Recap: 2018 ICEH Alumni Workshop & 2016/17 Graduation Ceremony, 6-9 March, 2018

The 2018 ICEH Alumni Workshop was held last week and it was a great success. I wish I could thank each one of you in person for the success of the workshop. Please enjoy the photo gallery of the week’s celebration (link below). I apologise in advance if you were not included.

Just like last year the alumni and current MSc Public Health for Eye Care students have expressed how valuable the alumni workshop is for them and this is accredited to the support and enthusiasm of everyone involved in attendance and those from afar throughout their entire MSc experience. As this is the only workshop of its kind at LSHTM we are happy to hear this.

There has been a large interest in the alumni presentations. Below is a summary of the presentations of the alumni who were in attendance at the workshop for your viewing.

On behalf of the Disability and Eye Health Group, thank you to everyone who contributing to a successful workshop and we look forward to celebrating our new alumni next year and the years to come.

Photos: Click here to view photos of the Alumni Workshop on Flickr
Each image can be downloaded by clicking on the desired image, clicking on the down arrow towards the right of the image and selecting size quality.

ICEH Alumni Presentation Summaries: 2018 Alumni Workshop – Presentation Summary

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World TB Day – March 24 2018

March 24th is World TB Day. World TB Day was designed to bring public awareness to what is still considered an epidemic in much of the world and was chosen to be on this date to commemorate the day in 1882 when Dr. Robert Koch announced he had discovered the cause of tuberculosis.

To mark World Tuberculosis Day on the 24th of March, we here at the archives would like to highlight the archive of Sir Arthur Newsholme, a pioneer in public health who took a special interest in TB.

Newsholme was born in Haworth, Yorkshire, who took his medical qualifications in London. Later, he went on to serve as the Medical Officer of Health for the parish of Clapham in 1884. In 1888 he took on the same role but in the parish of Brighton, where he campaigned against the contamination of the local milk supply by the use of cows suffering from tuberculosis, even bringing an infected cow’s udder to a meeting in 1897 to dramatise his case.

A lecture on TB by Newsholme, 1897.

Whilst serving as a Medical Officer of Health, Newsholme conducted research in epidemiology, particularly relating to tuberculosis. He has been credited with demonstrating that the decline in tuberculosis in England and Wales from 1838- 1894 was due to the segregation of poverty-stricken sufferers into workhouses, rather than improvements in public living standards. He noticed that in Ireland, where poor relief continued to take place in the home, the death rate from TB rose instead of falling during the same period.


Instructions for after leaving the sanatorium

Newsholme continued to do battle with the disease as Principal Medical Officer for the Local Government Board from 1908-1918 and as a member of the Army Sanitary Committee during the First World War. He was knighted in 1917, received the Bisset Hawkins Medal the same year and later retired in 1919. Even after retirement, Newsholme continued to consult, write and lecture on public health until his death in 1943.

Instructions for after leaving the sanatorium

Newsholme’s papers are held in the LSHTM Archives and include private correspondence, Annual Reports of Local Government Boards and articles, reports and notes on tuberculosis, with particular reference to compulsory notification. The archive also holds his writings on other areas of medicine, notably infectious and epidemic diseases and all aspects of public health.

If you would like to view or find out more about Sir Arthur Newsholme’s papers, or the records of other scientists involved in the fight against TB, please visit our webpage at or contact us at .

To find out more about World TB Day please visit

Or view an infographic here


Understanding Primary Care Co-Commissioning: Uptake, Development, and Impacts. Final report (March 2018)

The Health and Social Care Act 2012 gave the power and responsibility for commissioning health services and budgets to groups of GP practices called Clinical Commissioning Groups (CCGs). CCGs will commission the great majority of NHS services for their patients but will not be directly responsible for commissioning services that GPs themselves provide. The responsibility for commissioning primary care services (medical, dental, eye health, and pharmacy) was given to a new statutory organisation called NHS England (NHSE), known as the NHS Commissioning Board in statute. This was to ensure a more standardised model and consistency in the management of the four groups.

