Completed Projects

Lead Faculty: Gilbert Burnham

Monitoring Afghan Health Systems

Lead Faculty: Gilbert Burnham

This activity will provide third party evaluation for the performance of the WHO directed Yemen national malaria control program.

Lead Faculty: Nadia Akseer

Save the Children and Johns Hopkins University (JHU) are researching what combinations and durations of assistance are most effective and cost-effective to prevent severe and moderate acute malnutrition. To increase access to food and prevent wasting, Save the Children, funded by USAID’s Bureau for Humanitarian Assistance (BHA), is implementing the CashPlus for Nutrition project
in Somalia to alleviate hunger of the most affected families and children. This project includes Unconditional Cash Transfers (UCT) for food assistance and social and behavior change communication (SBCC). In the Hiiraan and Bay regions of Somalia, the Save the Children and JHU teams, along with national partners from the Ministry of Health and Somali National Bureau of Statistics, will conduct an evaluation to assess: What combinations of assistance are most effective and cost-effective to prevent wasting for children under five and pregnant and lactating women?

Lead Faculty: Chiara Altare

Support WHO Ukraine in developing a monitoring framework capturing emergency response and longer-term programming in Ukraine.

Lead Faculty: Paul Spiegel

READY is a global consortium designed to strengthen capacity for response to major infectious disease outbreaks or pandemics by filling critical gaps in outbreak response capacity and capability. It does this by leveraging expertise and best practices across these operational, academic, clinical, and communications organizations. By diversifying NGO capacity in coordination with other global outbreak initiatives, READY will strive to improve the humanitarian community’s response to infectious disease outbreaks that become international humanitarian emergencies, and even prevent many from ever becoming global. The program will also design and roll-out a multi-sectoral response approach that seeks to address the holistic needs of outbreak-affected communities – with community engagement and communications at the heart of the program design.

Lead Faculty: Paul Spiegel

The first phase of partnership between the BSPH-CHH and Momentum entailed the development of a landscape analysis and conceptual framework to guide HDN-health interventions in fragile settings. In continuation of this partnership, the CHH proposes to develop in-depth case studies of HDN-health interventions in select countries of implementation to document best practices, barriers to implementation, and harness learning to inform other contexts. Using the framework and models of implementation highlighted in the first phase of the project, the CHH will examine health interventions, specifically those of voluntary family planning (FP) and maternal and child health (MCH). Through these case studies, the CHH will help inform MIHR’s work to best operate within the nexus from a development perspective.

Lead Faculty: Courtland Robinson

The research aims to assess early marriage and fertility-decision-making among Rohingya refugees in Bangladesh and internally displaced persons (IDPs) in Yemen. Building on child marriage studies we conducted among these populations in 2019, the study will 1) explore how conflict and displacement affect demand for early marriage and childbearing; 2) understand how fertility intentions and fears of sub-fecundity affect use of SRH services; 3) build the evidence base for adolescent SRH programs and policies in humanitarian settings.

Lead Faculty: Jenny García Arias

Latin American countries are vulnerable to a range of natural hazards, political and economic crises, and armed conflicts; however, little is known about the demographic impacts of those crises in the regional demography. The main objective of this project is to produce accurate demographic estimates that enlighten our understanding of the complex dimensions of a humanitarian crisis in Latin America, using Venezuela as an example. Venezuela is undergoing a profound social and economic crisis with far-reaching consequences for its demographic trends. As migration became the only survival strategy possible for most Venezuelans, the crisis spilled over the continent, leaving no country in Latin America unaffected. The project applies advanced statistical techniques and demographic (in)direct methods to (1) produce high-quality and updated demographic estimates of the crisis; (2) forecast demographic responses to the crisis to shed light on public policy design; and (3) use a cross-country comparison and regional perspective to account for the feedback effects among neighboring nations. Data comes from the population censuses, civil registration and vital statistics system and specialized surveys in Venezuela and the main countries of destination for Venezuelans in Latin America.

Lead Faculty: Chiara Altare

This collaboration between Johns Hopkins' Centre for Humanitarian Health and the Eastern Mediterranean Regional Office of WHO aims to strengthen the operationalization of a regional monitoring framework for health emergencies in humanitarian and fragile settings. Key steps include: i) assess monitoring capacity and identify current constraints; ii) develop and finalize the regional operational monitoring framework (including definition of key performance indicators and development of an assessment checklist); iii) operationalize the monitoring framework in two countries; iv) learn and share lessons that are relevant for other countries and regions of WHO.

Lead Faculty: Paul Spiegel

This study aims to investigate the direct and indirect effects of COVID-19 in two refugee settings to: 
a) Better understand the epidemiology of SARS-CoV-2 infections among refugee populations; and
b) Examine how non-COVID-related health services and health outcomes have been affected by the pandemic.
COVID and non-COVID-related data will be compared with the specific policies and public health measures implemented by each country and setting to prepare and respond to the epidemic. 
The research sites where the study will be implemented include Uganda (the settlements in the north, as well as refugees in Kampala) and Jordan (both refugee camps of Za’atari and Azraq as well as refugees in Amman). Inclusion of urban refugees will depend on data availability. 

