Our Research | Health systems and policy

The overarching theme of our group is health systems and policy; these projects reflects our core health system perspective work that covers all our thematic areas.


Infection-related hospitalizations in Chinese patients with chronic kidney disease: Prevalence, clinical consequences, resistance to antibiotics and the role of physical activity

Guobin Su, Cecilia Stålsby Lundborg

Chronic kidney disease (CKD) is a global public health problem, due to its high prevalence, high rate of complications, high health care costs and poor outcomes. Among patients with CKD, infection is the second leading cause of mortality and hospitalization. Higher rates of infection and greater use of antibiotics might contribute to the emergence of resistant pathogens, placing the global population at risk.

In my PhD study, I will try to examine in-hospital consequences, antibiotic use in patients with CKD to address the burden from infection-related hospitalization, and to explore the role of physical activity as a potential mean of reducing risk of hospitalizations due to cardiovascular events or infections in this population.

The data will be collected from Guangdong Provincial Hospital of traditional Chinese Medicine (GDHTCM).

GDHTCM is a tertiary care hospital, located in the south of China in Guangzhou city, Guangdong province, is one of the oldest and largest hospital groups of traditional Chinese medicine (TCM) in China. It has four hospital branches located in different districts of Guangzhou city, with a total of 3,150 beds. Over 90,000 patients are admitted to GDHTCM each year, and considering population estimates that over 9,000 patients may have CKD.


Innovations in the health system: interventions for improved treatment of infectious diseases in children in rural Uganda.

Cecilia Stålsby Lundborg (PI), Jaran Eriksen*, Senia Rosales-Klintz* (* contact person)


Under-five mortality (U5M) is high in Uganda, and reduction has been slow, 90 children out of 1000 die before their fifth birthday with infections as the leading cause of death. Children may have poor access to health facilities or receive poor quality of care with inappropriate diagnosis and treatment. Antimicrobial and especially antibiotic resistance is globally considered one of the most severe threats to public health. One reason for development and spread of resistance is the inappropriate use of antimicrobials. In Uganda, the public health system which has the primary obligation of providing health care has difficulties delivering the evidence-based and affordable interventions that could save two-thirds of the children dying today. The private sector has stepped in but the poor quality of care in private, as well as public health care, is an important determinant of mortality. In this research partnership, we will address research questions that can assist in creating evidence for the Ugandan health system to enable possibilities for high-quality child health care.

 The scientific research questions we will address fall broadly under the following areas,

  1. how to develop, implement and evaluate simplified and field-adapted screening tools for monitoring of antibiotic and antimalarial use at the community level,
  2. how to determine the prevalence, distribution and antibiotic resistance patterns of tracer bacteria isolated from children,
  3. how to develop, implement, and evaluate context specific antibiotic stewardship programs in the public and private sectors as part of institutional quality improvement and safety initiative
  4. how to determine the optimal dosing of antimalarial drugs for children and develop evidence-based dosage recommendations
  5. how can the quality of care for children with malaria, pneumonia and diarrhoea be improved in the private sector
  6. how to adapt and evaluate point-of-care test (POCT) for rapid detection of pathogens causing infections and how to develop and evaluate a complementary automated data analysis system, using mobile phone technology for image acquisition and a database for results analysis and reporting
  7. how to develop, implement and evaluate the effectiveness of e.g. smartphones with respiratory timers for improved management of paediatric respiratory infections and improving clinical decision support.

These questions will be answered by in robust studies using qualitative and quantitative research including randomized controlled trials in rural Uganda. The results of the research will directly inform policy-making in the Ugandan health system and lead to better quality of care and subsequently increased survival of children.

Validation and implementation of rapid diagnostic methods for multidrug-resistant tuberculosis in Honduras

Senia Rosales Klintz

positive results

This collaborative project focuses on the dissemination of knowledge generated within previous bilateral collaborations between Honduras and Sweden. Our consortium, comprising Karolinska Institutet, the Public Health Agency of Sweden and Universidad Nacional Autonoma de Honduras, has been working within the field of Tuberculosis (TB) diagnostics and molecular epidemiology during the last 20 years.

The purpose of this collaborative research project is to support the improvement and expansion of tuberculosis (TB) diagnostic capacity in Honduras, building upon our previous results and by further develop joint research strategies.