In May 2014, following Simon Stevens appointment as the Chief Executive of NHS England, CCGs were delegated the responsibilities to commission primary care services. This was to enable better integrated care outside hospitals, ensure that primary, community and mental health are properly resourced, and CCGs having more influence over how funding is invested for local population, which would ensure sustainability of their local NHS. Co-commissioning would also enable the development of new models of care such as multispecialty community providers (MCPs) and primary and acute care systems (PACSs), as set out in the NHS Five Year Forward View.

This report presents the findings from a study following the development of Clinical Commissioning Groups (CCGs) in England. This is the third phase of the project, which aims to understand the ways in which CCGs are responding to their new primary care co-commissioning responsibilities from April 2015, providing feedback to NHSE supporting CCGs going through the approval process.

The study provides detailed evidence about the experiences of CCGs as they took on delegated responsibility for primary care commissioning. The study took place between May 2015 to June 2017. The strength of this study lies in the bringing together of evidence from senior policy makers as to the overall objectives for the policy with both telephone survey and case study evidence as to how it is playing out in practice. The specific research questions addressed in this report are:

  • What is the scope of co-commissioning activity and the process of change?
  • What approaches have been taken by CCGs to:
    • Develop governance structure to oversee primary care co-commissioning?
    • Commissioning and contracting?
    • Manage and develop the relationships between CCGs and their membership and between CCGs and external stakeholders?
    • Manage conflicts of interest?
  • What are the impacts and outcomes CCGs would expect from taking on delegated responsibility and claims of early successes?
  • What factors have affected CCGs’ progress and development?

Download report [pdf]>>

Download executive summary [pdf]>>


Planning and managing primary care services: lessons from the NHS in England

It is generally agreed that access to high-quality primary care is vital in the quest to provide the best possible health care at the lowest cost. Finding new ways to deliver and extend access to primary care services is of high priority in many health systems. The UK is no exception, and the past 30 years has seen a wide range of initiatives focused on primary care—particularly services provided by primary care physicians: GPs. Some initiatives have focused on payment models, altering contracts in an effort to change behaviour. Others have focused on the planning side, repeatedly enlarging, shrinking and reorganizing the organizations with responsibility for commissioning/purchasing primary care services on behalf of a population. In this paper we explore the latest of these policy and organizational changes, presenting the findings from an empirical study investigating recent changes to the commissioning of primary care services in England. Using an historical account of mechanisms to plan and manage GP services in England, we identify some of the issues involved. We explore the espoused logic underpinning the current reforms, and present early evidence about their implementation, highlighting the extent to which they may meet official aims and address the identified issues. The contribution offered is twofold:

  • First, we offer an account of the development of planning and management of GP services in England, bringing clarity to a complex field and providing valuable evidence for those responsible for overseeing primary care services in the UK and internationally.
  • Second, our exploration of the implementation of the latest round of reforms provides some lessons about the interplay between local, regional and national planning, and about the ways in which policy is made and implemented.

Read the paper >>

International Happiness Day, 20th March 2018!

Today, Tuesday 20th March 2018, is UN International Day of Happiness. Adopted by unanimous decision by UN members in June 2012 and first observed around the world the following year, the event is celebrated in 193 UN member states and was created by UN Special Advisor, Jayme Illien.

The objective of this international event is to recognise the importance that happiness serves in the overall achievement of good health and well-being. Yet the significance of happiness and how one goes about achieving it has been hotly debated, especially within the philosophical, political and health sciences. What do we mean by the term ‘happiness‘ and, what rights and duties do we have towards each other in ensuring adequate levels of happiness on an individual and societal level? How does one measure happiness and compare these values on an international level? In the case of euthanasia, the pursuit of happiness might be the achievement of death, in that case, what can one do to support an individual in achieving these goals? You can imagine some of the difficulties in translating the pursuits of happiness into policy.

