Our Alumni Blog has moved to the LSHTM website, you can keep up to date with our alumni community at https://www.lshtm.ac.uk/newsevents/blogs.
If you have any questions, please email firstname.lastname@example.org.
On the 15th of January 2021, our friend and colleague, Dr Bart Jacobs, died tragically in Cambodia where he lived with his wife and two children. He will always be remembered for his commitment to transforming health systems and making health care available to all, especially the poor.
We have collected some tributes from friends and colleagues of Dr Bart Jacobs below and have compiled a Bart Jacobs Tribute Research Collection of his published papers in Health Policy and Planning.
I and many friends and colleagues in Cambodia were deeply saddened to learn about the passing of Dr. Bart Jacobs. Bart was born in Vilvoorde, Belgium but lived and worked in South-East Asia for over two decades. Much of this time he spent in Cambodia, working with the government and various development partners, including the German international development agency GIZ. In Cambodia, he was not only a recognised public health professional and academic, but also a good friend to all who had the pleasure of working with him. His years of dedicated work as a public health programme manager and researcher have greatly contributed to the development and improvement of the Cambodian health system. He was a principal founder of Buddhism for Health, a Cambodian religious-based non-governmental organization that mobilizes community resources to help poor people access health care. In recognition of his significant contribution to the social welfare of the Cambodian people, Bart was recently conferred with the Grand Cross of the Royal Order of Monisaraphon by His Majesty Samdech Preah Boramaneath NORODOM SIHAMONI, the King of Cambodia. I have had the pleasure of working with Bart on various research projects and we have published a number of scientific papers together in the fields of health policy and health systems, in particular, on health financing and financial protection. I first got to know Bart when we worked on the implementation and evaluation of the Health Equity Fund, a health financing scheme enabling poor people to access health care. We became good friends when we pursued our PhDs together at the Institute of Tropical Medicine in Antwerp, Belgium. His two-year connection with the National Institute of Public Health (NIPH), where I am now based, strengthened our bond not only as colleagues but also as close friends. During these two years, Bart significantly contributed to individual and institutional capacity building at NIPH and has left his mark on all of us. His compassion and loving heart towards all Cambodians will always be remembered. In this saddest moment, we would like to extend our sincerest condolences to his beloved family for the loss of their most respectful and loving husband and father.
Dr Por Ir, PhD
Associate Professor and Deputy Director, National Institute of Public Health, Cambodia
Once upon a time, in Kirivong, I met a gentleman with sparkling eyes and a permanent smile. His name was Bart Jacobs.
It was in 2004, when I arrived in Cambodia to work as a health financing adviser at WHO Country Office in Phnom Penh. Everyone told me I should meet Bart Jacobs, who then worked for the Swiss Red Cross in Takeo. But before I could organize to get in touch, I received a phone call: he was in Phnom Penh and he offered to meet for a drink. He was faster. I later learned that this was pretty much was summed up Bart’s personality: always faster, always sharper, always ahead of all of us when it came to health systems and health financing in Cambodia.
Other tributes have summarized his degrees, professional and personal achievements. They are impressive. But even more impressive was his commitment to the people of Cambodia; to the poorest, the most vulnerable, the modest, smiling, hardworking Cambodia. That is what I discovered when I finally went to Kirivong for the first time, to take part with him at a flowering ceremony in a pagoda, where Buddhism for Health collected money to support access to health services for the poor. We met with the monks and the elders, I witnessed the power of this grassroot organization to help people in need at local level; and seeing him there, living a simple life and managing targeted operational projects on the ground, I could never imagine that he would write the papers he wrote. District health systems in South-East Asia are now forever associated with Bart Jacob’s account of successful interventions in Kirivong.
Over the years, we had many great laughs and a few fights too, when we struggled through a project or a paper. We wrote a few articles together, over which we fought some more, and then laughed at each other and at ourselves. I co-authored the paper that he used as a conceptual framework in his PhD and he co-authored mine. With Bart, nothing was serious but everything was important, especially when it came to protecting people from hardship and ill health. He was on a crusade, he did not deviate from his course, always with that smile and that stubborn drive which made him the purest of us all, global health workers.
