SASNET: International Health, Karolinska Institutet

Postal address: Karolinska Institutet, Department of Public Health Sciences, Division of Global Health (IHCAR),
SE-171 77 Stockholm, Sweden
Visiting address: Nobels väg 9, Solna Campus
Web page: http://ki.se/ki/jsp/polopoly.jsp?d=12350&l=en

The research at the Division of International Health focuses on health problems that are big in the world but small or non-existent in Sweden. Many know the division by its earlier acronym, IHCAR. It is part of the Department of Public Health Sciences. Since the start in 1984 it has developed extensive research in several fields within international health.
This multidisciplinary division pursues research and education in collaboration with researchers in Europe, North and South America, Asia and Africa. Through the experience of collaboration with global partners and stakeholders, the division aims at being a resource centre at the Karolinska Institutet, recognized for its comprehension of global health issues. Extensive collaboration exists within Karolinska Institutet and the division is an active stakeholder in the Karolinska International Research and Training (KIRT) Program and the Centre for Global Health (KICGH).
IHCAR has practiced the successful sandwich PhD system for many years, that has resulted in a large number of theses by PhD candidates from among other third world countries, India, Pakistan and Bangladesh.

A seven-member delegation from the international and private Aga Khan University’s (AKU) campuses in Karachi , Pakistan and Nairobi, Kenya visited Sweden on 9–11 June 2011. They came to visit Uppsala University’s Department of Women’s and Children’s Health, hosted by Prof. Lars-Åke Persson, on June 9th, and the Department of Public Health at the Global Health Unit, Karolinska Institutet in Stockholm, hosted by Prof. Bo Lindblad and Prof. Vinod Diwan (who is chairman of the Karolinska International Research and Research Training Committee, KIRT), on June 10th.
Photo of Vinod Diwan and Bo Lindblad.
The visits are part of planning for a new Centre of Excellence in Neonatal-Maternal-Child Health (NMCH) at AKU. The delegation wants to learn how KI and Uppsala University have organized the continuum of Reproductive Health and MCH programs from the academic point of view. They also like to discuss how current collaboration should proceed; initiatives are planned to be extended to both South Asia (Pakistan, Afghanistan, Tajikistan) and East Africa (Kenya).
Aga Khan University has had an official research and research training program with KI since 19 years (more information). Nine of the faculty at AKU Karachi currently have PhDs from KI, all have returned to Karachi and three of them hold interim chairs.
The Pakistani delegation was headed by Mr. Allaudin Merali, Vice President, Health and Operational Services, responsible for AKU’s operational functions across all locations, including: AKU Hospital in Karachi and affiliated health services in Pakistan and Afghanistan. Among the participants are also Prof. Zulfiqar A. Bhutta, Noordin Noormahomed Sheriff Professor and Founding Chair of the Division of Women and Child Health at AKU in Karachi. Prof Bhutta was a member of SASNET’s South Asian reference group till 2008.

The division has seven research groups addressing the major health and health system problems in low and middle income countries.

The focus is on public health, health system and policy, clinical and translational research. Main public health problems that are addressed are: HIV and AIDS, tuberculosis, malaria, diarrhoea, pneumonia, sexual and reproductive health, adolescents' health and development, child health, use of pharmaceuticals, consequences and causes of intentional and unintentional injuries and the Know-Do-Gap.

Educational Programmes

The division has well developed education programmes in Global Health at undergraduate, magister and doctoral level. A research school in Global Health is organised together with Umeå University. More information below.
IHCAR currently plans to introduce a virtual Centre for Global Health at KI, involving reearchers from different departments.
In addition, the division collaborates closely with Gapminder foundation for developing evidence based information. More information below.

Research projects related to South Asia

Projects by Professor Emeritus Bo Lindblad

Prof. Bo Lindblad has extensive experiences from a long career in clinical paediatrics and international health. At present he is Professor Emeritus of International Child Health, IHCAR, Karolinska Institutet, and Professor Emeritus of Paediatrics at Aga Khan University, Karachi, Pakistan. Every year, he spends a few months teaching in Karachi.
He has also held professor positions in paediatrics at the King Saud University, Riyadh, at the United Emirates University, Al Ain and also been professor and chariman in paediatrics at the Aga Khan University, Karachi. His main research interest is the impact of prenatal micronutrient nutrition on the metabolism of sulphur containing amino acids and fetal growth and development. On-going projects are supported by SASNET and Sida/SAREC in collaboration with Health Service Academy, Islamabad and Aga Khan University, Karachi, Pakistan.
During the period 2001–2006, Bo Lindblad was a member of SASNET’s board.

Research Group on Medicines and health system with focus on antibiotics

• Professor Cecilia Stålsby Lundborg (photo to the right) is Professor of International Health at Karolinska Institutet, visiting professor at R.D. Gardi Medical College, Ujjain India, and visiting faculty at Tata Institute of Social Science (TISS) in Mumbai, India. Her research interest includes all aspects of antibiotic use and ways to improve it and relations between antibiotic use and resistance.
Current projects include e.g. studies in India on antibiotic use and resistance in children and adults and environmental aspects of antibiotic use, studies in Vietnam on antibiotic use and resistance in children and intervention studies to improve antibiotic use in child infections and in reproductive tract infections in women and studies on farmers’ use of antibiotics Sudan. She is a member of the international secretariat of ReAct action on antibiotic resistance and the steering committee of Strama, the Swedish Strategic Programme for Rational use of Antibiotics and Surveillance of Resistance. Since January 2007, she is also deputy chairperson of SASNET, and the coordinator at KI of one of the Erasmus Mundus External Cooperation Window Lot 13 programmes for India, and scientific coordinator at KI for public health collaboration with India. Besides, she is a member of SASNET’s board during the period 2007– September 2010.
She is working on several South Asia related research projects.
In June 2006, she received SEK 1.4 million for a project titled ”HIV and STI infections among Female Sex Workers in Lahore, Pakistan – prevalence, resistance, knowledge and attitudes – a health systems perspective” from the the Sida programme Support to HIV/AIDS research. More information.
Project abstract: The aim is to establish a network between three institutions of Sweden and Pakistan, IHCAR, CONTECH International Health Consultants in Lahore, and Fatima Jinnah Medical College, also in Lahore, Pakistan. The latter is a medical school for women. A study will be done to assess the prevalence of sexually transmitted infections (STIs) among female sex workers of Lahore, Pakistan. Respondent Driven Sampling will be adopted to select female sex workers for interview. The study will help to assess the magnitude of sexually transmitted infection as well as to develop a health communication program for female sex workers. The study will serve as a basis for future studies like measuring the antibiotic resistance while using the syndromic management of STIs, assessing the knowledge, attitude and practices of health care providers and policy analysis of STIs. All of this together would result in a major policy dialogue. In the subsequent studies, another institution i.e. Örebro University Hospital, Department of Microbiology will also join the network.