To get you thinking about the relevance of happiness in global health studies I’ve listed a few references with blurbs selected from both the physical and online Library collection at LSHTM:

The World Happiness Report 2018, UN Sustainable Development Solutions Network, UN World Happiness Report PDF

Not surprisingly, the top 3 happiest countries were dominated by Northern European countries; Finland, Norway and Denmark. However, in addition to measurements of subjective well-being, the report also included data of the happiness of immigrants where Finland came top. Interesting to note is that contrary to the traditional use of GDP as a measure of well-being, the report revealed that the richest countries did not necessarily have the happiest populations, where Latin America experienced a ‘happiness bulge’ attributed to strong a emphasis on familial and social relationships.


Glatzer, W. (2015). Global handbook of quality of life : Exploration of well-being of nations and continents (International handbooks of quality-of-life). LSHTM Catalogue

This book aims to bring together an insightful account of the concept of quality of life and well-being research on a global scale. Focusing on regions such as Sub-Saharan Africa, South America and Eastern Europe, contributory highlights include the importance of balancing the measurement of well-being between traditional economic and social values as well as issues surrounding migration and old age.


Withington, P. (2016). Utopia, health, and happiness. The Lancet, 387(10033), 2084-2085.

In this insightful article, Withington celebrates the 500th anniversary of Thomas Mores’ Utopia and asks what we can learn from this text in the theme of helath and happiness.




Cieslik, M. (2015). ‘Not Smiling but Frowning’: Sociology and the ‘Problem of Happiness’. Sociology, 49(3), 422-437.

Cieslik warns that we shold be wary of attributing happiness to the pursuit and progress of modernity. Through qualitative interviews, evidence suggests that lay experiences of happiness are far more social in nature than previously put forward by theorists Durkheim and Marx and contemporary writers, Ahmed and Furedi. What truly matters to people is the balance between suffering and having a floursihing life.


Scikszentmihalyi, M. (2002). Flow : The classic work on how to achieve happiness ; [with a new introduction by the author]. (Rev. and updated ed.). London: Rider. Classmark: UJBM

The raw gist of the book is that happiness is not something that happens to a person or an experience of luck. Instead, happiness is a condition that must be prepared for, developed and refined by an individual. This book is a culmination of about a decades worth of research by Scikszentmihalyi, regarding the positive elements of the human experience such as joy and creativity which contributes to the process of full involvement with life, what the author describes as ‘Flow‘.

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INFOGRAPHIC: Global Strategy for TB Control


To download this infographic in a larger PDF form, click here: Global TB Control Infographic.

The below infographic is interactive and clickable where hyperlinked.

We invest millions in health, but still millions are dying

By Shelly Batra (Co-Founder and President, Operation ASHA)

TB – a disease that continues to plague the poorest

When I was a student in King George’s Medical College, India, a group of doctors came from the UK to visit our hospital. They said to my Professor,

May we see a tuberculosis (TB) patient.”

They wanted to see just one patient as a learning experience, because at that time, TB had largely been eradicated from high income countries. I recall my Professor’s reply:

We have wards and wards full.”

This was in the 70s. Today, there are 10.9 million new TB cases in the world every year. A disease which is as old as the hills has become a global pandemic, leading to huge suffering, economic loss and deaths. In fact, TB has been responsible for the death of more people than any other infectious disease in history. In 2006, I established Operation ASHA with a focus on TB, the biggest health crisis in the world and , which the World Health Organization declared a ‘global emergency’ in 1993.

Health systems challenges in India

We conducted extensive research to find out what the reason was for this sorry state of affairs with respect to tackling TB, focusing first on India. What we found was an eye-opener. India has a huge government program where there are well equipped TB centers all over the country. These have the best equipment, specialists, medicines & diagnostics, all available for free – everything was available- but not accessible. The challenge was of last-mile delivery (close to patients’ homes), which is essential both for early diagnosis and for ensuring completion of the six-month TB treatment course .