We will miss you Jaco. Although we worked and lived in different countries since a decade now, I can’t imagine a world where I cannot sit with you and reinvent health systems built around and for the most vulnerable. Your memory will keep us going, for you, my friend, would never leave anyone behind.
WHO Representative to Morocco
Those of us who had the pleasure of working with Bart know that to work with him also meant being a friend. He was always fun to be around and his cheeky grin is something few will forget. His thirst and curiosity for knowledge were infectious. Bart will also be remembered for his uncanny ability to straddle the worlds of health programme delivery and academia. He understood the complexities of working in global health and cleverly navigated the many, often competing agendas at play. Bart was an expert in agitating for change when he thought things were unfair or could be done better.
I had the pleasure of working with Bart on a number of health financing studies in the Asia-Pacific and it became apparent very early on that, despite being incredibly modest, he knew an awful lot about epidemiology, economics, health policy, health systems, and many other fields of research. He was in his element when conducting impactful, policy-relevant, multi-disciplinary research with partners from all around the world. While Bart’s research interests were diverse, ranging from access to medicines to the role of Health Equity Funds, a common theme emerged throughout his career which was improving access to health care by the poor. His research helped push forward the agenda for financial protection in health, especially in Cambodia where he was adept at bringing together decision-makers and analysts to consider the evidence on what interventions and policies worked best.
Bart was a very good friend to Health Policy and Planning. Below is only a snapshot of his contributions to our journal. He began publishing with us in 1999 and his last paper appeared very recently, in August 2020. While Bart always denied to me that he was an ‘academic’, many academics would envy his record in publishing and policy impact. Bart was not only a well-respected author, but he also reviewed many papers for our journal. He rarely rejected an invitation to review, often doing a review in the wee hours of the morning before starting his morning trek to work. While many of us are left with a great emptiness both professionally and personally, we can take heed in the vast legacy of research and lessons that this very unique, passionate, and hard-working man has left behind.
Dr Virginia Wiseman, PhD
Professor of Health Economics & Health Systems
Chair of Health Economics & Health Systems, Kirby Institute, University of New South Wales
London School of Hygiene & Tropical Medicine
Co-Editor-in-Chief of Health Policy and Planning
Bart Jacobs Tribute Collection
Feasibility of hospital-based blood banking: a Tanzanian case study
Bart Jacobs, Alec Mercer
Health Policy and Planning, Volume 14, Issue 4, 1999, Pages 354-362, https://doi.org/10.1093/heapol/14.4.354
Published: 01 December 1999
Community participation in externally funded health projects: lessons from Cambodia
Bart Jacobs, Neil Price
Health Policy and Planning, Volume 18, Issue 4, December 2003, Pages 399–410, https://doi.org/10.1093/heapol/czg048
Published: 01 December 2003
The impact of the introduction of user fees at a district hospital in Cambodia
Bart Jacobs, Neil Price
Health Policy and Planning, Volume 19, Issue 5, September 2004, Pages 310–321, https://doi.org/10.1093/heapol/czh036
Published: 01 September 2004
Improving access for the poorest to public sector health services: insights from Kirivong Operational Health District in Cambodia
Bart Jacobs, Neil Price
Health Policy and Planning, Volume 21, Issue 1, January 2006, Pages 27–39, https://doi.org/10.1093/heapol/czj001
Published: 17 November 2005
Improving access to hospital care for the poor: comparative analysis of four health equity funds in Cambodia