Lead Faculty: Shannon Doocy

We will conduct a health landscape analysis and provide support to the Simon Bolivar Foundation to revise their grant making strategy to maximize public health impacts for vulnerable populations in Venezuela.

Lead Faculty: Shannon Doocy

This project will adapt an mHealth application for use in a Kenyan refugee camp with the aim of providing increased continuity of care and information management.

Lead Faculty: Shannon Doocy

This systematic literature aims to update a previous review and to summarize the evidence base for humanitarian health interventions from 2013 thru 2020. The review will have nine different thematic areas and will summarize current evidence gaps and provide recommendations for strategic areas on inquiry going forward.

Lead Faculty: Paul Spiegel

Objectives:
1. To explore and document how health systems in the Americas have responded to the inclusion of migrants, asylum seekers/refugees and other displaced populations in their COVID-19 responses, specifically by assessing the challenges encountered by both the public, private and humanitarian components of their health systems.
2. To assess whether the short, medium and long-term policies and strategies adopted in the Americas to cope with the evolving needs of health systems during the COVID-19 pandemic have enhanced the responsiveness of and accessibility to the health system for people on the move. 
3. To offer specific recommendations for health policy and humanitarian response that are informed by the findings.
4. To share and promote discussion with policymakers, humanitarian actors and academics throughout the region.

Lead Faculty: Paul Spiegel

Research and produce a summary report on the current concepts and programs on RMNCH and related public health programming in humanitarian-development nexus contexts.

Lead Faculty: Paul Spiegel

WHO is leading production of a “Handbook on Conducting Assessments of Barriers to Health Services” to identify supply- and demand-side barriers using the Tanahashi framework for effective coverage. WHO has been working with John Hopkins University (Alliance for Healthier World and the Bloomberg School of Public Health), and EquiAct for this, which includes various modules to conduct barrier assessments.
The handbook does not focus on humanitarian crises/ emergency settings, which requires specialized approaches. The plan is to include an annex with the adaptations necessary for these settings, using rapid assessment methods and accounting for scarcity of data and other contextual factors. This will involve close collaboration between the Johns Hopkins Center for Humanitarian Health and the Johns Hopkins Alliance for a Healthier World, along with WHO and its partners.

Lead Faculty: Shannon Doocy 

The Center for Humanitarian Health will collaborate with UNFPA to provide technical support for research and evaluation on cash and protection in various humanitarian settings where UNFPA has programming.

Lead Faculty: Shannon Doocy

The proposed research will characterize nutrition and other risk factors for poor COVID-19 outcomes and clinical progression of disease in resource-poor humanitarian contexts in Africa, specifically in South Sudan and Eastern DRC, with the aim of informing the ongoing COVID-19 response. These locations were identified because IMC operates or supports facilities with capacity to provide clinical care for COVID-19 patients, making the study feasible, and because they offer the opportunity to generate evidence about risk factors for poor COVID-19 outcomes (e.g., acute malnutrition, anemia, malaria) that are prevalent in humanitarian contexts but have not yet been assessed due to the pandemic beginning in China, Europe and North America. There is a significant lack of evidence related to both malnutrition and infectious diseases and COVID-19 and a need to quickly generate evidence to contribute to real-time response efforts less lower and middle income countries and in particular in humanitarian settings which lack capacity to address the pandemic. While extensive research on risk factors for COVID-19 are underway globally, at present the proposed work is one of only a few studies planned in a humanitarian context. As such, this research can play an important role in understanding the generalizability of findings from other high-income settings to contexts such as South Sudan and DRC– where both patient risk profiles and health system capacity differ radically.

Lead Faculty: Yusra Shawar

National policy responses to protect vulnerable population groups during the COVID-19 pandemic have varied significantly. Some countries have largely neglected these populations; others have paid attention to a large number of these groups; and still others have adopted policies that support some vulnerable populations and not others. While policy trackers exist for general economic and political policy responses to COVID-19, there is no such database with a health justice lens, accounting for policies aimed at supporting the welfare of vulnerable populations. Furthermore, there is little understanding of why countries are broadly prioritizing or neglecting vulnerable populations in their COVID-19 policy response, and why particular vulnerable groups are prioritized over others within countries. This project seeks to track national policy responses dedicated to supporting vulnerable populations (refugees, elderly, vulnerable children, prisoners, and disabled); explain variance in prioritization of vulnerable populations across and within countries; and provide policy guidance for advancing health equity in response to COVID-19. The project will therefore result in three products: 1) an open-source, multi-country database that tracks national policies aimed at supporting or protecting particular vulnerable populations; 2) an analysis delineating the factors shaping the level of priority vulnerable populations receive across and within countries; and 3) a policy brief that discusses implications and potential uses of the policy database, with a view to creating better policies that promote equity in response to COVID-19 and future crises.

Lead Faculty: Hannah Tappis

This project will support humanitarian health stakeholders in identifying facilitators and bottlenecks to newborn health policy, strategy and action plan implementation in a wide range of humanitarian settings. Case study findings will be used to generate recommendations on how to adapt advocacy, resource allocation and technical assistance to accelerate progress towards Every Newborn targets and SDGs for maternal and newborn health in humanitarian and fragile settings. 