Prof. Stålsby Lundborg’s research group is also engaged in a project titled ”Antibiotics as environment pollutants and resistance in waters in rural India – relation to antibiotic management”. It is carried out in collaboration with R.D. Gardi Medical College in India. The project was given SEK 1 425 000 as a three-years project grant (2007–09) from the the Swedish Research Council in November 2006. The project also received SEK 600 000 as an additional three-years grant as Swedish Research Links Programme in October 2006.
It deals with the fact that antibiotic resistance is an emerging global public health threat. Morbidity and mortality are substantial especially for poor women and children. Little research has been done in relation to the public health problem of antibiotics in waters and its implications for resistance. The overall purpose is to assess environmental aspects and public health consequences of antibiotic management in rural India. Long-term aim is to disseminate findings in collaboration with policymakers to improve antibiotic use and antibiotic waste management in order to contain resistance and maintain the possibility to treat infections in need of antibiotics. More information about the project.

On 21 October 2009, Prof. Stålsby Lundborg received SEK 2 250 000 as a three-years project grant (2010–10) from the Swedish Research Council, for a continuation of the above-mentioned project on antibiotics resistance. The project is now called ”Antibiotic pollutants in waters and resistance in rural India – Interventions to improve antibiotic resistance management”. More information.
In October 2010, she was then awarded a major grant from Sida/SAREC’s Developing Country Research Council, this time SEK 2.7 m for a comparative research project over three years (2011-13). The project is entitled ”Antibiotic resistance a global challenge – contextualized interventions to improve infection control and antibiotic management in Vietnam and India”. More information.

• Mohsin Saeed Khan from Islamabad defended his doctoral dissertation entitled ”Poverty of Opportunity for Women Selling Sex in Lahore, Pakistan: Knowledge, Experiences and Magnitude of HIV and STIs” on Wednesday 15 June 2011. The faculty opponent was Prof. Eric Sandström, KI. The main aim with the thesis is to estimate the magnitude and severity of HIV / STIs among women selling sex along with their health seeking behaviour and the level of preparedness of the health system for management of HIV/STIs. He has been supervised by Cecilia Stålsby Lundborg.
Mr. Khan has 17 years of public health experience working for Government of Pakistan and multilateral, bilateral and international NGOs including World Bank, UNFPA, UNHCR, UNICEF, CIDA, DFID, GTZ, EC, British Council and National AIDS Control Program as a Health Systems Specialist.
Venue: Rockefeller, KI, Nobels väg 11, Solna.
More information, with link to full-text thesis.

Results from the studies were presented with a poster presentation at the conference on current Swedish development research, organised in Uppsala 27–29 May 2008. The conference, “Meeting Global Challenges in Research Cooperation”, was organised on behalf of the Swedish International Development Cooperation Agency (Sida) by the Centre for Sustainable Development in Uppsala.

During 2009, Mr. Saeed Khan was a member of SASNET’s South Asian Reference Group. More information.
As such, he participated in the SASNET funded conference on ”Women and Migration in South Asia – Health and Social Consequences”, held in Colombo, Sri Lanka in February 2009. More information.
On Tuesday 24 November 2009, while being in Sweden working on his doctoral thesis, Mr. Khan visited the SASNET root node office in Lund, along with another member in the South Asian Reference Group, Prof. Kumudu Wijewardena. The purpose was to have informal discussions with Anna Lindberg and Lars Eklund about the future direction of SASNET from 2010. More information.

• Dr. Farzeen Tanwir defended her doctoral dissertation, entitled ”Absence of toothache syndrome. Oral health and Treatment needs among urban Pakistanis”, at KI’s Department of Periodontology, Institute of Odontology in 2008. Her post doc research at IHCAR focuses on pattern of antibiotic prescribing for oral care. Further, she also analyses the perceptions and treatment seeking behavior regarding management of oral diseases in a poor area and investigate antibiotic prescribing practices of dentists. Dr. Tanwir is also Director of Post graduate Studies and Research, and Assistant Professor at the In-charge Department of Periodontology, Ziauddin University, Karachi, Pakistan.

• Dr. Megha Sharma is another post-doc researcher within the research group on Medicines and health system with focus on antibiotics. She has done Masters and PhD in Drugs and Pharmaceutical Chemistry from India. Megha is working on antibiotic use in hospitals. She is the research coordinator of a project ”Antibiotic pollutants in waters and resistance in rural India - implications of in- and outpatient antibiotic management”. Besides, she is working in R.D. Gardi Medical College, Ujjain, India as Pharmaceutical Chemist.

• Dr. Vishal Diwan (photo) is working on drugs in environment focusing antibiotics and antibiotic resistance in hospital associated waters. Vishal has masters and PhD in Limnology and Masters in International Health. For his PhD he worked on constructed wetland for wastewater treatment in India. He is Assistant Professor of Public Health & Environment in R.D. Gardi Medical College, Ujjain India. His other interests are hand hygiene, sanitation, waste management, Health Information Management System and GIS.