Mathieu Noirhomme, Bruno Meessen, Fred Griffiths, Por Ir, Bart Jacobs, Rasoka Thor, Bart Criel, Wim Van Damme
Health Policy and Planning, Volume 22, Issue 4, July 2007, Pages 246–262, https://doi.org/10.1093/heapol/czm015
Published: 25 May 2007
From public to private and back again: sustaining a high service-delivery level during transition of management authority: a Cambodia case study
Bart Jacobs, Jean-Marc Thomé, Rob Overtoom, Sam Oeun Sam, Lorenz Indermühle, Neil Price
Health Policy and Planning, Volume 25, Issue 3, May 2010, Pages 197–208, https://doi.org/10.1093/heapol/czp049
Published: 16 November 2009
Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries
Bart Jacobs, Por Ir, Maryam Bigdeli, Peter Leslie Annear, Wim Van Damme
Health Policy and Planning, Volume 27, Issue 4, July 2012, Pages 288–300, https://doi.org/10.1093/heapol/czr038
Published: 12 May 2011
Access to medicines from a health system perspective
Maryam Bigdeli, Bart Jacobs, Goran Tomson, Richard Laing, Abdul Ghaffar, Bruno Dujardin, Wim Van Damme
Health Policy and Planning, Volume 28, Issue 7, October 2013, Pages 692–704, https://doi.org/10.1093/heapol/czs108
Published: 22 November 2012
Equality in financial access to healthcare in Cambodia from 2004 to 2014
Adélio Fernandes Antunes, Bart Jacobs, Richard de Groot, Kouland Thin, Piya Hanvoravongchai, Steffen Flessa
Health Policy and Planning, Volume 33, Issue 8, October 2018, Pages 906–919, https://doi.org/10.1093/heapol/czy073
Published: 27 August 2018
Financial protection and equity of access to health services with the free maternal and child health initiative in Lao PDR
Somil Nagpal, Emiko Masaki, Eko Setyo Pambudi, Bart Jacobs
Health Policy and Planning, Volume 34, Issue Supplement_1, October 2019, Pages i14–i25, https://doi.org/10.1093/heapol/czz077
Published: 23 October 2019
Transforming health systems financing in Lower Mekong: making sure the poor are not left behind
Augustine D Asante, Bart Jacobs, Virginia Wiseman
Health Policy and Planning, Volume 34, Issue Supplement_1, October 2019, Pages i1–i3, https://doi.org/10.1093/heapol/czz098
Published: 23 October 2019
Exploring the determinants of distress health financing in Cambodia
Por Ir, Bart Jacobs, Augustine D Asante, Marco Liverani, Stephen Jan, Srean Chhim, Virginia Wiseman
Health Policy and Planning, Volume 34, Issue Supplement_1, October 2019, Pages i26–i37, https://doi.org/10.1093/heapol/czz006
Published: 23 October 2019
Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy
Augustine D Asante, Por Ir, Bart Jacobs, Limwattananon Supon, Marco Liverani, Andrew Hayen, Stephen Jan, Virginia Wiseman
Health Policy and Planning, Volume 34, Issue Supplement_1, October 2019, Pages i4–i13, https://doi.org/10.1093/heapol/czz011
Published: 23 October 2019
Can social accountability improve access to free public health care for the poor? Analysis of three Health Equity Fund configurations in Cambodia, 2015–17
Bart Jacobs, Sam Sam Oeun, Por Ir, Susan Rifkin, Wim Van Damme
Health Policy and Planning, Volume 35, Issue 6, July 2020, Pages 635–645, https://doi.org/10.1093/heapol/czaa019
Published: 03 May 2020
Cross-border medical travels from Cambodia: pathways to care, associated costs and equity implications
Marco Liverani, Por Ir, Bart Jacobs, Augustine Asante, Stephen Jan, Supheap Leang,Nicola Man, Andrew Hayen, Virginia Wiseman
Health Policy and Planning, Volume 35, Issue 8, October 2020, Pages 1011–1020, https://doi.org/10.1093/heapol/czaa061
Published: 16 August 2020
We were very sad to hear about the death of Dr Joseph Sonnabend on 24 January 2021 at the age of 88. In 2014, Joseph Sonnabend deposited a large collection of his archives with the LSHTM Archives Service. Sonnabend was not connected to the School but we received an urgent message from his friend Simon Watney that the collection needed a home or was going to be dumped in a skip. We made a quick decision that this collection was too important not to be saved and it also complimented our other collections relating to HIV and AIDS. In 2019, we received an additional set of material.