Lead Faculty: Abdullah Baqui

This project aims to assess indicators of child mortality and influencing factors in Iraq.

Lead Faculty: Shannon Doocy

This study will inform the development of Red Cross Movement (RCM) health in emergency surge services that are designed to be deployed internationally by Participating National Societies (PNS) to complement a response of the Operating National Society (ONS) residing in the affected country. In particular, the research will seek to identify what health service(s) should be developed or expanded by PNS to optimize the humanitarian impact of RCM health interventions over the next decade.

Lead Faculty: Leonard Rubenstein

We aim to:

1. Understand the nature and severity of impacts of attacks on medical facilities and personnel in war-affected areas of Syria on the availability and utilization of health services and on selected health outcomes including incidence of infectious diseases We aim to:

2. Utilize research findings to inform health service program planning and preparedness in post-conflict Syria and present a model for monitoring public health vulnerabilities stemming from attacks on health in other contexts.

Lead Faculty: Nancy Glass

WHO is working to strengthen the capacity, readiness and quality of health services to address GBV in its own emergency work and within the Global Health Cluster. This project is a quality assessment/quality improvement initiative to strengthen existing health services for GBV survivors in humanitarian settings.

An interdisciplinary team of WHO, JHU and in-country collaborators will use mixed methods approaches to:

1) examine capacity, readiness and quality of health services in selected facilities;

2) adapt existing GBV Service Readiness Assessment/Quality Assurance Tools for humanitarian settings;

3) examine facilitators, barriers, and bottlenecks to access and provision of quality care for GBV survivors;

4) provide an adapted GBV Service Readiness Assessment/Quality Assurance Tool for implementation in humanitarian settings.

Lead Faculty: Paul Spiegel

Conduct a comparative analysis across different countries to determine factors and indicators that support optimal delivery mechanisms and interventions for WASH and health RRTs for cholera in humanitarian settings and fragile states according to various contexts.

The specific aims are to:

1. Assess and analyze the various characteristics of different WASH and health cholera RRTs (and any integration between the two), such as delivery mechanism components and intervention types.

2. Explore methods to monitor and evaluate the effectiveness of WASH and health RRTs to the extent feasible: a. Assess and analyze the measurement of key RRT indicators, including those outlined in UNICEF’s RRT Global Review related to the above-mentioned characteristics and how they have been applied in the countries studied; b. Assess and analyze the effects of the RRT activities on the epi-curve of cholera epidemic.

3. Document lessons learned and provide guidance for future implementation of cholera RRTs in humanitarian and fragile settings in different contexts.

Lead Faculty: Hannah Tappis

The USAID HEMAYAT project seeks to increase the utilization of high-quality family planning (FP) and maternal and newborn health (MNH) services through the introduction and scaling-up of culturally appropriate, cost-effective, high impact interventions that strengthen and enhance existing primary care services provided through the Basic Package of Health Services (BPHS) and the private sector. HEMAYAT targets five regional hubs of provinces of Afghanistan: Balkh, Herat, Kabul, Kandahar, and Nangarhar. The HEMAYAT project is led by Jhpiego - an affiliate of Johns Hopkins University, in collaboration with FHI360 and Palladium.

Lead Faculty: Mair Hans

We plan to inovate the Digital Twin of the Disaster Healthcare System. As a decision tool for disaster healthcare, the Digital Twin will enable cost/resourcing analysis, disaster response planning, workforce projections and training, and system readiness (preparedness) assessment. It will also force the implementation of objective performance metrics. Recognizing the evolution of Disaster Healthcare as a complex socio-technological system, we apply Systems Thinking via System Dynamics Analysis (SDA) to create the analytic framework of Disaster Healthcare. Our proof-of-concept project focuses on Disaster Nursing as a collaboration between JHU Divisions – the Applied Physics Lab (JHU-APL), the School of Nursing (JHU-SON), and the Bloomberg School of Public Health (JHU-BSPH).

Lead Faculty: Paul Spiegel

The aims of the case studies are twofold:

1) Examine how reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) services have been and are being delivered in conflict affected settings.

2) Identify factors influencing the design, implementation and effectiveness of these services in conflict-affected areas of South Sudan, Eastern DRC and Yemen.

Lead Faculty: Paul Spiegel

This project’s aim is to save the most lives in humanitarian settings by providing recommendations on which interventions are most effective in terms of outcome and cost according to context.

Specific objectives include:

1. Adapt the Lives Saved Tool (LiST), a software used to forecast the impact of interven-tions on survival of mothers and children in development settings, for use in different ref-ugee settings according to availability of key resources (e.g., skilled staff, essential drugs and equipment).

2. Explore how to add a cost-effectiveness component specific to refugee settings.

Lead Faculty: Paul Spiegel

The Center for Humanitarian Health at the Johns Hopkins University (JHU) will work with a wide range of international, regional, national and local partners across multiple disciplines to prepare for and rapidly respond to public health emergencies in an agile, context-appropriate, scalable and sustainable manner. We propose a project that will align with the global health security agenda (GHSA) and International Health Regulations (IHR) and focus on: • Training and building the capacity of CDC-chosen partners using operational training modules based on country needs assessments; • Deploying rapid response support teams that will conduct just-in-time training, deliver information management strategies, and provide technical guidance, support and monitoring of compliance; and • Applying a Continuous Quality Improvement (CQI) approach to evaluate trainings (all-hazards and hazard-specific) and rapid response support.