• PhD candidate Ashish Pathak is Assistant Professor in Department of Pediatrics at RD Gardi Medical College Ujjain, India where he teaches and serves as member of various scientific committees. Ashish has done his Diploma in Pediatrics from Mumbai University and Diplomate of National Board (Pediatrics). His topic of research isAntibiotic use and bacterial resistance, diagnosis prescribing and antimicrobial susceptibility surveillance-studies in rural Madhya Pradesh, India.

• PhD candidate Krushna Chandra Sahoo (photo) has done masters in Zoology from Utkal University, India and Masters in Environmental Sciences from Halmstad University, Sweden. His PhD research is on Association between environmental factors and antibacterial agent resistance in Orissa, India.

A number of Visiting Researchers from India have been working at IHCAR recently, some of them within the framework of the Erasmus Mundus External Cooperation Window Lot 13 mobility programme, in which Karolinska Institutet is a member. They include:
– Dr. A.J. Tamhankar, who has also been supervisor for post-doc and PhD students at KI. He is the national coordinator of the Indian Initiative for Management of Antibiotic resistance (IIMAR), visiting professor of Environmental Medicine at R.D. Gardi Medical College, Ujjain India and professor emeritus at Acharya and Marathe College, Mumbai, India. He was previously head PSIT, BioMedical Group, Bhabha Atomic Research Centre, Mumbai, India. His research interest include the association between environmental factors and antibiotic resistance, antibiotic use in hospitals, antibiotic residues and resistant bacteria in aquatic environments with an emphasis of developing interventions and the impact of non-human use of antibiotics on resistance.
– Dr. Harshad P. Thakur, Associate Professor and Chairperson, Centre for Health Policy, Planning & Management, School of Health Systems Studies, Tata Institute of Social Sciences (TISS), Mumbai. He is also an MPH Programme Coordinator.
– PhD candidate Jennifer Kipgen from School of Social Work, Tata Institute of Social Sciences in Mumbai, India. Her PhD research focuses on ”Utilization pattern of health services by widows living with HIV/AIDS: A study in Manipur”. She has also worked as an HIV/AIDS Coordinator at World Vision India, Pune.
– Dr. Sujith J Chandy, Professor of Clinical Pharmacology and Head, Pharmacy at the Christian Medical College, Vellore, India. He is also visiting faculty at Oman Medical College, Sohar. Besides teaching undergraduate and postgraduate students in Pharmacology, he has been actively involved in research in the area of medicine use with a focus on antibiotic use. He has collaborated with INCLEN and WHO on projects looking at community use of antibiotics and surveillance systems for antibiotic use. He is on a number of committees in the areas of Antimicrobial Policy, Hospital Infection Control and Drugs & Therapeutic Committee. He is now looking forward to collaborating with the Division of Global Health, KI in the area of antibiotic use and is a prospective PhD candidate.

Research Group on Epidemiology and Health systems research focusing on equity and gender

This multi disciplinary research group aims at contributing to improved health in low and middle income societies through research and research training. The group focuses on TB, HIV/AIDS, health financing and insurance systems, public/private mix in health care, training of health personnel, maternal health, childhood studies and human rights. The group has competence in caring sciences, medicine, epidemiology, bio-statistics and health economics. The group is a scientific partner to socio-economic and demographic surveillance sites: FilaBavi in northern Vietnam and Palwa Field Laboratory in Central India. Several research and research training projects are on-going in these sites. The group has collaborative projects in India, Vietnam, China, South Africa and Zambia. More information about the research group.

Professor Vinod Diwan (photo to the right) defended his doctoral thesis on ”Epidemiology in Context. Effectiveness of Health Care Interventions” at IHCAR in 1992, has also worked at the Nordic School of Public Health, NHV, in Göteborg, and he chairs KIRT, Karolinska Institutet Research and Training Committee.
Prof. Diwan leads the research group, that involves research on Gender and Tuberculosis, identifying gender inequalities in India, Pakistan, Bangladesh and Nepal. Part of the research has been located to the city of Ujjain in Madhya Pradesh state, India, where studies of a rural district, with a population of 60.000, has been carried out in collaboration with the RD Gardi Medical College. The project has included a socio-demographic surveillance system, where two persons from each village has been trained to collect data on births, deaths, migration and pregnancies. A 500 bed hospital serves as the teaching hospital.

Professor Diwan is involved in five large research projects, partly India related, funded by the European Commission. One project deals with IT and Access to Health services and has been given a research grant of SEK 150 m. It deals not only with India, but also China, Vietnam, Uganda, South Africa and a couple of other countries.

Another EC project deals with Distance Education and has been given a grabnt of SEK 40 m, dealing with 11 countries.

In November 2005 Prof. Diwan received SEK 600 000 as a three-years (2006-08) Swedish Research Links grant for a project titled ” Equity and gender in tubercolosis control in high burden countries – from research to policy”. The Asian partner in the project is Biao Xu. More information on the Swedish Research Links grants 2005.

Prof. Diwan is also engaged in a project titled ” Information technology in Health: A geographic health management information system in Madhya Pradesh, India”. The project is carried out in collaboration with Ram Mohan Singh, National Center for Human Settlements and Environment in India. The project was given SEK 600 000 as a one-year grant from the the Swedish Research Links Programme in October 2006. It deals with the use of information technology for better health management in the central Indian province Madhya Pradesh. More information about the project.

In August 2007, Prof. Diwan received a SASNET planning grant for a new research project on ”Improving maternal health outcomes in Madhya Pradesh, India – bridging the gap between research and practice.” See the full list of SASNET planning grants 2007.
The projects aims at developing the already established collaboration between the RD Gardi Medical College in Ujjain, Madhya Pradesh, and IHCAR at Karolinska Institutet, to study maternal mortality and morbidity from the perspective that these women’s deaths and suffering could to a large extent be prevented.
The other collaborating partners on the Swedish side in the project were Grethe Fochsen (more information below) and Ms. Linda Rydberg, currently working for the Women and Gender Equity Knowledge Network, which is part of the WHO’s Commission for Social Determinants of Health. Ms. Rydberg planned to start her PhD studies in Madhya Pradesh in 2008, and her role in the project is to contribute with the social and political sciences perspective. She was also supposed to coordinate the planning of a workshop to be held in the beginning of 2008.
The collaboration partners on the Indian side are Prof. V.K. Mahadik, medical director of the RD Gardi Medical College; and Dr. Kirti Deshpande, Assistant Professor in Community Medicine, RD Gardi Medical College.

