research and develpment; University of Heidelberg Sabine Gabrysch Rahel Goitein-Straus award of the Medical Faculty of the University of Heidelberg 2010-11 Postdoctoral fellowship of the Baden-Württemberg Foundation 2011-13 Young investigator award at the 19th IAE World Congress of Epidemiology Nicholas Nana Adjei Kyei Class 2010/2011: Best master student Andreas Ruppel 2011: Best teacher Sylvia Sax 2011: Best short course coordinator Hans-Christian Stahl Letter of appreciation from the Afghan Ministry of Public Health Annelies Wilder-Smith Mercator prize Heiko Zimmermann Poster prize of the annual conference of the gmds and DGEpi, September 2011 Poster prize of the annual conference of the NAgP in Bonn, October 2011

131 Committee Memberships

Name Member Heiko Becher Elected member of the "Fachkollegium" of the German Research Foundation (DFG) for the subject "Epidemiologie, medizinische Biometrie, medizinische Informatik, Public Health" Speaker of the PhD programme "Epidemiology (Graduiertenkolleg 793)", University of Heidelberg Member of the council of the Berlin School of Public Health Elected executive board member of the German Society of Epidemiology, 2012-2014 Sabine Gabrysch Steering committee member of the John Snow Society Albrecht Jahn Commission Dr. sc. hum. of the Medical Faculty in Heidelberg (since 2011) Gerald Leppert German Society for Health Economics - International cooperation (Prof. Flessa) microinsurance network working group on health insurance Olaf Müller Commission Dr. med. of the Medical Faculty in Heidelberg Florian Neuhann Chairman of the section Universal Acsess of the German AIDS Society Andreas Ruppel Commission Dr. sc. hum. of the Medical Faculty in Heidelberg (until 2011) Hans-Christian Stahl German Society for Health Economics - international cooperation (Prof. Flessa) Waisenmedizin e.V. - PACEM (executive board) Annelies Wilder-Smith President, Asia Pacific Society of Travel Medicine Chair, conference of the Asia Pacific Society of Travel Medicine Singapore 2012 Executive board member, International Society of Travel Medicine

132 Editorial Certificates Boards in 2010 / 2011

Journal Name Certificate Heiko Becher Biometrical Journal Manuela De Allegri "Baden-Württemberg Certificate" for University Teachers Global Health Action Andreas Deckert "Baden-Württemberg Certificate" for University Teachers Sabine Gabrysch Emerging Themes in Sabine Gabrysch "Baden-Württemberg Certificate" for University Teachers Epidemiology Heribert Ramroth "Baden-Württemberg Certificate" for University Teachers Olaf Müller Malaria Reports Malabika Sarker "Baden-Württemberg Certificate" for University Teachers Scientific World Aurélia Souares "Baden-Württemberg Certificate" for University Teachers Journal Hans-Christian Stahl Lecturer training Heidelberg (DOS I & DOS II) Rainer Sauerborn Global Health Action Volker Winkler "Baden-Württemberg Certificate" for University Teachers Annelies Wilder- Journal of Travel Smith Medicine Expert Review of Vaccines

133 List of Abbreviations

Some frequently used abbreviations

ART Antiretroviral treatment HDSS Health and demographic SSA Sub-Saharan Africa BMBF Bundesministerium für Bildung surveillance system tropEd International network of in- und Forschung (Federal Minis- HIPH Heidelberg Institute of Public stitutions for higher education try of Education and Research) Health in international health CRSN Centre de Recherche en Santé INDEPTH International network for the WHO World Health Organization de Nouna demographic evaluation of DAAD Deutscher Akademischer populations and their health in Austauschdienst (German developing countries Academic Exchange Service) ITN Insecticide-treated mosquito DFG Deutsche Forschungs- nets gemeinschaft (German JPGSPH James P Grant School of Public Research Foundation) Health DKFZ Deutsches Krebsforschungs- LSHTM London School of Hygiene and zentrum (German Cancer Tropical Medicine Research Center) MDG Millenium development goal DSS Demographic surveillance PI Principal investigator system REACH Research for equity and EU European Union community health FP Framework programme SFB Sonderforschungsbereich GIZ German Agency for (Special research center) International Cooperation SRHR Sexual and reproductive health and rights

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506 523

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