Lead Faculty: Paul Spiegel

Building upon existing initiatives, Johns Hopkins Center for Humanitarian Health aims to contribute to the ongoing efforts to improve public health information in emergencies by addressing two major challenges in measuring the effectiveness of humanitarian assistance: the lack of standardized indicators and methods; and the prominence given to output indicators instead of outcome and impact indicators. This work aims to define core public health indicators and to monitor the effectiveness of humanitarian action in out-of-camp humanitarian settings according to different contexts. The core indicators are intended to: • Measure outcomes in terms of population health status and health services provision. • Be operational in purpose. • Inform decision makers at district/national levels to guide response. • Define proxy indicators according to measurement challenges in different contexts. Project outputs will be a field-piloted set of core indicators according to different contexts, and an operational guide on measurement methods and performance analysis. They will be widely disseminated among humanitarian actors.

Lead Faculty: Emily Harroz

The overall objective of this implementation grant is to bring together a diverse yet complementary expertise to empower local organizations to implement a sustainable, multi-level, suicide prevention program for refugees in the Mae La camp, with a key focus on reducing suicide-related health disparities for refugees living in Thailand. To address the critical health equity problem in refugees by working upstream to prevent suicide through low-cost, preventive services, while simultaneously gathering information on how best to address root causes leading to inequalities in suicide outcomes among refugees compared to the general population.

Lead Faculty: Judy Bass

This proposal follows on current activities conducted under a related project (“Phase 1”), which has been focused on examining the evidence base and building consensus among stakeholders for priority psychosocial programming needs. With support from OFDA, under the current proposal (“Phase 2”) the Johns Hopkins University Applied Mental Health Research Group (JHU AMHR) will apply our methods and expertise to building an evidence base for priority PSS programming in humanitarian settings.

Lead Faculty: Paul Bolton

The purpose of this program is to design and implement effective and scaleable community-based mental health programs for common mental disorders in low and middle income countries. The program is currently testing the Common Elements Treatment Approach (CETA) – a transdiagnostic intervention that is capable of treating multiple disorders and designed specifically for these countries – in Ukraine and Myanmar. The program is also developing CETA trainer capacity in both countries in order to ensure sustainability, and introducing a CETA Short Session intervention (CSS) to precede full CETA. This program consists of a single session provided to community groups of interested persons. CSS includes psychoeducation and some fundamental skills to deal with stress, as well as screening participants for mental disorders. The intent is to inform communities about mental health, identify persons in the communities who need referral to CETA or other available mental health services, and encourage them to seek and accept services.  Based on our experiences in both countries JHU will roll out a combined CSS-CETA approach to community mental health services in other communities and other countries.

Lead Faculty: Courtland Robinson and Shannon Doocy

Assess the impacts of cash transfers on gender-based violence within the context of an ongoing resilience program.

Lead Faculty: Shannon Doocy

Evaluate if/how decision support tools and abbreviated elecronic medical records can support management of diabetes and hypertension.

Lead Faculty: Shannon Doocy

Assess health outcomes of multipurpose cash grants among refugees.

Lead Faculty: Shannon Doocy

Develop predictive models for spikes in acute malnutrition prevalence in at risk countries.

Lead Faculty: Shannon Doocy

Assess health outcomes of multipurpose cash grants among refugees.

Lead Faculty: Gilbert Burnham

Characterize the medicine supply chain and access to medicines in Non-Government Controlled Areas of N Syria. 

Lead Faculty: Shannon Doocy

Assess impacts of household transfers on prevention of acute malnutrition in CU5 and PLW.

Lead Faculty: Anita Shankar

The main objectives of the study is to understand the link between the adoption of cleaner cookstoves and/or fuels and gender based violence (GBV), and to assess the impact of a group based empowerment workshop (I-ACT) on women’s health and GBV.

Lead Faculty: Paul Spiegel

READY is a global consortium designed to strengthen capacity for response to major infectious disease outbreaks or pandemics by filling critical gaps in outbreak response capacity and capability. It does this by leveraging expertise and best practices across these operational, academic, clinical, and communications organizations. By diversifying NGO capacity in coordination with other global outbreak initiatives, READY will strive to improve the humanitarian community’s response to infectious disease outbreaks that become international humanitarian emergencies, and even prevent many from ever becoming global. Operational consortium members will be supported to build and retain standing capacity to more quickly and effectively respond to large-scale disease outbreaks. The program will also design and roll-out a multi-sectoral response approach that seeks to address the holistic needs of outbreak-affected communities – with community engagement and communications at the heart of the program design.

Lead Faculty: Gilbert Burnham

To assess compliance with treatment and control of disease over three years among vulnerable and low income populations in Ghana (with a companion study in the Philippines for which Shannon Doocy is the co-investigator).

Lead Faculty: Jura Augustinavicius

To identify and specify means of verification that will accompany the existing IASC MHPSS common monitoring and evaluation framework.