In November 2007, Prof. Diwan was given SEK 1.5 million as a three-years grant (2008-10) from Sida's Developing Country Research Council (U-landsforskningsrådet), for this same project, now titled ”The Know-Do gap: a case study of the implementation of reproductive and child health policies in Madhya Pradesh, India”. More information about the Sida grants 2007.
In November 2008, Prof. Diwan was given SEK 400 000 as a one-year grant (2009) from Sida's Developing Country Research Council (U-landsforskningsrådet), for a project titled ”A randomized controlled trial: Improving adherence to Anti Retroviral Treatment in South India”. More information about the Sida grants 2008.

• Dr. Grethe Fochsen is a researcher who was associated to the Research Group on Epidemiology and Health systems research focusing on equity and gender. Before that she worked on a research project at Department of Nursing regarding health care personnel's work environment. Her research concerns tuberculosis control from a gender perspective in rural India.
On Friday 14 December 2007, she defended her PhD thesis titled ”Encounters with power: health care seeking and medical encounters in tuberculosis care: experiences from Ujjain District, India”. In the thesis, Grethe Fochsen examines health care seeking and medical encounters in the context of TB care in a rural district in Madhya Pradesh. More specifically, the study focuses on how relations of power between health care providers and patients are created, altered and maintained during medical encounters in a diversified health system. More information.
Dr. Fochsen now works at The National Board of Health and Welfare (Socialstyrelsen), a government agency in Sweden under the Ministry of Health and Social Affairs.

• Ayesha de Costa (photo to the right) is an MD who has trained and worked in India. She has worked as a resident at the All India Institute of Medical Sciences and with the Danish International Development Assisstance (basic health services programme) in Madhya Pradesh, India.She has worked with drug policy and geographic information systems for health in Central India. Her interests include health systems, access to essential medicines and ethics. Her research project focuses on the private health sector in India.
Ayesha defended her doctoral dissertation entitled ”Barriers of mistrust : Public and private health care providers in Madhya Pradesh, India” on 17 September 2008. The thesis highlights the heterogeneity and dominance of the private health sector, and the distribution of different provider groups in rural and urban areas/districts. Rather than an absolute shortage of manpower, maldistribution seems a problem here. Access to women providers is low, important in a setting where women would prefer seeing women providers. The possibility that scheduled castes might have lower access to health care providers than the rest of the population is presented, a finding with important political implications. The barriers to trust between the public and private health sectors in the setting are complex. Addressing these as a step to making real collaboration possible, calls for deeper more structural changes in the working of the health system, including a redressal of the regressive fee-for-service payment mechanism. The government must consider some form of health insurance for more vulnerable groups of people. More information, with link to full-text thesis.

• Fazlul Karim from the Research and Evaluation Division (RED) at BRAC in Dhaka, Bangladesh, defended his doctoral dissertation entitled ”Gender matters: Understanding of access barriers to community-based tuberculosis care in Bangladesh” at IHCAR on 17 April 2009. The thesis concludes that sex differences exist at different clinical steps for TB control. Women compared with men, encountered longer delays at various clinical stages for TB treatment. The adverse effects of stigma both reflected and worsened gender inequalities. Gender disparities were evident in the patterns of distress, perceived causes, and help seeking behaviours, affecting more women, whilst TB-related financial distress affected more men. The estimated true period prevalence of smear-positive PTB was high in the community, and almost all socio-economic groups were at risk of TB. More information, with link to full-text thesis.

• Syed Farid-ul-Hasnain defended his doctoral dissertation entitled ”Young Adults in Urban Pakistan; Barriers and Challenges for Improving Health Behaviors in the wake of the HIV/AIDS Epidemic” on Thursday 16 September 2010. The faculty opponent was Professor Urban Janlert, Dept. of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University. Read an abstract with a link to the full-text thesis.

Syed Farid-ul-Hasnain (photo) is a medical doctor previously holding a masters degree in Epidemiology from Aga Khan University Pakistan and has ECFMG certification (MD) from USA. He is a faculty in ‘Population and Reproductive Health' Program at the Department of Community Health Sciences the Aga Khan University, with major involvement in undergraduate and graduate teaching. He is also involve in facilitating & directing short courses on ‘Reproductive Health Research' and participating in ongoing research activities pertaining to Reproductive Health program. His main interest is in adolescent reproductive health and gender issues.
The thesis is grounded in the fact that HIV/AIDS is spreading globally more specifically among the younger generation. Pakistani young adults having inadequate knowledge and awareness are vulnerable to the global HIV/AIDS epidemic. Both young men and women are well motivated to acquire good education and employment; and seem to belief in gender equality. Transition to better education and gender equality will result in new health related challenges, which emphasize that these young people should be equipped with proper knowledge about STDs and health related behaviors. Religious and cultural barriers to discuss reproductive health issues further deteriorate the situation. Nevertheless, as the prevalence of HIV/AIDS is still comparatively low, the epidemic has not yet enforced a general discussion on the importance of a well-informed younger generation.
Dr. Syed did his PhD research under supervision by Professor Gunilla Krantz, Dept. of Community Medicine and Public Health, the Sahlgrenska Academy, University of Gothenburg.

• Tazeen Saeed Ali is another PhD candidate at IHCAR. She started this programme in October 2007. She has completed an MSc Epidemiology, has a Masters of Science in Epidemiology and Bachelors of Science in Nursing from Aga Khan University as well as a Diploma in Nursing from Aga Khan University, and Midwifery training, from Aga Khan Jan Bhai Maternity Homes, Karachi. Tazeen is an Assistant Professor at Aga Khan University School of Nursing (AKU-SON) and Department of Community Health Sciences (CHS). She is primarily an educator and researcher, and she has qualifications in nursing, midwifery and Epidemiology. More information.
Her doctoral research project is entitled ”Violence against women in the family – a normal part of Pakistani women’s lives or a serious transgression of women’s human rights?”. Tazeen is also supervised by Professor Gunilla Krantz in Gothenburg, and is expected to defend her thesis in the end of 2011.