Cecilia Stålsby LundborgOliver Dyar 

Microbiology sample

The Sino-Swedish Integrated Multisectorial Partnership for Containment of Antibiotic Resistance is a collaborative effort between Sweden and China to minimize emergence and dissemination of antibiotic resistance.

The aim is to minimize emergence and dissemination of antibiotic resistance (ABR), a holistic one-health approach is called for at national and international levels. The project aims to:

Increase basic knowledge of the complex routes of dissemination of ABR between sectors (humans, animals, the environment)
Increase basic knowledge of factors contributing to irrational use of antibiotics in humans and animals 
Integrate this new knowledge with existing evidence to design and pilot interventions aiming to limit development and spread of ABR
Promote adequate infection prevention and control and access to effective antibiotics for humans and animals for improved public and animal health, and consequently efficient, sustainable animal food production. 

Molecular investigations will map and correlate the occurrence of ABR clones in humans (commensal, clinical isolates), animals (household, farm animals), food, drinking water and the environment (water, sewage, manure). Antibiotic residues will be mapped as well as AB use (humans and animals), perceptions, knowledge, attitudes and practice among key stakeholders (community members, farmers, health care providers, animal health advisors). The project continues an ongoing collaboration coordinated by SMI and Zhejiang University and will be conducted in Shandong Province, China, and includes additional partners with human medicine, animal, food- and environmental competence.


Student Prepare

Cecilia Stålsby LundborgOliver Dyar, Cecilia Lindsjö 

Student-PREPARE (PREscriber Perspectives on Antibiotic use and Resistance Education) is a survey on antibiotic education for all final year medical students in Europe. The study is coordinated by ESGAP (the ESCMID Study Group for Antibiotic Policies).

The study has the goal of finding ways to improve education on antibiotic use and antibiotic resistance. Junior doctors are responsible for much antibiotic prescribing, which is why it is so important to support their undergraduate education on the prudent use of antibiotics. The results of this survey are intended to identify if there is a perceived need for further education, and to guide clinicians and lecturers responsible for curriculum and course development across Europe. A forty point questionnaire was developed and has now been answered by more than 10,000 students across Europe.

The study has strong connections to the Improving use of medicines subgroup. Professor Cecilia Stålsby Lundborg is a member of the scientific committee for the study, and the country coordinator for Sweden. Dr Oliver Dyar is the coordinator for the overall European project. The Swedish part is assisted by Cecilia Lindsjö. 


Antibiotic resistance: implications of hospital practices for public health -A study from Vietnam

Lien La Thi QuynhAshok TamhankarCecilia Stålsby Lundborg 

The aim of this project is to explore hospital practices in relation to antibiotic resistance in hospital wastewater. Hospitals are high users of antibiotics and thus hospital wastewater can contain large amounts of antibiotics that can allow generation of antibiotic-resistant bacteria. In high-income countries, hospital wastewater undergoes treatment to remove contaminants. In low and middle-income countries (LMICs), however, hospital wastewater is often not treated and enters the environment contaminated with antibiotics and antibiotic resistant bacteria. Such water can get released into water bodies, wherefrom it might be used for irrigation or later come into water used for household purposes, resulting in infections by resistant organisms in humans and animals. Another possibility is horizontal gene transfer from bacteria harbouring resistance genes to susceptible bacteria. Specifically, the project explores the perceptions of hospital staff regarding infection control, analyse antibiotic prescribing in hospitals, determine antibiotic residues in hospital wastewater in relation to the antibiotic use of the hospitals and antibiotic resistance patterns of E. coli isolated from hospital wastewater before and after treatment. The settings are the rural Ba Vi hospital (220 beds) and the urban Thanh Nhan hospital (520 beds) in Hanoi. 


MASPIC – Maltese Antibiotic Stewardship Programme in the Community

Erika SalibaSenia RosalesCecilia Stålsby Lundborg

The MASPIC project aims to improve antibiotic prescription for respiratory tract infections (RTI) by family doctors through a behaviour change intervention. It encompasses several components, including:

I:       Developing a better understanding of family doctors’ views, experiences and perceptions on antibiotic prescribing for RTI

II:     Exploring the views and perceptions of other stakeholders, namely pharmacists and caretakers of school-going children.