Lead Faculty: Sarah Murray

Our overall objective is to strengthen the implementation, effectiveness, and acceptability of a scalable and integrated health intervention being delivered to new South Sudanese mothers and infants living in Nguenyyiel refugee camp in Gambella, Ethiopia. Specifically, we aim to: 1. Use a mixed methods approach to explore the uptake, acceptability and participation of women in the Baby Friendly Spaces (BFS) program. 2. Explore the needs and experiences of staff delivering the BFS program. 3. Assess whether and how participation in BFS activities is associated with improved maternal (mental health, breastfeeding practices, mother-child interactions) and child (morbidity and growth) outcomes.

Lead Faculty: Samira Sami

Over the last several years, a concerted effort by IAWG members under the leadership of Save the Children and UNICEF led to the development of an inter-agency newborn health in humanitarian settings field guide and associated newborn supply kits. While newborn health care delivery has garnered interest and funding in the last year, there is still a lot to do to ensure that it is systematically integrated and delivered. To further global commitment and be held accountable, we are proposing the development of a five-year strategic vision and workplan.

Lead Faculty: Paul Spiegel; Yusra Shawar; Mohammad Darwish; Marwa Ramadan; Kathleen Fallon; Julia Roche

The research project aims to investigate the impact of the 2018 US budget cuts on UNRWA health services provided to Palestinian refugees in Lebanon and then present different future scenarios to ensure the health of Palestinian refugees.

Lead Faculty: Michele Decker; Nancy Glass

Adapting and testing the myPlan app (safety decision aid for women in abusive dating/intimate relationships) to the low-resource settings of Kenya and Somalia in collaboration with health and psychosocial support programs and providers.

Lead Faculty: Michele Decker; Nancy Glass

Development, implementation and evaluation of pre-service and in-service training curriculum using the WHO/PAHO clinical guidelines on prevention and response to intimate partner violence and non-partner sexual assault.

Lead Faculty: Courtland Robinson

1. To estimate the number of women and girls from Myanmar trafficked to China for forced marriage and child-bearing disaggregated by age, geographical region, and other demographic characteristics (socioeconomic status, educational attainment, ethnicity, religion, etc.); 2. To generate profiles of the “typical” victim and the common vulnerability factors and pathways leading to trafficking; 3. To generate profiles of the “typical” victim and the common vulnerability factors and pathways leading to trafficking; and 4. To generate profiles of the “typical” victim and the common vulnerability factors and pathways leading to trafficking.

Lead Faculty: L. Appel; K. Matsushita; S. Tamplin; E. Miller; D, Peters; A, Sommer; D. Celantano; G. Pariyo; A. Edwards

Prevention and management of hypertensive disorders

Lead Faculty: Catherine Lee; Emily Haroz

To synthesize the evidence base for psychosocial programming and identify promising programs to rigorously evaluate.

Lead Faculty: Emily Haroz; Catherine Lee

To plan for the implementation of a suicide prevention program for refugees in Thailand.

Lead Faculty: Gilbert Burnham

To develop a humanitarian leadership program targeting leadership of National NGOs in Low and Middle Income Countries.

Lead Faculty: Alex Vu, Andrea Wirtz

This study will assess the prevalence of and vulnerabilities to experiences of Gender-based violence among stateless persons residing in Cote D’Ivoire and the Dominican Republic. Associations with GBV-related health outcomes and access to health care and services will also be explored. Estimates will be compared to neighboring citizen populations to identify differences in GBV and health outcomes associated with statelessness. Results will be used for policy and programmatic efforts for stateless persons.

Lead Faculty: Paul Spiegel; Chiara Altare; William Weiss; Hannah Tappis; Marwa Ramadan

This project aims to develop and pilot a set of core public health indicators for humanitarian emergencies according to different contexts. The core indicators (covering health, nutrition and WASH sectors) strive to support decision makers and operational actors by providing information as to whether the humanitarian assistance provided is achieving its intended results, i.e. the health status of conflict-affected populations is improving (or not further deteriorating) and services reach the desired quality and coverage. The core indicators will therefore focus on outcomes in terms of population health status, coverage and quality of services provided (and not on operations input or output). The proposed core indicators will be context-specific and will take into account accessibility, human resources availability, feasibility of measurement, validity, and costs. 

To ensure complementarity of efforts and sustainability of action, the project will build upon existing systems and processes for public health information management, both globally and in humanitarian emergencies, and will coordinate with the key actors who are currently working on developing and/or modifying these principles, systems and methods.
The core set of public health indicators will deliberately be kept to a minimal amount to ensure that they will be prioritized as well as be consistently, reliably and robustly measured. They will be disaggregated by age and sex. Since public health indicators are more easily measured in camp settings and UNHCR has developed a web-based system to report on them in refugee settings, the core set of indicators of this project will be developed for non-camp settings in humanitarian emergencies.

Lead Faculty: W. Tol; J. Annan; M. Carswell; V. Ommeren; K. Nemiro; P. Ventevogel

Adaptation, piloting, and evaluation of a scalable psychological intervention to reduce psychological distress with young Burundian refugee adolescents in Tanzania.