Research Group on Health Systems and Policy research

The multidisciplinary research group “Health Systems and Policy” (HSP) at IHCAR deals with individuals’ perceptions of health and health care, health seeking behaviour and at the macro level policymaking and how the system meets needs and demands of consumers of care. Action research with robust evaluations have been core activities in studies in Africa, Asia and Europe often conducted in consortia with other research teams. Method development includes multifaceted interventions in public and private sectors for improved quality of care evaluated in randomised control trials with health facilities as study units. The basis of any health system - the household-is being studied in relation to management of children with fever. Malaria case management is studied including the interface between consumers and providers as well as drugs and resistance. Several projects and courses (senior decision makers, PhD and MPH students) aim at more evidence based health policymaking.
More information on the Health Systems and Policy Research group.

The group is led by Göran Tomson, Professor in International Health System Research (photo to the right). It has an extensive international network especially in Africa and Asia. Swedish collaboration includes the Dept. of Political Science, Lund University and Stockholm School of Economics. European collaborative institutions include Institute of Tropical Medicine Antwerp, Department of Tropical Hygiene and Public Health of University of Heidelberg and London School of Hygiene and Tropical Medicine.

• Dr. Fauziah Rabbani, Associate Professor at the Dept. of Community Health Sciences at AKU (photo to the left) has been a member of the research group. During the period 2005–10, she carried out a sandwich PhD training at IHCAR, supervised by Prof. Tomson. On 24 March 2010, she defended her doctoral dissertation entitled ”Science and practice of balanced scorecard in a hospital in Pakistan: Feasibility, context, design and implementation”. The external examiner was Dr. Zoe Radnor, Associate Professor, Warwick Business School, United Kingdom.
Abstract: Millennium Goals emphasize good governance and health systems research. In Pakistan, hospitals provide the major bulk of both basic and advanced care. Challenges faced by the hospitals in Pakistan include: poor quality of care, weak management structures, inappropriate resource allocation and a lack of timely information system for decision making. Balanced Scorecard (BSC) is a strategic performance management tool that could offer an opportunity to improve performance measurement and management. The main aim of the study was to determine whether BSC application is feasible in the context of a low- income hospital setting, to identify organizational culture, as well as design the scorecard and describe the contextual barriers and strategic processes that hinder or facilitate its implementation. More information, with a link to the full-text thesis.

Dr. Rabbani’s special interest is health systems development and health care administration. She has served as WHO technical advisor and grant recipient of WHO UNISOL, which is a WHO network grant of ‘Universities in Solidarity for the health of the disadvantaged’. She is member of various national and international committees and networks, attended numerous international conferences and has many peer reviewed publications to credit. Together with Prof. Tomson she is trying to evolve a Swedish-South Asian Network on health administration and management training and research. A project to be realised through collaboration between IHCAR, the Medical Management Centre at Karolinska Institutet, and the School of Business at Stockholm University on the Swedish side, and with the departments of Community Health Sciences and Medicine at the Aga Khan University Hospital in Karachi on the South Asian (Pakistani) side.
In August 2005 Prof. Tomson and Dr. Rabbani received a SASNET planning grant for an educational project on ”Networking in research and training for better health administration and management (NHART)”. More information on the August 2005 SASNET grants.
Project abstract: In low income countries research and training in health systems and good governance has been identified as a major challenge in achieving millennium development goals. Medical universities and hospitals are an important but often neglected component of health system. Research and training is needed to develop balanced set of performance measures and in use of information systems to continually and simultaneously assess clinical outcomes, financial performance, patient satisfaction and provide this feedback to all parties. Balanced Scorecard (BSC) is one such performance management tool.
With AKU’s MSc in Health Policy and Management Program a formal networking for health systems development and management research training between Swedish partners and AKU will open new avenues for health administration and policy in South Asia. Moreover AKUH has elaborate computerized information technology and operational systems to improve quality of care for patients but there is a need to integrate these systems from a professional and managerial perspective. Therefore AKUH presents a good study site to test various performance measurement and management models in health care administration.

As part of the educational programme an International three day workshop on ”Health Administration: Strategic Planning and Performance Management” was held at Aga Khan University (AKU) in Karachi, Pakistan, 22–24 November 2006. It was organized by the Department of Community Health Sciences, Dept. of Medicine and Medical Director’s Office at Aga Khan University. The aims of the workshop were; to understand how to develop vision and mission statements, get familiar with methods for conducting organizational assessment and stakeholder analysis, learn to develop outlines of a strategic plan, appreciate some experiences of strategic planning in health care organizations through case studies and be informed about use and application of Balanced Scorecard as a strategic performance management tool in health care organizations. Participants came not only from Pakistan but also from Afghanistan and East Africa (on the photo above). Read a full report from the workshop (as a pdf-file)

PhD candidate Meena Daivadanam has a bachelors degree in Medicine and a bachelors degree in Surgery from Christian Medical College, Vellore and a Masters degree in Public Health from Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India. She is currently doing her PhD, sandwich-model between SCTIMST and division of global Health (IHCAR) under the Erasmus Mundus scholarship program. Her research topic is Community-based Intervention to change dietary behaviour for prevention of chronic NCDs in rural Kerala. She will most probably defend her dissertation in 2013.
The project aims to translate currently available scientific knowledge related to diet as a risk factor for chronic NCDs into a practical and sustainable intervention that is socially and culturally acceptable to the local population. She has mainly worked in the area of non-communicable disease epidemiology particularly risk factor surveillance, training of lay community volunteers for surveillance and estimation of catastrophic health expenditures and its consequences for households in relation to acute coronary syndrome.
She was also selected as an Emerging Voice from the Global South for 2010 through an essay competition organized by the Institute of Tropical Medicine, Antwerp, Belgium.