III:    Developing and evaluating a behaviour change intervention targeting family doctors’ antibiotic prescribing practices for RTI

IV:    Monitoring family doctors’ antibiotic prescribing practices when consulting patients with RTI

By gaining a better understanding of the underlying mechanisms of antibiotic prescribing for RTI in the community, we seek to design an effective intervention and tool for future initiatives where the goal is to ameliorate antibiotic prescribing in the community, both in Malta and other similar settings. The project is planned to continue at least until 2018.

Systemic drug therapy for treatment of acne vulgaris in adolescents – a Norwegian prescription database study

Ingvild OdsbuCecilia Stålsby Lundborg

Acne vulgaris is affecting 80-85% of all teenagers. Tetracyclines are recommended as the first choice for severe acne vulgaris, and - if not sufficient effect - isotretinoin could be prescribed. Both therapy options have disadvantages; tetracycline use gives side effects like phototoxicity, influences the normal gut microbiota and contributes to antibiotic resistance, and isotretinoin is a teratogen highly likely to cause birth defects. In recent years, systemic drug therapy for severe acne vulgaris is more frequent, and isotretinoin has exhibited the greatest increase. The aim of the project is to investigate the prescribing of systemic drug therapy for the treatment of severe acne vulgaris in adolescents by use of prescribed drug data from the Norwegian Prescription Database. The project is done in collaboration with the Norwegian Institute of Public Health, Oslo, Norway.


Global Critical Care/Anaesthesia

Tim Baker

Care of critically ill patients and Anaesthesia are under-prioritised areas of health care in low-resource settings. Critical care utilises a horizontal approach to healthcare – involving all patients, all specialties, and all diseases. We are researching methods to identify critically ill patients using context appropriate tools based on patients’ vital signs, and treatment strategies to improve care and reduce mortality. Current projects include the development and implementation of the Vital Signs Directed Therapy, checklists in Obstetric and Paediatric Anaesthesia, quantification of the burden of critical illness, and development of guidelines for the management of patients with sepsis and other critical illness.

Ongoing collaborations include those with Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, Dar es Salaam Regional Medical Authorities, the Dept. of Anaesthesia, Intensive Care and Surgical Services at Karolinska University Hospital and the European Society for Intensive Care Medicine. The projects are run together with the Muhimbili-Karolinska Anaesthesia and Intensive Care Collaboration (MKAIC) and Life Support Foundation, an independent, medical organisation aiming to prevent deaths due to acute, life-threatening conditions in low-income countries. As well as research, we carry out training, exchanges and capacity building projects.

Funding has come from the Kavli Fund, Laerdal Foundation, Olof Norlander Stipend, AAGBI, SFAI, and SSMF.   



Helena HildenwallTim Baker

Sugar Requirements in Febrile African Children Trial. While antibiotics and anti-malarial drugs constitute the definitive treatment for paediatric infections, the role of supportive therapies, such as maintaining normal blood sugar and electrolyte balances, has been given limited attention. Hypoglycaemia is common in children admitted with fever and outcomes are poor. One in four children has “low-normal” blood glucose levels of 2.5-5.0mmol/l.  These children also have a greater risk of death.

We will conduct studies in Malawi to investigate the causes of the low levels of blood glucose and the reasons for increased mortality. We will conduct intervention studies that aim to reduce mortality rates.  We aim to strengthen the evidence base for management of children with febrile illness and to challenge the current global definition of hypoglycaemia.

Collaborations: the University of Malawi, College of Medicine; Dept. of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi; Dept. of Paediatrics, Karolinska University Hospital, Huddinge, Stockholm; Dept. of Anaesthesia, Intensive Care & Surgical Services, Karolinska University Hospital, Stockholm.

Funding:  Vetenskapsrådet; Stockholms Läns Landsting.


KI-Makerere Collaboration

Stefan Petersson, Göran Tomson

Towards better health services for vulnerable groups in Uganda: The long-standing collaboration between Karolinska Institutet and Makerere University in Uganda serves to build capacity while tackling important health system questions in Uganda.


The development in Africa with the epidemiological transition leads to maternal and infectious disease causes of death increasingly co-existing of chronic diseases, the double burden challenging the often fragile health system. Equity in access to good quality care is a concern at measurement and intervention levels. The research also needs to develop and evaluate strategies to scale up evidence-based interventions in maternal, neonatal health as well as increasingly for non-communicable disorders such as diabetes mellitus. There is a need to develop national resources to conduct health policy and systems research through PhD, Post-doc, and Institutional capacity building.