Lead Faculty: L. Rubenstein, P. Spiegel, D. Server, G. Govind, N. Singh

The Trump Administrations proposals to suspend admission of refugees for resettlement and considerably reduce the total number of refugees brought to the United States has raised questions concerning refugee resettlement and national security, the U.S. role in resolving the global refugee crisis, and U.S. obligations to provide a home to people fleeing violence and persecution. This project explores the critical and related question about policy, ethical and human rights considerations in determining how to make decisions on the number of refugees admitted. We propose to explore this question by 

a) Conducting a literature review on policy questions concerning the refugee program and ethical and human rights considerations relevant to refugee resettlement and the determination of numbers of people to be admitted; 
b) Engaging in approximately 15 key informant interviews to ascertain how numbers of refugees accepted for resettlement have been determined in the recent past; the interviews will be conducted with former Assistant Secretaries for Population, Refugees, and Migration in the U.S. State Department, senior congressional staff, leaders of refugee resettlement and advocacy organizations, and refugee experts from think tanks and academia;
c) Analyzing the results of the interviews to identify key themes;
d) Proposing relevant ethics and human rights frameworks to apply to determinations of numbers of refugees admitted for resettlement, taking into account the empirical evidence yielded by the key informant interviews and literature reviews;
e) Seeking feedback from initial proposals from experts and discussions within JHSPH, the Berman Institute of Bioethics and SAIS;
f) Writing an article for publication about our findings and recommendations;
g) Dissemination of our findings and recommendations to policy makers directly and through public events at JHSPH and SAIS.

Lead Faculty: P. Spiegel, C. Robinson, L. Sauer, J. Freeman, S. Lewis, N. Hellman, M. Ververs, A. Labrique, C. Catelett, W. Wiess

Johns Hopkins University will work with a wide range of international, regional, national and local partners across multiple disciplines to prepare for and rapidly respond to PHEICs in an agile, context-appropriate, scalable and sustainable manner. In alignment with the GHSA and International Health Regulations (IHR), we will focus on
• training and building the capacity of CDC-chosen partners using operational training modules based on capacity-building needs assessments;
• deploying rapid response support teams (RRSTs) that will conduct just-in-time training, develop information management strategies, and provide technical guidance, support and monitoring of compliance; and
• applying a Continuous Quality Improvement (CQI) approach to evaluate trainings (all-hazards ad hazard-specific ) and rapid response support.

Lead Faculty: Kiemanh Pham, Junaid Razzak

Reducing delays in transport of prehospital patients to healthcare facilities.

Lead Faculty: Jeremy Kane, Claire Greene, Peter Ventevogel

Conduct a desk review of existing prevention and treatment approaches for substance and alcohol use problems among refugee populations, including camp settings, other humanitarian settings, and among refugees resettled in LMIC.

Lead Faculty: Paul Spiegel, Adam Kushner, Kent Garber

Lead Faculty: Nagendra Luitel, Jeremy Kane, Wietse Tol

Assess prevalence of depression, anxiety, PTSD, hazardous alcohol use, and functional impairment among a representative sample of earthquake-affected regions of Nepal.

Lead Faculty: Paul Spiegel, Shannon Doocy, Hannah Tappis, Michelle Willcox

Review the cost recovery systems used by NGOs in Eastern DRC and provide recommendations for improvement. This will include analysis of types of cost recovery systems that are in place, taking into account non-displaced, displaced and vulnerability considerations, and the application of cost recovery mechanisms both in theory (e.g. SOPs) and in practice (e.g. implementation). The review will produce recommendations regarding standardization, flexibility according to context and short-cost-recovery strategies in Eastern DRC and have the potential to influence access to and utilization of health services as well as health service provision and funding strategies.

Lead Faculty: Shannon Doocy, Hannah Tappis

This project will document lessons learned in cash transfer, shelter, and protection programming with the aim of identifying vulnerable groups and understanding what programming strategies are successful for addressing basic needs and protection.

Lead Faculty: Shannon Doocy, Gilbert Burnham

To improve the quality of care for patients with non-communicable diseases (NCDs) at 10 primary health care centers in Lebanon. This  study focuses on the delivery of health services for both refugees and local patients with hypertension and type II diabetes by working to develop new guidelines and improvements to quality of care and patient compliance. 

Lead Faculty: Courtland Robinson

This study will adopt a rights-based approach to conduct a systematic literature review; analyze personal data collected over 15 years on the China-North Korea border; and collect primary, qualitative data among North Korean-born populations in China and South Korea.

Lead Faculty: Nancy Glass

To conduct a community-based trial to test the effectiveness of a village led microfinance program on health and economic status and stigma reduction among survivors of trauma and violence in the Democratic Republic of Congo (DRC).

Lead Faculty: Tener Veenema Goodwin

To assess healthcare workforce readiness and health systems capacity for responding to a mass casualty event in Ireland. This study will assess disaster education needs in the healthcare workforce and explore how educational and mobile technology could contribute to increasing national health care provider preparedness in Ireland.

Lead Faculty: Wietse Tol

To conduct a cluster randomized trial to evaluate the efficacy of a guided self-help intervention aimed at reducing psychological distress in South Sudanese refugees in northern Uganda.

