Dell Saulnier

Dell Saulnier

Assistant Professor
Visiting address: Widerströmska huset, Tomtebodavägen 18 A, Plan 4, 17177 Stockholm
Postal address: K9 Global folkhälsa, K9 GPH von Schreeb, 171 77 Stockholm
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About me

Research

  • 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:

    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: 

Teaching

Articles

All other publications

Grants

  • Economic and Social Research Council
    30 September 2023 - 29 September 2027
    Climate change is affecting health systems around the world, with those in low and middle income countries (LMIC) at particular risk due to limited health resources and greater exposure to climate hazards such as floods and extreme heat. Mothers and children are especially vulnerable to the effects of floods and heat, and they require access to routine and emergency services, which can be compromised by these hazards. Our project is focused on understanding the health system that provides services to mothers and children. This includes the people, resources, and activities that are involved in delivering services. We want to better understand the characteristics that make this system vulnerable to floods and heat, as well as the characteristics that make it resilient - able to absorb, adapt or transform - when faced with these hazards. By doing this, we hope to protect the health of mothers and children over the long term. Existing studies often focus on the effect of individual hazards on individual elements of the maternal and child health (MCH) system (such as health workers, or the number of services delivered) after the hazard occurred. However, health systems evolve over time, and comprise interconnected elements with feedback (where outputs of the system affect inputs). Further, climate hazards can occur together or sequentially, with implications for the MCH system. We will use system science methods which help us better understand how complex systems work and how we can make them work better. These methods have been used in health systems and environmental research and have great potential to help us understand how health systems function and respond to climate hazards and resilience building interventions over time. We will use causal loop diagrams (CLDs) - visual representations of system elements and their interconnections - and two types of mathematical models: a model of how the MCH system functions in terms of the overall flows of patients and drugs and supplies (a system dynamic model - SDM) and a model of the way community members and facilities interact and behave (an agent-based model- ABM). These models will then be integrated to provide a more holistic picture of the MCH system. The research will be carried out in Zambia and Brazil, two LMIC which are vulnerable to floods and heat, but which differ in terms of MCH care. This will allow us to explore how context affects health system vulnerabilities and responses. The research comprises a number of stages. First, will examine the relationship between floods and heat and MCH service outcomes and the affordability of health care. Second, we will define the MCH system and how flood and heat interact with it and affect service delivery, identifying vulnerabilities, and points of intervention to reduce these using CLDs. Then, we will identify potential interventions to build climate resilience, their feasibility acceptability and cost, and a plan for their financing. Next, we will build an SDM and ABM and an integrated model to quantify the effects of flood and heat scenarios on MCH service delivery and demand and the impact of resilience building interventions. Scenarios describing flood and heat events and their interactions with the MCH system, the CLDs and the models will be produced through repeat engagement with stakeholders at community, health facility and district levels, using surveys, in-depth interviews and participatory workshops. We will also use evidence from literature and existing household and facility data in each country. The model will be designed so that it can be used by decision makers at the local level to guide intervention selection and indicators to monitor the MCH system in relation to floods and heat. The project builds on a strong existing partnership and comprises a unique interdisciplinary team.
  • Swedish Research Council
    1 January 2023 - 31 December 2024
  • Swedish Research Council for Health Working Life and Welfare
    1 January 2023 - 31 December 2025
    Research problem and specific questions: Sweden’s emergency preparedness has met several acute challenges in the past years, now in the form of the COVID-19 pandemic. The pandemic has shocked the society, including the Swedish health system. There remains little empirical evidence on how health systems can remain resilient when exposed to shocks, but tested and trained emergency preparedness plans appear to be crucial elements. To be prepared for future shocks it is essential to systematically compile, assess and analyze to what extent emergency preparedness plans were adequate and have been implemented during the pandemic. The purpose of this project is therefore to assess the implementation and effectiveness of regional emergency preparedness plans in Sweden during COVID-19, so that Sweden will learn from the pandemic to build resilience of the Swedish health system for future shocks.Data and methods: The project is based on four individual studies that all apply different, well established research methods to study the Swedish emergency preparedness during the pandemic. Qualitative methods (interviews, Delphi panel) and systems thinking methods (Group Model Building) will be used to capture experiences from key stakeholders of the regional emergency preparedness plans and management of the pandemic. In addition, quantitative methods will be used to assess potential differences between the regional preparedness plans and how they may have affected provision of health care.Plan for project realization: The main applicant will lead the project together with one of the co-applicants. A doctoral student will be recruited for the project to further develop the research plan and perform most of the project work. Due to the nature of the proposed project, the budget costs in this application are mainly salary costs. The research group recently received funding from Karolinska Institutet, a doctoral training grant, in October 2021 for this project.Relevance: To develop emergency preparedness within the Swedish health system is key to be able to meet future health shocks, mitigate their effects and for recovery after the emergency has passed. This project aims to generate new knowledge on emergency preparedness from lessons learnt from the COVID-19 pandemic and thereby support decision makers to develop more resilient health systems for the future.
  • Swedish Research Council
    1 January 2022 - 31 December 2024

Employments

  • Assistant Professor, Department of Global Public Health, Karolinska Institutet, 2025-2031

Degrees and Education

  • Degree Of Doctor Of Philosophy, Department of Global Public Health, Karolinska Institutet, 2020

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