  • Evaluate costs and effects of integrated community case management (iCCM) for malaria and pneumonia through community health workers.
  • Evaluate costs and effects of facility and community interventions for maternal/neonatal care practices in facilities and communities on newborn care practices and newborn survival
  • Determine enablers and barriers to adherence to chronic care models using HIV as tracer
  • Evaluate social and material capital for assessment of equity of access to care
  • To determine the distribution of type 2 diabetes-related risk factors and disease prevalence as well as exploring options for screening and intervention at PHC levels in a rural low-income setting

Former PhD students from Makerere have become post-docs and principle investigators of some of the above studies. Attempts are made to facilitate institutional capacity building through the establishment of a local research group with joint supervisory teams. Most of the studies are being carried out in the Iganga/Mayuge Health and Demographic Surveillance Site (DSS) established in collaboration between our research group and the School of Public Health Makerere university.

The evaluation of the Home Based Management of Fever, as well as the shown symptom overlap (malaria and pneumonia) in children, led to a policy change introducing the iCCCM which is now being evaluated. Studies within the neglected field of neonatal health have facilitated a number of processes nationally including quality and access challenges. Funded by: Sida.


Equity Aspects of Patient Choice

Göran Tomson 

Equity Aspects of Patient Choice in Primary Care in Stockholm County Council: Impact on need-based resource allocation, primary care doctors, and health care utilization in disadvantaged areas aims to assess the impact of patient choice on equity, utilization of services, and allocation of resources among socioeconomic groups and health care providers.


Health care reform is currently occurring in many European countries with a goal of improving the efficiency of the health care systems and responding to patients’ wishes. However, it is unknown if the changes being implemented are having unintended effects on other components of the health system, particularly on equity.  A change in primary care provider selection was made in Sweden in 2010, allowing patients to select whomever they wished; the reform also affected primary care providers and their work situation. This project now has the opportunity to assess the impact of the reform on equity, reception by primary care providers, and on the allocation of resources for primary care and utilization of services between socioeconomic groups and areas in the Swedish setting. Overall, it will aim to contribute to knowledge on how to make primary care services better meet the needs of the patients and populations they serve, and to reducing inequalities in health. To perform the assessment, the focus will be on four areas of work: (i) changes in allocation of resources to primary care over time between different socioeconomic groups and geographic areas, (ii) perceptions of primary care doctors regarding their ability to provide equitable care before and after the reform, and (iii) change in patterns of utilization over time of health care in different socioeconomic groups. Collaborators are Uppsala University and the University of Liverpool. Funded by: Forte. 



Göran Tomson

The Consortium for Health Policy and Systems Analysis in Africa works to extend sustainable African capacity to produce and use high-quality Health Policy Systems research. The development of sustained African health policy and systems research capacity requires the consolidation and strengthening of relevant research and educational programmes as well as engagement between the policy and research communities. CHEPSAAs goal is to extend sustainable African capacity to produce and use high-quality Health Policy Systems (HPS) research by harnessing synergies among a Consortium of African and European universities with relevant expertise. This goal will be reached through CHEPSAAs five work packages as shown in the diagram below.

CHEPSAAs five work packages

Coordinated by School of Public Health and Family Medicine UCT, South Africa the consortium consists of also School of Public Health Western Cape, Centre for Health Policy Witwatersrand S-A, School of Public Health University of Ghana, Tropical Institute of Community Health University of Kisumu Kenya, College of Medicine University of Nigeria, LSHTM UK, Nuffield Centre of International Health Leeds University UK, Swiss Tropical and Public Health Institute and Karolinska Institutet. The work starts with a needs assessment, followed by organizational and country networking (networking the networks) identifying factors influencing performance and methods for Getting Research Into Policy and Practice. Staff and organizational development and course development are other work packages including also overall knowledge management. Funded by: EC FP 7




Göran Tomson 

Primär Ledare Implementerar Strokeevidense is a collaborative study between Swedish institutions on implementing evidence-based guidelines for stroke care in Sweden.