Lead Faculty: Adam Kushner, Gilbert Burnham

To study, in collaboration with Medecins Sans Frontiers (MSF) Operational Centre Brussels, multiple aspects of surgerical procedures performed at MSF facilities in over 20 countries from 2008 to the present. Past published studies have focused on  surgical deliveries, surgical needs of children, surgical infections, operations in the elderly, operative trauma, burn care, anesthesia care, and the health burden averted at the Kunduz Trauma Centre in Afghanistan prior to its closure in 2015. 

Lead Faculty: Gilbert Burnham, Antonio Trujillo

Lead Faculty: Gilbert Burnham, Mija-Tesse Ververs

To develop and launch a massive open online course (MOOC) focusing on humanitarian health and designed for people with interests in the public health component of humanitarian emergencies.

Lead Faculty: Gilbert Burnham, Anbrasi Edward

To prepare the faculty of medicine at Kandahar University to teach the coursework required for a Master of Public Health degree that the University will offer beginning in January 2017.  The project consists of a series of workshops for these faculty that cover curriculum design, MPH program management, teaching methodology, epidemiology, biostatistics, and other public health fundamentals.

Lead Faculty: Alexander Vu

To evaluate the effectiveness of an innovative, compassionate, community-based approach to identify, inform, and educate refugee survivors of violence/trauma and link them to medical, psychological and social referral services.  The intervention is a multi-level one that includes 1) provider/staff training; 2) universal education with screening for trauma and violence; 3) brief trauma-informed counseling with harm reduction, referrals to additional services, and safety planning; and 4) for refugees who do not disclose trauma or violence during the visit, offer of an information card on trauma/violence and wellbeing, with contact information for local and online resources. 

Lead Faculty: Alexander Vu

To conduct national surveys in Cote d’Ivoire and the Dominican Republic to assess the impact of statelessness on health access, access to protection, and vulnerabilities to gender-based violence compared to citizens of these host countries. 

Lead Faculty: Alexander Vu

To set up and conduct surveillance of traumatic injuries in the prehospital setting in Beirut and Northern Lebanon.

Lead Faculty: Alexander Vu

To set up and conduct surveillance of cardiac arrest in the prehospital setting in Beirut and Northern Lebanon.  

Lead Faculty: Tener Veenema Goodwin

To establish a collaborative among nine stakeholder organizations and build on an existing call to action initiative to advance national nurse readiness for disasters/public health emergencies. The collaborative will reach out to state innovation model sites and partners within two localities (Baltimore and St. Louis) to provide training in primary care that promotes a population health approach to disaster preparedness/response.

Lead Faculty: Tener Veenema

To assess the global adoption of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies and its impact upon improving population-based health outcomes following a disaster event. Barriers and opportunities for expanding adoption will be addressed. 

Lead Faculty: Wietse Tol

This project aims to build a relevant, feasible, acceptable, and effective mental health component into routine maternal and child health care in rural Uganda, both with Ugandan populations and with South Sudanese refugees.  

Lead Faculty: Wietse Tol

To evaluate a psychosocial intervention for reducing intimate partner violence and improving mental health in female Congolese living in the Nyaragusu refugee camp in Tanzania. 

Lead Faculty: Paul Spiegel, Shannon Doocy, Antonio Trujillo, Hannah Tappis

Providing universal health care coverage to refugees can enable the achievement of three important but often unattainable objectives: 1) affordable and cost-effective health care for refugees from the onset of an emergency until its resolution; 2) development of a (sub) national health care coverage system for refugees or the improvement of an existing health care coverage system for nationals; and 3) a reduction in dependency and an improvement in the sustainability of health care services for refugees - while reducing costs to governments and humanitarian and development organisations. Numerous innovative approaches for financing health care have been implemented successfully in a variety of contexts, but these approaches have not been sufficiently explored as solutions for financing the health care of refugees.  This study aims to fill this gap by producing a white paper that will explore various options for providing universal health care coverage to refugees in different contexts.  The feasibility of implementing each option will be a key part of the study.  

Lead Faculty: Lauren Sauer

To conduct a systematic literature review and legal analysis to understand the level of empirical evidence associated with travel restrictions around emerging infectious disease outbreaks, and the resulting policy changes that occur in a crisis.

Lead Faculty: Lauren Sauer

To understand the timeline of resource deployments to Sierra Leone during the most recent Ebola outbreak, and to understand the associated behavioral and community interventions and their association with (or impact on) the outbreak curve. 

Lead Faculty: Lauren Sauer

To understand the impact of infrastructure damage from the Nepal earthquake on the healthcare system of Nepal, using pre-, immediate post-, and 1-year post-earthquake assessment data.  Data address physical infrastructure, healthcare capacity changes, patient movement patterns, and service delivery interruptions.

Lead Faculty: Lauren Sauer

To compare two approaches for specimen characterization in an urban academic emergency department in order to identify pandemic-potential strains of influenza.  Comparing two novel-diagnostic technologies will allow us to better understand the potential timelines for an early pandemic identification and warning system.

Lead Faculty: Leonard Rubenstein, Courtland Robinson

To investigate the ethical quandaries health providers face in Syria as a result of systematic attacks against hospitals and medical staffs, and to develop tools to enable them to make decisions about how and where they offer services in the face of such extreme violence.

