- Gizachew Balew (학생연구원)
- 날짜2018-07-02 13:39:51
[Gizachew Balew (학생연구원)]
Please give us a brief introduction of yourself.
Please give us a brief introduction of an institution you are involved in.
Currently, I am working in a sexual and reproductive health organization, EngenderHealth Inc. as director of a project. This project is implemented by a consortium of four organizations, namely EngenderHealth ( the one I am working for and specialized in technical capacity building to the public health institutions), Philips Health Africa (providing innovative medical technologies), Amref Health Africa (leading the community based interventions), and Triggerise (providing a mobile based rewarding platform and strengthening the referral network).
Why did you choose to study public health policy?
In Ethiopia, most students join public universities once they pass a national school leaving exam. I can see changes through time, but while I was joining my undergraduate university, I didn’t have the opportunity to choose our university, we were assigned through a lottery method. Similarly, the way I joined public health was more of a chance than an interest. However, once I joined my studies, I really enjoyed it and was motivated to further pursue on it. As I have tried to mention it in my experience, I was trained in public health and continued applying public health in the rural part of Ethiopia. When I was working in a health center, I used to serve too much patients in a health facility and experienced many challenges in expanding health promotion and disease prevention interventions in the community. This made me decide to join the academic environment and better contribute to the community through training and deployment of health experts, which still has challenges in quality of training. Overall, most of the issues that I encountered require to be addressed through creating a better health care management structure and evidence based decisions. I also want to learn other countries experience in bringing to Ethiopia and found further studies in abroad to be an option to advance my academic and professional experience in public health policy. By now, I feel that I have met my professional skills and it is time to apply it and contribute for a better health system in my country and beyond.
Why did you choose to study in Korea? And Why Seoul National University?
This is an interesting question that everyone whom I meet used to ask me. I have two important reasons to study in Korea. First, I have been working with KOICA volunteers in a Korea International Cooperation Agency (KOICA) supported project in Ethiopia. Throughout our stay for one year in the organization I used to work, I have got the opportunity to know more about Korea. Indeed for my decision to study in Korea, knowing about Korea was not only enough to decide my studies. There was one very important issue that I was considering while applying. Second, most Ethiopians used to apply to European countries, US and Canada for their study program, and very limited applicants to Asian countries. However, the current business interaction with Ethiopia shows a growing interaction with the Asian community; Japan, Korea, China and India to mention some. I was expecting that this might be very important to bring new insights to the Ethiopian public health and these two reasons were very important for me to decide my studies in Korea. At this point, I would like to acknowledge my Korean friends who have helped me in my application and my professor to provide me such opportunity to study in Seoul National University.
Please tell us about project or program you have participated in the field of public health.
To start from the recent projects which I have participated in Ethiopia; social and behavioral change intervention for fertility reduction, introducing blended learning program as a continuing health professional development, adolescent sexual reproductive health interventions especially on family planning services and life skill development, and Expansion of access to better reproductive health interventions in pastoralist communities were some of those. The first two were national projects while the last two are a regional projects.
What kind of challenge or difficulties have you encountered? (while implementing project or program)
Most of the projects that I have involved are jointly implemented by the Ministry of Health and international non-governmental organizations. The first issues that arises while implementing projects supported by international aid organizations are alignment of project interventions to government priorities and meeting donor requirements, both of which are very important to ensure accountability and responsibility of aid money. However, it is not also a simple task to address both donor requirements and public interests. Projects are simple and focused in terms of scope of work, geographic coverage and duration of implementation. At the same time, both the donor and the public bodies require outcome and or impact level indicators to be met in a short period of time. However, as most of us are aware, it is not easy to have behavioral change and bring changes in long-term outcome or impact in a community in a short period of time. In some projects, the result might be noticed after a long period of time due to the nature of implementation. At the same time most studies that are conducted to generate baseline and end line data lack methodological strength and the ability to show those changes. Moreover, I have experienced challenges in infrastructure to access the last mile beneficiaries. Due to their mobility, Implementation in pastoralist communities specifically has challenge in road access, access to potable water, lack of qualified health professional and emergency public health problems that affect development interventions, including the health sector. On the other hand, in areas where humanitarian interventions are targeted, it is not uncommon to find management challenges, lack of data for evidence based decision, and poor quality of interventions to the community. Overall, the quality of health care service delivery is not to the standard as expected. Indeed, the low awareness of the community by itself challenges the quality of health care service provision. Despite all the above challenges, in my perspective poor infrastructure and investment on quality data generation takes the biggest share for an evidence based decision and monitoring the outputs of any intervention.
What is the most important factor when implementing such project or program?
Here is where public health becomes more of an art. Whatever professional skill is there, public health interventions require the skill and expertise to mobilize the community and have the buy in from the public sector and the community. Every community has its own structure and culture that they want to keep on. The best clinical or medical evidence might lose attentions if those community figures didn’t address it as their priority concern. Understanding the local culture and its approach through its structure is very vital to meet project or program interventions. At the same time, AID effectiveness principles require alignment of any program intervention to the national agenda and harmonization between donors. Some donors are very committed for program harmonization while others focus on accountability and responsibility to their citizen who funded the program. At the same time some public bodies are reluctant in pushing for the alignment of aid supported projects to their national agenda. However, taking the experience of Ethiopia, we have a very strong aid alignment strategy. This has put strong controlling and monitoring mechanisms in place that require any aid business to pass through the national agenda. Meeting those requirements, donor requirements and internal organizational policy are very challenging for a program implementer. At the same time, as I have tried to mention above, for short period interventions like projects documenting success and showing outcomes is a challenge for implementers and a requirement both from the community and donors.
What is the most necessary health issue in Ethiopia?
The global burden of disease shows that the major causes of burden in Ethiopia are lower respiratory tract infections, neonatal disorders, diarrheal diseases and neglected tropical diseases; most being communicable diseases. However, the country is also experiencing a fast increment in the burden of non-communicable diseases in the last decade. Car accident is also one of the most fatal injuries in Ethiopia, these all making Ethiopia to be in a triple burden: communicable diseases, non-communicable disease and car accident. Ethiopia is also in a fast economic development track since the last couple of years. This has brought challenges in rural urban migration, growing urbanization, growing population, booming construction sector and growing unemployment. It might be very difficult to associate and generalize, but the poor waste management system, growing air pollution and its weak management, poor quality of health care service and education system can be associated to those challenges.
What would you like to do in the future? (related to public health)
My first interest to continue with is to develop my academic potential and I hope I will be an academician in the coming Future. However, I have also a humanitarian interest, which I am currently working on. I would like to participate in local humanitarian interventions that support disadvantaged groups.
Please give an advice for people who are studying or interested in the field of global health.
Global health is both an art and science. Throughout my experience I have learned that despite the academic and scientific competency, it requires very strong negotiation skills, decision making, and personal commitment. I recommend new applicants to consider the need for commitment and team play in addressing public health challenges.