Patienter får inte alltid tillgång till hälso- och sjukvård som är baserad på aktuell och relevant kunskap. Det förekommer även att patienter utsätts för vård som är onödig eller skadlig. Ett sätt att förbättra kvalitet och säkerhet i hälso- och sjukvården är att öka tillämpningen av evidensbaserade riktlinjer. Rehabilitering i hemmet är en av de högst rankade rekommendationerna enligt de Nationella riktlinjerna för strokesjukvård. Trots detta visar en nationell utvärdering stor variation i genomförandet av rehabilitering i hemmiljö i olika delar av Sverige. Följaktligen finns ett behov av att öka förståelsen för vilka faktorer som påverkar följsamhet till riktlinjer för strokesjukvård och att utveckla och utvärdera strategier för implementering.

Chefen har en central roll i att utveckla och upprätthålla hälso- och sjukvårdens kvalitet. Tidigare forskning betonar ledarskapets betydelse för framgångsrikt införande av ny kunskap. Dock är forskning som fokuserar på chefens kapacitet för förbättringsarbete nästintill obefintlig. Detta gäller även experimentella studier som utvärderar strategier som syftar till att stödja chefen.

PLIS inleddes som ett pilotprojekt i februari 2013 och kommer att följas av en klusterrandomiserad studie. I pilotprojektet undersöker vi genomförandet av ett interventionsprogram. Syftet med programmet är att stödja cheferna i att implementera Nationella riktlinjer för strokesjukvård i öppenvårdsrehabilitering i Sverige. För att undersöka genomförbarhet av interventionen i olika hälso- och sjukvårdsorganisationer och geografiska områden genomförs pilotprojektet vid två öppenvårdsenheter i Stockholm och tre i Dalarna. Pilotstudien rapporteras under hösten 2014. Samarbetspartners är Högskola Dalarna, Sahlgrenska Akademin och Hässelby Akalla akademiska vårdcentral. Funded by: Vårdalstiftelsen



Göran Tomson 

Supporting the Use of Research Evidence for Policy in African Health Systems works to inform health policy in African countries through relevant, reliable, accessible and timely research evidence.


Universal and equitable access to health care, health-related MDGs, and other national health goals are unlikely to be achieved without evidence-informed health policies and actions. Unfortunately, health policies are often not well informed and poorly informed decision-making is one of the reasons why high-quality services fail to reach those in need. Problems include production and accessibility of relevant research as well as the use of existing evidence by policymakers. The aim is to improve decisions about health systems in Africa by improving policymakers access to and use of research evidence that is relevant, reliable, accessible and timely. To develop capacity for evidence-informed health policy. Coordinated by Norwegian Knowledge Centre for Health Services the consortium works with Research syntheses (Task shifting; Improving governance for district development; Reducing maternal mortality; Human resource capacity building for malaria elimination; Motivation and retention of health staff) . Other elements include User-friendly formats for policy briefs and clearing houses, and Rapid response mechanisms, Dialogues, and Evaluation. The consortium includes Makerere University (Uganda), MoH (Cameroon), MoH (Burkina Faso), University de Bangui (Central African Republic), Ethiopian Health and Nutrition Research Institute, Universidade Eduardo Mondlane (Mozambique), Zambia Forum for Health research, McMaster University (Canada), WHO, Karolinska Institutet. A set of research syntheses has been developed (see website) and will be used to test user-friendly formats and deliberate forums with researchers, policymakers and civil society.




Birger Forsberg

The Private Sector Programme in Health addresses the often overlooked private sector and its role in the development and improvement of health systems in poor countries.

The private sector constitutes a large and important source of care for many people in low- and middle-income countries, not least the poor. Yet, the private sector has often been overlooked when trying to improve health systems in poor countries. Information on the scope of the private health care sector and the services it provides, including their quality, has often been missing. The Private Sector Programme in Health - PSP - is a research and policy network for those interested in issues related to the non-state health sector in low- and middle-income countries. The ambition of PSP is to be at the forefront of the international research and policy dialogue on these issues. The programme promotes networking and exchange between research institutions, policy makers, international organizations and the private sector for a nuanced and constructive debate on how best to utilise the private health care sector to reach national health objectives. The aim of the program is to strengthen health systems' performance and their outcome in terms of improved health for all by exploring the non-state (private) health sector, its role in service delivery in low- and middle-income countries and how it can be involved in providing adequate health care to people, in particular, those in most need.