All over the country there are posters that say, if you are coughing, go to the nearest government laboratory for a sputum test. The message is loud and clear but unfortunately, it does not reach the people. No one seems to know where the nearest laboratory is located. Very often the disadvantaged are intimidated by government infrastructure and absenteeism in government programs is as high as 40%. How many times would a daily wager or laborer go for a simple sputum test to the lab? Each day means a loss of work, and when there is no work there is no food for the family. This is one of the reasons why, in some cases, patients go undetected for decades.

Those who do get diagnosed, find it impossible to travel every day to the government center in order to take their 6 month medication. In the DOTS program, medicines have to be swallowed at a designated center in the presence of a trained provider. Existing centers are few and far between and are open during working hours. It is unfeasible for patients to travel, say 10 miles daily, invest in bus fares, and suffer a loss of wages for the day. Patients who do initiate treatment often leave midway when they start feeling better, and this is how drug-resistance sets in.

Stigma and TB

Another issue is the stigma related to TB. Patients suffering with TB remain hidden in the shadows and live with fear, shame and guilt. Every day they struggle with negative thoughts:

TB is a curse from the gods. It’s because of my past karma. It’s a curse from the gods. I am doomed to die. My children will die.”

Every year, a 100,000 women are abandoned by their families if they have TB and 300,000 children forced to leave school. People are thrown out of jobs, and the loss of wages is 260 million GBP every year.

We concluded that the only solution was to fill the gaps within the government program, and we tackled this in several ways.  

  • We collaborated with the Indian government’s TB control program to get free services, including medicines from the government
  • In urban slums, we opened treatment centers in the premises of community partners. This could be for instance, a religious place like a temple, mosque or gurdwara a local doctor’s clinic, or even a small shop. These would be conveniently located and open early morning and late at night
  • Following success in India we applied this model in Cambodia

This was all about providing doorstep delivery, convenience and privacy.

  • We hired a cadre of workers called TB Providers. They belonged to the same community they would serve. They would eat the same food and worship in a similar manner as the rest of the community. We train our Providers in nutrition and hygiene and other health issues, so that they project themselves as health workers, not TB workers. This helped them overcome stigma. Our Providers carry out the full spectrum of TB activities which includes awareness, detection and counselling of families. They facilitate testing of patients in the government centers, either by finding out what time the lab technician will be available, or by carrying sputum samples themselves to the lab. They also provide every medicine with their own hands, so every dose is supervised. They use eCompliance (a Microsoft Research collaboration) where we use fingerprints to track every dose taken. We are now using eyeAdherence, where iris scans are used for the same purpose. Providers help dispel myths, ensure unstigmatised provision of care, and also offer free over-the-counter medicines to take care of treatment side effects. Where patients are scattered, providers go on bicycles, motorcycles and even on boats, right up to the doorsteps of patients to do their work.

Outcomes of treatment

We have successfully overcome many challenges, and our results are there for all to see. A research paper by Soumya Swaminathan (Deputy Director General, WHO) says that

Our default rate is less than 3%, and we have a system where data fudging is not possible. A fingerprint/iris print cannot be fudged. According to Soumya, the treatment success rate in India is only 74%, while ours is 89%.

Our cost is also 32 times less than others. A post published by Deen Garba in CSIS (Center for Strategic and International Studies), says:

Globally, NGOs spend an average of $852 detecting each patient. By contrast, Operation ASHA spends $80 on both detection and treatment.”


While the fruits of labour give great happiness and success is sweet, I must truthfully say that it has been an uphill task. Over the years, I have faced ridicule, opposition, resistance and even threats. Even today there are some government officers who claim that their results are superlative and they don’t require NGOs, neither do they require technology for accuracy and transparency. No doubt it has been difficult, but I am not daunted. There’s miles to go, and I know there are many people like me, who work with courage and joy in their hearts, and together one day we hope to eradicate TB for good.