Research Group on Injuries' Social Aetiology and Consequences (ISAC)

The ISAC group is concerned with the mechanisms underlying the social patterning of injuries between groups and geographic areas and also with the short and long term consequences of injury events. Emphasis is placed on injuries among the young and the elderly. Both intentional and unintentional injuries, in particular in the traffic environment, are considered. More information about the ISAC Research Group

• PhD Candidate Samina Mohsin Khan is working on a doctoral project entitled ”Pakistan - Disability and support mechanisms among older citizens. Studies among non-injured and injured in Islamabad”. The main aim of the research is to document the needs and living circumstances of older Pakistani men and women, in particular those who are disabled or suffer from injury. The study will be conducted in the tertiary hospital in Islamabad the capital city of Pakistan among the patients 60 years and above coming to hospital. Both quantitative and qualitative research methods will be employed. The former will measure the nature and levels of disability among both non-injured patients (cross-sectional assessment) and injured patients (longitudinal assessments) and will relate this to family support mechanisms available and health related quality of life. More information.

Research Group on Sexual and Reproductive Health and Rights

The group is led by Staffan Bergström, Specialist in Ob/Gyn, PhD, Professor of International Health (Chair). It gives priority to research related to maternal mortality and severe morbidity. Several projects are ongoing in HIV/AIDS related areas with focus on obstetric infections, postpartum haemorrhage and outcome for orphans after maternal death. Female genital mutilation and infertility belong to other areas of priority research.
The researchers have benn involved in a long-standing collaboration with the Christian Medical College and Hospital, Vellore, India, regarding studies on antenatal prediction of low birth weight and some factors that detarmine birthweight. A numvber of PhD sndwich programmes evolved from this collaboration.

• Dr Matthews Mathai, present chair of the Obstetrics and Gynaecology Unit in Vellore, defended his doctoral thesis at KI in 1999. It was entitled “Fetal growth in India: studies on antenatal prediction of low birthweight and some factors that determine birthweight” – see abstract.
Later Dr. Mathai has been involved in a collaborative study with IHCAR on Preganacy Related Morbidity and Mortality.

• Dr Elisabeth Matthai was involved in another sandwich PhD training at IHCAR on Pregancy related morbidity, supervised by Prof. Bergström. She defended her doctoral thesis, entitled ”Genital and Urinary Tract Infections in Pregnancy in Southern India. Diagnosis, managhement and impact on perinatal outcome” at KI on 15 December 2004. Read the abstract.

• Saima Hamid works as Assistant Professor at Health Services Academy (HSA), Islamabad, Pakistan. She defended her doctoral dissertation entitled ”Becoming a Woman in Silence: Studies on preparedness for reproductive life of young women in Pakistan” at IHCAR on 8 December 2010. The study explores the preparedness of young women for married life (communicating with spouse, initiation of sexual activity and child bearing) and ability to negotiate in marriage with spouse on number of children to have and on contraceptive use. In a culture of silence around sexuality, young women’s socialisation into submissiveness lays the foundation for the lack of control over their future reproductive health (I and II). The parents realised, though, that bringing up daughters for marriage requires not only obedience, but also building confidence and knowledge during their childhood (III). Women who had decision making freedom in their parental home carried this ability with them into marriage in their new home and were better able to negotiate about their fertility (IV). Knowledge about reproductive life could prepare young women better for the future life and give them more control of their fertility. Innovative interventions targeting women need to challenge current societal norms of womanhood to promote the upbringing of confident and knowledgeable young women.
The faculty opponent was Associate Professor Pia Olsson, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University. More information, including link to full-text thesis.

Research Group on Sexual and Reproductive Health with focus on Youth

All projects in this group are carried out in low-and middle-income countries. Several projects focus on issues related to young people and sexual and reproductive health, such as young people's health seeking behaviour, coping strategies and quality of care for pregnant adolescents, the role of the nurse/midwife in meeting young people's needs, sexually transmitted infections (STI) including HIV/AIDS prevention, the needs and role of young men/fathers, emergency contraception and other contraceptive methods, and sexual education in schools. More information about the Research Group

• Professor Emeritus Bengt Höjer, Head of IHCAR during the period 1995-2001, developed a research collaboration with the Thiruvananthapuram Medical College (TMC), and the Mangalapuram Primary Health Centre, both in Kerala, India. The collaboration partner on the Indian side was Dr K.T. Shenoy. The objective was to quantify the determinants for public health care seeking among pregnant women. It was designed to be a population based cross sectional and prospective study, involving a rural community with six health centres of six panchayats. The study included 1 345 pregant women at 24 weeks gestation.
Besides, Prof. Höjer has been the leader of a number of major research undertakings like ”Interdisciplinary research for HIV/AIDS prevention in southern Africa” (Zambia and Kenya) and ”Health systems research for development in Vietnam”.

South Asia related educational courses:

Erasmus Mundus External Cooperation Window Programme scholarship programme

A large number of Indian students, PhD candidates, post-docs and academic staff has come to Karolinska Institutet during the academic year 2009-10, as scholarship holders through the Erasmus Mundus External Cooperation Window mobility programme Lot 15, coordinated by Lund University. This programme was announced in 2008, and out of a total mobility of 320 persons, 20 Indian students, researchers and academic staff were selected to come specially to Karolinska Institutet. Out of them, 5 are Masters students, 7 PhD candidates, 4 post-docs, and 3 academic staff. Another five people have gone from Karolinska Institutet to Indian universities, out of them 2 Masters students and 3 academic staff. More information about the EMECW programme lot 15 (from 2009 renamed to be one out of four programmes under the mobility lot 13). Prof. Cecilia Stålsby Lundborg is the local coordinator fro the programme at Karolinska Institutet.