The PSP seeks to fill a knowledge gap by supporting descriptive and analytical studies of the private sector in low- and middle-income countries and by communicating facts, new knowledge and policy stand on private health sector development. In earlier stages of the program, methods were focused on technical tools development, technical support to project proposal development in countries and mobilization of financial support for country studies. After country studies were completed, the program has worked more on dissemination of information through publications and active participation in conferences and meetings.


From 2002-2008 the PSP, in collaboration with eight partner institutions, undertook extensive research on the role of the private sector in health. The programme was coordinated by the Division of Global Health (IHCAR) at Karolinska Institutet, in collaboration with the International Health Systems Program (IHSP) at Harvard School of Public Health. During the first phase of the programme, the work was focused on facilitating the development of country-specific research proposals that corresponded to the overall programme objectives and to secure comparability between the country projects. For this, a generic research protocol and a toolkit for mapping public and private providers were developed by the IHCAR/IHSP team. Country-specific research proposals were developed by the partner institutions in China, Vietnam, India, Uganda, and Zambia. Extensive research was conducted and the program generated a wealth of information on the private sector in the countries. Results were presented at conferences in San Francisco, Barcelona, Jinan (China), Copenhagen, Geneva, and Washington. In 2009, the program took an initiative to a conference on the role of the private sector in Beijing. The conference preceded the 7th World Congress of the International Health Economics Association (iHEA) and it was attended by some hundred scholars in the field. Selected papers from the conference are currently in the process of being published in a special supplement to the Health Policy and Planning. The PSP has demonstrated the immense importance of the private health sector in countries of great diversity with different political and health care systems in Asia and Africa. It has also led to extensive networking and collaboration with research institutions, international organisations, and donors around the world. This networking has allowed pro-poor perspectives and a focus on health outcomes to influence developments within the international health community on private sector issues. The work on PSP has also demonstrated the role and need for interaction in international health among international and national organisations on private health sector development.




Cecilia Stålsby LundborgOliver Dyar 

The Sino-Swedish Integrated Multisectorial Partnership for Containment of Antibiotic Resistance is a collaborative effort between Sweden and China to minimize emergence and dissemination of antibiotic resistance.

The aim is to minimize emergence and dissemination of antibiotic resistance (ABR), a holistic one-health approach is called for at national and international levels. The project aims to:

Increase basic knowledge of the complex routes of dissemination of ABR between sectors (humans, animals, the environment)
Increase basic knowledge of factors contributing to irrational use of antibiotics in humans and animals 
Integrate this new knowledge with existing evidence to design and pilot interventions aiming to limit development and spread of ABR
Promote adequate infection prevention and control and access to effective antibiotics for humans and animals for improved public and animal health, and consequently efficient, sustainable animal food production. 

Molecular investigations will map and correlate the occurrence of ABR clones in humans (commensal, clinical isolates), animals (household, farm animals), food, drinking water and the environment (water, sewage, manure). Antibiotic residues will be mapped as well as AB use (humans and animals), perceptions, knowledge, attitudes and practice among key stakeholders (community members, farmers, health care providers, animal health advisors). The project continues an ongoing collaboration coordinated by SMI and Zhejiang University and will be conducted in Shandong Province, China, and includes additional partners with human medicine, animal, food and environmental competence. Funded by: Swedish Research Council.



Stefan Peterson 

The Community and District Empowerment for Scale-up focuses on health service management strategies to allow the improvement in the coverage and quality of interventions for common childhood illnesses.

New approaches are urgently needed to resolve the many difficulties of scaling up life-saving interventions to prevent deaths due to pneumonia and diarrhea, which together account for more than a third of child mortality. Previous studies have demonstrated that the obstacles are essentially due to four factors: the lack of supportive policies, failure to prioritize those interventions that are most likely to prevent deaths, problems with the essential commodities for vaccination services and treatment of illnesses, and the absence of community-based health promotions activities and care. CODES aims to develop and evaluate the effect of a focused approach to scaling up high impact intervention to accelerate mortality reduction from pneumonia and diarrhoea. Uganda, which has one of the highest child mortality rates in Africa and a highly decentralized health system, will be the case study for this approach. The CODES project aims to demonstrate that a management strategy based on three pillars will lead to improvements both regarding coverage and quality of key interventions to prevent children from dying of diarrhea and pneumonia. The three pillars of improvements are:

  • Improved targeting of interventions to match disease burden, and better allocation of resources;
  • Regular review and improvement of district health team performance, and use of evidence-based management tools and focal funding to overcome management bottlenecks;
  • Community oversight and inputs.