Continue reading

12 – 18 March 2018

An editorial by Lucinda Hiam and University of Oxford’s Danny Dorling is reported widely by UK media. Based on latest mortality statistics from the Office for National Statistics, they state that the government is failing to investigate a clear pattern of rising death rates in England & Wales. Lucinda is quoted by the Daily Mail: “The figures for this year make the case for an investigation both stronger and more urgent with each passing day.” Articles are also published by the Daily Telegraph, The Independent, Daily Express, Daily Mirror, The Times (£), i News, BBC Wales, The Herald (Scotland), Yahoo News UK and Die Welt (Germany).

A study led by the LSHTM Cancer Survival Group found that despite the introduction of national cancer strategies since 2000, further improvement of cancer survival in England has rarely been observed. Lead author Aimilia Exarchakou is quoted by the The Times (£): “We found little evidence that cancer policies have had a direct impact on survival in England, with outcomes consistently worse among the more deprived patients.” The study is also reported by the Daily Mail.

Suzanna Francis is quoted by Times Live (South Africa) on an LSHTM-led study that found young women in rural South Africa are more likely to carry two common sexually transmitted infections (STIs) than young men. Suzanna said: “STIs can cause serious morbidity‚ including pregnancy complications‚ cancer‚ infertility and enhanced HIV transmission. Most of these … are preventable if STI testing and treatment is implemented.

PRUComm Annual Research Seminar

Since the establishment of PRUComm in 2011 our research has focused on examining how the changes to the English NHS and public health system have developed. We continue to examine the development of CCGs and the new commissioning structures. We have also been exploring the mechanisms by which commissioning is undertaken, such as contracting and the use of competition and cooperation within the new system.

While most media attention has focused on changes to the commissioning and delivery of healthcare, the shift of public health to local authorities was a major part of the reforms introduced in April 2013. We have examined the progress and developments in the public health system with a particular emphasis on how governance and organisational structures develop and whether being embedded within local councils changes the way that public health services are provided. We have also been focusing on primary and community health care with recent projects examining general practice – including methods of funding primary care; research on recruitment and retention; QOF, scaling up primary care and running and analysing two rounds of the GP WorkLife survey (eight and nine).

Our research on CCGs has most recently focused on primary care co-commissioning and new forms of contracting, such as outcomes-based and alliancing. Given the increasing policy emphasis on this area of healthcare we anticipate that we will be increasingly involved in further research on primary and community healthcare. All these topics will be explored in today’s seminar with presentations by researchers from PRUComm.

Programme and speakers biographies [pdf]>>


9.30 Registration and refreshments

10.00 – Welcome and introduction: Professor Stephen Peckham (Director PRUComm).

10.00 – 10.25 Jonathan Walden: (Commissioning Policy Lead): Policy update – Department of Health and Social Care priorities.  Slides [pdf]>>

10.25– 11.00 Dr Lindsay Forbes: Incentivising GPs: Review of the Quality and Outcomes Framework in England. Slides [pdf]>>

11.00 – 11.20 Coffee

11.20 – 12.00 Dr Jon Gibson and Prof Kath Checkland: Satisfaction, sources of stress and intentions to quit amongst GPs in England: the results of the 9th GP Worklife survey

12.00 – 12.40 Dr Marie Sanderson: Examining the implementation of new models of contracting in the NHS: what are the lessons for the formation of Accountable Care Systems? Slides [pdf]>>

12.40 – 13.20 Lunch

13.20 – 14.00 Dr Valerie Moran: How are CCGs managing conflicts of interest when they commission primary care? Lessons for Accountable Care. Slides [pdf]>>

14.00 – 15.50 Panel Discussion – STPs, and ACS’s the re-emergence of planning?

15.50 – 16.00 Professor Stephen Peckham: Current PRUComm research programme

16.00 Close