Global Health courses and other programmes with relevance to South Asia

A 7.5 ECTS credits course in Global Health is arranged every semester for three weeks at KI, and then two weeks abroad – in East Africa, Cuba, Iran, India or Pakistan. The course is run in collaboration between IHCAR, the Dept. of Public Health Sciences, and the Department of Nursing at Karolinska Institutet. It is open to students at Karolinska Institutet in the Medical programme, Midwifery programme, Nursing programme, Dental programme, Biomedical laboratory programme, Physiotherapy programme, Occupational therapy programme, and the Biomedical programme. In South Asia, the students can choose to do the field work at Karolinska’s two main collaboration partner institutions: The Aga Khan University in Karachi, Pakistan; and Trivandrum Medical College (TMC) in Thiruvananthapuram, India. More information on the Global Health course.
Course coordinator: Dr. Birgitta Rubensson, phone: +46 (0)8 524 833 89.
The courses in Global Health has been running twice a year since 1996. The initiative originally came from Prof. Hans Rosling, at that time working at the Unit for International Child Health, Uppsala University but soon after changing over to the Division of International health (IHCAR), Department of Public Health Sciences at KI. Earlier, during the 1990s, Prof. Shenoy worked together with Prof. Hans Rosling in a project on Cassava Toxicity, funded by WHO and Sida/SAREC. The Global Health course was a side effect of their collaboration. More information on Prof. Rosling below.
As former Head of IHCAR, Prof. Bengt Höjer was also instrumental in realising the collaboration programme.
More than 500 medical students from KI have received training in Global Health only at TMC. The students coming to Kerala mostly has had a background in Medicine, Dentistry and Biomedicine, and they stay for two weeks. Prof. K.T. Shenoy, Dean, Faculty of Medicine, University of Kerala, has been the person in charge of the collaboration from the start on the Indian side. Read a SASNET report from TMC, November 2007.

Prof. Vinod Diwan at IHCAR organises Sida funded courses in Global Medicine for Junior Hospital Doctors (ST-läkare) on behalf of the Center for Public Health, CeFAM (a collaboration between Karolinska Institutet and the county council of Stockholm). The courses has dealt with diseases like malaria, TB and AIDS, and take place either in Ethiopia or in India (four months at R.D.Gardi Medical College, in Ujjain, Madhya Pradesh. More information on the training in Ujjain (in Swedish only)

Torkel Falkenberg is Professor of Pharmacology at the Center for Studies of Complementary Medicine (CAM).
Prof. Falkenberg is Head of the Research Group on ”Drug Utilisation and Complementary & Alternative Medicine”.
The Center is involved in research, development and education related to traditional medicine (TM), complementary and alternative medicine (CAM) and integrative medicine. Staff members at the center collaborate with a wide range of professions including professionals from conventional medicine and TM/CAM, health care planners and decision makers nationally and internationally. The mission is to promote the development of evidence based health care systems in which appropriate conventional medicine practices and TM/CAM practices are integrated on equal terms. Such integrative health care programes are sensitive to the patients' freedom of choice and safety and acknowledges health and wellness of the whole person including biological, psychological, social and spiritual aspects, when relevant. More information on the International research.

European Master of Science International Health Degree Programme

IHCAR is one of eight European institutions awarding degrees in a new European Master of Science International Health Degree Programme. The programme is part of tropEd, a network of European institutions for higher education, in existence since 1996 and collaborating closely with institutions in Asia, Africa, and the Americas in providing postgraduate education and training opportunities.
The European Master of Science Programme in International Health is a one year, full-time study programme taught in English. The main objective of the programme is to raise awareness of current global health concerns. Students become qualified to identify and critically analyse key factors shaping the health and well-being of populations in low- and middle-income countries and to formulate effective and appropriate responses to complex health-related issues. Six possible study tracks are offered for this degree and reflect the strengths of the consortium institutions: Tropical Medicine and Disease Control; Health Systems, Health Policy and Management; Sexual and Reproductive Health; Child Health; Health Research Methods; and Health in Emergencies.
Each study track begins with a 3 month core course from September to December. Core courses provide a common basis of the main subject areas for all students. Students receive 20 European Credit Transfer System (ECTS) credit points upon successful completion of their core course. More information on the European Master of Science International Health Degree Programme.
Contact person: Anna-Lena Paulsson

Linnaeus palme International Exchange programmes

An exchange programme was introduced in the year 2000–01, through the Linnaeus-Palme Foundation International Students and Teachers Exchange Program, between Karolinska Institutet Medical University; Aga Khan University (AKU), Karachi, Pakistan (AKU); and Thiruvananthapuram Medical College (TMC), Kerala, India.
The programmes includes both undergraduates and teachers in the medical field, as well as students and teachers in the field of nursing and midwifery. Official exchange programs has been established for the Study programme in Medicine ("Läkarprogrammet") and Nursing ("Sjuksköterskeprogrammet") in Pakistan and in India for the study programmes in Medicine and in Midwifery, ("Barnmorskeprogrammet"). Exchange regularly takes place, even in times of political turmoil in the region.
The collaboration between KI and TMC was further stabilised after a meeting between representatives of KI and the Chief Minister of Kerala was held in November 2004. It was then proposed that KI doctors should be sent for clinical courses/workshops and carry out the clinical part of KI’s postgraduate courses in TMC. A new International Office in TMC coordinates these activities as a single window clearance system.
Coordinator for the undergraduate medical students and teachers: Professor Bo Lindblad (concerning Pakistan) and Associate Professor Sanjeevi Carani at the Center for Molecular Medicine (concerning India).
Coordinator for the undergraduate Midwifery students and teachers with India: Anna Hjelmstedt
Coordinator for the undergraduate Nursing students and teachers: Helen Conte
Information about the Linnaeus Palme grants 2009, given by Swedish International Programme Office for Education and Training (Internationella programkontoret).