The method Diagnose-Intervene-Verify-Adjust will be used to identify and respond to the health system and demand-side bottlenecks that arise at the district level in order to strengthen the district health system, support capacity development and empower communities. The core partners are U.S. Fund for UNICEF, UNICEF Uganda Office, Karolinska Institutet, Makerere University and Ministry of Health of Uganda. Funded by: Bill & Melinda Gates foundation.



Karin Källander

The Integrated Community Case Management of Common Childhood Diseases: Mozambique and Uganda project looks at the limitations surrounding scale-up of community case management, a proven method of delivering lifesaving treatment to children.

Community-based agents (CBAs) can deliver lifesaving treatment to children. However, scale-up can be problematic in terms of low motivation, attrition and poor performance of CBAs. The Innovations at Scale for Community Access and Lasting Effects (inSCALE) project will identify and document limitations to national scale up of Integrated Community Case Management (ICCM) in terms of its geographical distribution and quality. The aim of the project is to demonstrate that coverage of government-led integrated community case management programmes can be increased to cover up to 33 percent of the districts, primarily resulting in more children with diarrhoea, pneumonia, and malaria accessing appropriate care. 

 Funded by: Bill & Melinda Gates Foundation.


Community-based care for improved child health in low-income countries: Distributional impact and sustainable financing

Frida Kasteng

Integrated community case management (iCCM) of common childhood illnesses (malaria, pneumonia, diarrhoea) was endorsed by the WHO and UNICEF in 2012 as an equity-focused strategy to improve access to appropriate treatment of illness in children and is currently introduced in a number of countries in sub-Saharan Africa, provided by lay Community Health Workers (CHWs). The aim of the research is to assess the extent to which community-based care for children in Uganda and Mozambique has led to more equitable distribution of healthcare services in relation to need and explore the cost and financial strategies associated with sustaining iCCM, considering that an important reason for failure of CHW programmes in the past has been the underestimation of resources and support needed to maintain high-quality services at the community level. 



The Uganda Newborn Study focuses on improving newborn mortality in Uganda by developing an integrated maternal-newborn care package that links community and facility care and evaluating its effects for policy information and scale-up.



The Helping Mothers Survive - Bleeding After Birth project aims to evaluate the impact of a short training session on maternal morbidity and mortality from post-partum hemorrhage.


EQUIP Expansion

Two studies will build on the original Expanded Quality Management Using Information Power (EQUIP) intervention to improve maternal and newborn mortality. One study aims to document community-oriented approaches to improve recognition and use of appropriate care-seeking for newborn and/or maternal complications in five countries, and the other will pilot the scale-up of the EQUIP approach.


Project I 

Management, teaching, monitoring of disasters and networking


Project II

Needs assessments in disasters


Project III

Health effects of sudden onset disasters


Project IV  

Best practices in disaster health care response


Project V

Clinical prediction modelling for trauma care



Stefan Peterson, Meena Daivadanam 

The Self-management and Reciprocal Learning for the Prevention and Management of Type 2 Diabetes aims to strengthen the capacity of health systems to treat and prevent the growing Type 2 Diabetes burden through proven strategies like task-shifting and expanding care networks.

SMART2D is a 4-yr collaborative EC Horizon 2020 funded project. The consortium consists of five university partners - three from Europe (Karolinska Institutet, Uppsala University & Institute of Tropical Medicine, Antwerp) and two from Africa (Makerere University school of Public Health, Uganda and University of Western Cape School of Public Health, South Africa); and one social innovations enterprise (Collaborative Care Systems Finland). In Stockholm, SMART2D has partnered with Stockholm läns landsting (SLL) through the 4D project. In addition, SMART2D is actively establishing connections with the vårdcentrals and medborgarkontor of four selected municipalities (Jakobsberg, Hässelby, Rinkeby, and Tensta) with a high proportion of immigrant population within Stockholm County. Through these linkages, we are also exploring local networks and connections that would enable us to mobilize communities during the intervention development and implementation phase of SMART2D. On the policy front, SMART2D is also engaging with other relevant actors such as Diabetesförbundet, private food retailers such as ICA, and Innovationslandstingsråd (within SLL) at the national level and the Global Alliance for Chronic Diseases (GACD) at the international level.

Global Health