Lead Faculty: Courtland Robinson

To collect data on child marriage rates in emergencies and evaluate outcomes of existing child marriage interventions implemented in Ethiopia, Lebanon, and Burma by the Women's Refugee Commission and its partners. The findings from this study will provide the humanitarian community with evidence-based approaches to prevent and respond to child marriage in emergencies.  

Lead Faculty: Adam Kushner

To complete a population-based survey that is assessing unmet surgical needs in Nepal two years after the 2014 earthquake. This study is a replication of a 2014 population-based survey of surgical needs in the same area. Results from these surveys will be compared to understand how the earthquake has affected the surgical needs of the population. Another survey undertaken in 2016 is documenting the continued limitations  of 70 hospitals affected by the 2014 earthquake.

Lead Faculty: Adam Kushner

To determine what components of Alaska’s trauma system might be applicable to low-resource settings and ultimately improve trauma care in low-income countries.  Despite geographic and meteorologic challenges, a dispersed population with multiple cultural differences, and health care resource limitations, the Alaska Trauma System is able to provide quality lifesaving care to injured persons, so it could serve as a model for trauma care in countries facing similar challenges.

Lead Faculty: Nancy Glass

To estimate prevalence, risk factors and consequences of gender-based violence (GBV) among adult men and women in the three regions of Somalia.

Lead Faculty: Nancy Glass

To carry out a community-based trial that will test the effectiveness of a gender-based violence (GBV) prevention and response program in Somalia and South Sudan.

Lead Faculty: Nancy Glass

To conduct a community-based trial that will evaluate the effectiveness of a youth-led microfinance program on health outcomes for youth aged 10-14 and their families in rural villages in the Democratic Republic of Congo (DRC).

Lead Faculty: Nancy Glass

To test the effectiveness of a trauma-informed intervention in adult women seeking health care/family planning services in urban and rural clinics in 3 US states (WVA, Arizona, Mass).

Lead Faculty: Nancy Glass

To test the effectiveness of a safety decision aid application (myPlan App) with young women (18-25 years) in abusive relationships and concerned friends (also 18-25 years) enrolled in 41 colleges/universities in Oregon and Maryland (total of 41 colleges/universities in the two states represented).  At the end of the effectiveness phase of the study, we will work collaboratively with colleges/universities, professional organizations, student organizations, etc. to evaluate dissemination of the myPlan app nationally.

Lead Faculty: Anbrasi Edward, Thomas Kirsch

To carry out a  case control, retrospective research study on the effectiveness of an Ebola Virus Disease (EVD) intervention on EVD knowlege and careseeking at the community level. Findings from this study will inform policy and practice for future emergency interventions fimplemented by World Vision and other NGOs. 

Lead Faculty: Anbrasi Edward, Henry Perry, Antonio Trujillo

To carry out a  a multi-country, two arm,  quasi experimental study - with a comparison group - that will evaluate the impact of integrated community based interventions on maternal, newborn, and child health. 

Lead Faculty: Shannon Doocy, Hannah Tappis

To assess the effectiveness and cost-effectiveness of three different point-of-use water treatment technologies (a flocculent-disinfectant, a disinfectant, and water filters) in reducing the incidence of child diarrhea and length of stay in the Community-based Management of Acute Malnutrition (CMAM) program.  Based on the well-documented cyclical nature of waterborne disease and undernutrition, we hypothesize that the addition of safe drinking water will reduce the amount of time for children impacted by severe acute malnutrition to recover, which will in turn increase the cost-effectiveness of CMAM programs by reducing the quantity of Ready-to-Use Therapeutic Foods (RUTFs) that are required by each child.  

Lead Faculty: Shannon Doocy, Hannah Tappis

To evaluate World Food Program (WFP) lean season assistance, in the form of in-kind food and cash transfers, to rural households facing extreme food insecurity in Zimbabwe, especially during the lean season leading up to the harvest. The evaluation will (a) examine the effectiveness of the food and cash transfers in helping households achieve food security; (b) understand beneficiary preferences and challenges associated with each transfer modality in the Zimbabwean context; and (c) determine if WFP-funded productive asset creation projects help to increase resilience.  

Lead Faculty: Shannon Doocy, Hannah Tappis

Building on feasibility studies in Northern and Southern Syria in 2015-2016, this assessment aims to provide information to plan and improve future humanitarian response in Syria.

Lead Faculty: Judy Bass, Paul Bolton, Laura Murray

To evaluate the impact of two different models of an evidence-based psychotherapy (Common Elements Treatment Approach - CETA) model for treating common mental health problems among internally displaced persons (IDPs) and veterans in Ukraine.  One model is a standard 8-12 session treatment regimen and the other model is a shortened 5 session version.  We will evaluate the effectiveness of each approach compared to a wait-control approach and also compare the short and long approaches  to demonstrate that that the short version is not worse than than the longer one.  

Lead Faculty: Judy Bass, Paul Bolton, Laura Murray

To investigate the 5-year impacts of a group psychotherapy program by conducting qualitative and quantitative interviews with the counselors and participants from a previously conducted trial.