Dell Saulnier

I am an assistant professor of health systems in crises in the research group Global Disaster Medicine - Health Needs and Response at the Department of Global Public Health, Karolinska Institutet (KI). My research focuses on health systems resilience and systems thinking for health systems in crises.

In addition to my role at KI, I am also affiliated with the Geneva Centre of Humanitarian Studies at the University of Geneve. Between 2022 and 2024 I was a visiting researcher at the Department of Economics at the University of Zambia and I continue to collaborate with colleagues there.

I graduated with a bachelor’s degree in epidemiology from Hampshire College in 2006 and then spent three years working in cystic fibrosis clinical research at Massachusetts General Hospital in Boston, MA, USA. I completed a master’s degree in international health from Uppsala University in 2013 and defended my PhD, titled Towards health systems resilience to extreme weather events: managing health needs during floods in Cambodia, at KI in 2020.

My research can be broadly split into three overlapping themes:

Health systems resilience

My focus within this theme as primarily been on identifying characteristics and behaviours that generate and sustain resilience capacity. This includes looking at decision-making structures, knowledge sharing, trust and interdependence. I am also at the forefront of discussions on the future of the health system resilience research field. On this topic, I collaborate closely with colleagues at the Geneva Centre of Humanitarian Studies at the University of Geneva.

At present my focus is on the role of for-profit and not-for-profit private sector actors in resilience, such as information sharing between sectors, trust and legitimacy, and organisational resilience.

I am also exploring issues of power in resilience and in the outcomes of resilience interventions, as well as identifying the thresholds between the three main resilience capacities for different kinds of crises.

Within health systems resilience I am currently part of two research projects:

• Discerning the role of the private sector in creating health system resilience: A case study in Zambia. Funded by the Swedish Research Council
• Towards Universal Health Coverage in Zambia: How to build a sustainable and resilient health system. Funded by the Swedish Research Council 
• Health systems resilience in managing the COVID-19 pandemic: lessons from regional preparedness plans in Sweden. Funded by Forte. As part of this project, I co-supervise My Fridell in her PhD project.

I also co-supervise three other students working on resilience projects:

• Claudia Truppa at the Università del Piemonte Orientale in her PhD project, that looks at the resilience of an ICRC program in Lebanon. 
• Linda Esso at KI on learning from the Covid pandemic to prepare for future epidemics in low-resource settings
• Maisoon Elbukhari Ibrahim at the University of Geneva on developing indicators to measure health system performance and resilience in fragile and conflict-affected settings

Systems thinking for health systems

Systems thinking for health systems is an approach to help understand the complexity of problems within the health system, by looking at them holistically, viewing them as interconnected, and understanding the relationships and interactions between system stakeholders and parts.

I am currently leading a project that looks at the casual relationship between social health insurance and financial protection, service utilisation and health outcomes, which focuses on Cambodia and is funded by the Swedish Research Council. The project is called: 

• Social health insurance in the Universal Health Coverage era: Does it impact health? 

I am also one of the founders and co-leaders of the European region of the Systems Thinking Accelerator (SYSTAC) network that promotes systems thinking for health systems.

Impact of crises on health service demand and utilisation

Within this theme, I primarily study the effects of floods on demand and utilisation of health services, which was also the topic of my PhD project. Beyond the impact of crises, I am also interested in how health systems can be strengthened to cope with crises.

Within this theme, I am currently co-leading a work package in the REACH project to assess the impact of floods and extreme heat on maternal and child healthcare utilisaiton and coverage: 

• REACH: Building resilience to floods and heat in the maternal and child health system in Brazil and Zambia. Funded by the UK Economic and Social Research Council

At Karolinska Institutet I primarily teach the courses Applied Research Methods for Disasters and Qualitative Research Methods for Disasters, which I also developed. Moreover, I supervise master’s and medical students in topic such as health systems, resilience, and disasters.