Gapminder

Hans Rosling, Professor of International Health at IHCAR, is one of the strongest personalities at IHCAR. He has 20 years of worldwide experience on global health concerning the character of the links between economy and health in Africa, Asia and Latin America. Furthermore, he has been advisor to WHO and UNICEF, co-funded Médecines sans Frontiers Sweden and has started new courses an published a textbook on Global Health.
Prof. Rosling was the driving force behind the creation of Gapminder, originally a non-profit venture based at Malmö that launched an animated computer programme using the so-called Trendalyzer software. – turning time series of development statistics into attractive moving graphics. A first project was the creation of a World Health Development Chart – in collaboration with WHO – showing the relation between the rates of child survival and GDP per capita during the last 50 years in all the countries of the World. Since 2003, Gapminder – now a registered foundation based in Stockholm – has developed through a collaboration with United Nations Division of Statistic and the UNDP, visualizing the fulfillment of the millennium development goals in the yearly Human Development Reports directly on the Internet. Since 2001, funding for the project has been given by Sida.
On 16 March 2007, Google acquired Gapminder’s Trendalyzer. Google intends to improve and scale up Trendalyzer, and make it freely available to those who seek access to statistics. The Stockholm-based Gapminder Foundation on the other hand will continue to spearhead the use of new technology for data animations. The goal is to promote a fact-based worldview by bringing statistical story-telling to new levels. In collaboration with producers of accurate statistics that are eager to give the public free access to databases, Gapminder hopes to recruit and inspire many users of public statistics. More information about Gapminder.

Today, Prof. Hans Rosling travels the world, virtually and in real life, to share insights about major global trends, and he confronts our prejudices about the world – as he himself has done with his own prejudices. Watch a 55-minute documentary on Prof. Rosling (with subtitles in English)

In April 2010, Gapminder Desktop was released. This is the tool Hans Rosling uses to present global trends.
In a new video, Hans shows how you can use the tool from your own laptop and he gives 5 tips for a successful bubble-graph presentation. Go for the presentation.
– Watch the 3-minute how-to video and
– Download Gapminder Desktop

In a new TED video, Hans Rosling explains why ending poverty – over the coming decades – is crucial to stop population growth. Watch the TEDTalk

SASNET conference on The role of South Asia in the internationalisation of higher education in Sweden

In November 2006, Karolinska Institutet hosted a workshop on ”The role of South Asia in the internationalisation of higher education in Sweden” in collaboration with SASNET and the Swedish Institute. Prof. Bo Lindblad at IHCAR (also a member of SASNET’s board) was one of the main organisers of the workshop, that took place at Nobel Forum 28-29 November.
Full information about the workshop.

It was inaugurated by Professor Harriet Wallberg-Henriksson (photo to the right), President of Karolinska Institutet, and after that Associate Professor Elias Arnér (photo to the left), Dean of Post graduate education, gave a introductory presentattion about KI’s International activities. Read Dr. Arnér’s presentation at the workshop
(as a pdf-file)

Professor Cecilia Stålsby Lundborg and PhD Candidate Mohsin Saeed Khan gave a presentation about Karolinska Institutet’s experiences from the PhD sandwich programme with Pakistan, in the session titled ”Recruitment of South Asian students in hard sciences in Sweden”. Read Dr. Stålsby Lundborg’s presentation at the workshop (as a pdf-file)
Cecilia Stålsby Lundborg was also an invited speaker in the final panel discussion titled ”Best strategies for marketing Higher Swedish Education in South Asia, and for sending students to Higher Education in South Asia?”

Partner driven Swedish-Asian collaboration project on Evidence for policy and implementation

In July 2010, the Swedish International Development Cooperation Agency (Sida), through its program for Partner Driven Cooperation (Aktörssamverkan), announced a call for applications for grants to collaborative projects related to access to and use of research for the period 2010 – 2012. This program is not support to research but rather assisting partners in assessing and using research in policy formulation and innovation. Sida’s initiative for Partner Driven Cooperation is aiming to support sustainable cooperation relationships, and concerns only a few selected countries, namely China, India, Indonesia, Vietnam, South Africa, Botswana and Namibia. More information.
In December 2010, decisions were made. A total number of 32 projects were selected, out of which nine refers to Indo-Swedish collaboration projects. Information about all India related projects given grants.

Professor Vinod Diwan at Karolinska Institutet is the main applicant for one of these Asia related grants. He and his colleagues behind the application are given SEK 12 m for three years (2010-12) for a project entitled ”Evidence for policy and implementation – intensifying efforts to achieve health related MDGs in four Asian countries with developing economies (EPI-4) India, China, Vietnam, Indonesia”. At Karolinska Institutet, Dr. Rolf Wahlström from IHCAR’s research group on Health Systems and Policy Research, and Dr. Sarah Thomsen from IHCAR’s research group on Sexual and Reproductive Health with focus on Youth, are involved in the project implementation. Sarah is the Scientific Coordinator for EPI-4.

In Sweden, four universities participate in the project. Besides Karolinska Institutet, Gothenburg University, Umeå University and Uppsala University are partners.
In India, the partner institution is the Public Health Foundation in Ahmedabad, in the state of Gujarat. The EPI-4 India team will be led by Professor Dileep Mavalankar and include three Swedish senior researchers from participating universities. They will convene a small network (10-15 persons) of key policymakers, stakeholders and academicians to discuss emerging data on maternal health (MDG 5) and malaria and tuberculosis (MDG 6) in relation to disadvantaged populations and to make proposals for interventions to be prioritized by the Ministry of Health in their annual workplans. The data will be generated by analyses of existing national health surveys and from systematic reviews of the literature concerning disadvantaged populations and health.
The EPI-4 India network will produce policy briefs and other publications in an effort to assist the Government of Gujarat in applying evidence-based policy to improve the health of all its citizens. The project is currently funded for 2011 and 2012.

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Last updated 2011-08-31

SWEDISH SOUTH ASIAN STUDIES NETWORK

Other departments/units at Karolinska Institutet Medical University

Division of Global health (IHCAR), Karolinska Institutet Medical University, Stockholm:

The history of 60 years of KI research collaboration with Pakistan and India

Bo Lindblad report on collaboration between KI and Aga Khan University