By Dofini Nankoita, Communications Director, ISSP, and APHRC Guest Blogger
Translated from the original French by Lauren Gelfand, Director, Policy Engagement and Communications
One year ago, Dr. Hermann Donfouet joined APHRC as its resident health economist, bringing his skills and considerable experience in cost-effectiveness analysis to support research projects led by the Maternal and Child Wellbeing, Education and Youth Employment units. I recently had an opportunity to speak with him about his work.
Question: You are the only health economist at APHRC ; how does your experience and background help with their research ?
Response: For now, I am the only health economist, and my primary role is to contribute to the econometric methods for impact evaluation. Hence, I bring my expertise on the study design, sample size calculation and the appropriate econometric methods to be used.
I am also involved in assessing cost effectiveness of certain projects: a way to compare the relative costs and outcomes, or effects, of different interventions. More and more we can see that decision-making is informed by how much return on investment is possible from any given project. So my aim is to provide guidance on this.
Q: What research project are you finding the most interesting ?
R: I am currently working on a really interesting project about malnutrition in the northern semi-arid regions of Kenya, Isiolo and Turkana. We are working with community health volunteers to teach them how to screen, and provide treatment for malnutrition. If we can teach these community-based non-professional health workers to spot and respond to malnutrition, in a cost-effective and sustainable manner, is it possible to control malnutrition? Furthermore, we are exploring whether this intervention is cost-effective.
Q: What sort of results have emerged from this project so far? And what are you most proud of thus far?
R: This UNICEF-funded project is in its early stages, so it is premature to talk about results. And since I am only one year in at the Center, that’s where most of my work is. It’s about developing the methodology currently, versus assessing results.
Work that I participated in before coming to the Center, as part of my doctorate, is something I am very proud of – particularly because the results could be used by national and regional policymakers in how they respond to the chronic challenges confronting low-income households.
After five years of research, I demonstrated that low-income households can, and will, contribute to community-based health insurance if they are well-conceived and respond to the particular context of the area where they are being implemented. Health insurance schemes need social capital to be effective in communities, and I used some econometric tools to demonstrate the strong correlation between prepaying for health services and social capital.
I also demonstrated that networks play a critical role in ensuring that community-based health insurance is sustainable. We know that networks, are at the heart of our society. So buy-in at the household level for something new or different is not going to happen unless there is strong network at the community level. Therefore, there is a strong correlation between my decision to buy a new product or adopt a new policy with the decision of a contiguous household.
Q: Even the most rewarding work has its challenges ; describe some of the obstacles you’ve faced specific to research.
R: So there are a lot of challenges, but none of them are insurmountable. Here at APHRC we come from a variety of different backgrounds, with different cultures and traditions – and those manifest themselves in different ways. So managing that, managing how you respond to, or work with, someone who looks at the world in a different way than you do, is really important and sometimes can be tough.
Impact evaluation is also a relatively new field, and requires a significant investment of time and resources – which sometimes is not as forthcoming as we would want. We’re working on building this kind of analysis in our new projects, but it’s not guaranteed as yet.
And for me as one of the only francophones at APHRC, and new to Kenya, I am finding it hard to communicate as well as I would like, particularly in the field. I need to learn how to speak Swahili!
But these are all little challenges; fortunately, none of them are keeping me from pursuing what I am interested in, namely how research can help to improve the quality of life for the poorest and most vulnerable, and collaborating with my colleagues.
Q: What would you do if you weren’t a researcher?
R: If for some extraordinary reason there was no longer any use for economists, I think I would work in the humanitarian assistance sector. I’d contribute to build schools, feed children and well, do anything I could to help ensure the future of all communities.