We have very fond memories of sitting at Joseph’s kitchen table in his London flat, drinking tea, stroking his beautiful cat and discussing his records. He could pick up a letter and tell you in great detail the story behind it. He also spoke about his childhood in Africa, it was fascinating to hear about his views on colonialism and his career in early AIDS research and care.
Joseph Sonnabend (b.1933) was a physician, clinical researcher, and community activist who played a significant role in the fight against AIDS from its earliest onset in the United States. His archives chiefly relate to his experience treating and researching AIDS in New York City and includes extensive research notes, laboratory notebooks, research data, scientific articles and medical records of patients he treated in his Greenwich village private practice along with material relating to his involvement in community based research such as papers relating to AIDS Medical Foundation (which he co-founded) and the Community Research Initiative/Community Research Initiative on AIDS, as well as the PWA Health Group.
Alongside the material relating to AIDS, the archives also holds research papers from his earlier career as a virologist studying interferon with Alik Isaacs, one of the discoverers of interferon. He spent more than a decade studying interferon largely for the Medical Research Council based in Mill Hill but later in the United States. Papers also include his work on infectious and venereal diseases in the States and include one of his earliest medical posts as a medical investigator onboard a ship returning Muslim pilgrims to Indonesia during an epidemic of meningitis.
The collection includes material on the publication ‘How to Have Safe Sex in an Epidemic: One Approach’, published in 1983. This publication was the first to advocate safe sex as a way to prevent the spread of AIDS. Joseph Sonnabend provided the scientific advice for the manual which was produced by two of his patients, Michael Callen and Richard Berkowitz. The book proved controversial with parts of the gay community as it opposed many aspects of sexual freedoms practiced at the time. The guide provides rational advice for safer sex for sexually active individuals, rather than condemning all physical contact or using medical language. There is further information on this publication in this blog post: Who was reading ‘How to Have Sex in an Epidemic’? – Library & Archives Service blog (lshtm.ac.uk).
In addition, to the papers deposited at the LSHTM archives and equally significant archive collection is held at the New York Public Library. The online catalogue provides a more comprehensive biography of Joseph’s pioneering work fighting AIDS in the United States.
For further information on the collection, please contact email@example.com.
Here are links to some obituaries on Joseph Sonnabend:
Here are some numbers that summarise our in-DEPTH work for 2020…
The number of citations of our piece in The Lancet, Community participation is crucial in a pandemic. In it, we lay out steps governments and health bodies must take to ensure citizen participation.
The number of sickle cell patient and carer experts with whom we co-produced This Sickle Cell Life. We recently collaborated with them to present study findings to London NHS Trusts.
The number of hits on our tweets in 2020 from our DEPTH Twitter feed. If you don’t follow us already, now’s your chance!
Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. The journal consists of four sections; Health Systems Research, Health Economics, Health Policy Processes and Implementation Research and Evaluation.
2020 was an extraordinary and challenging year with the COVID-19 pandemic hitting the world, workloads and ways of working shifting to new norms and journal submissions continuing to rise. At Health Policy and Planning in 2020, we published another two supplements with popular podcasts with authors on Health Systems Research Mentoring: Supporting early career women in LMICs and Innovations in Implementation Research in LMICs, new Research Collections including Evidence to inform the COVID-19 Response and a collection In Memory of Professor Val Curtis. Our editors processed over 960 submissions (not including revised submissions) and published 140 articles. Our impact factor remained steady at 2.704 providing us with a 5-year impact factor of 3.154 and placing us 18th out of 87 within the Health Policy & Services category.
Below you can find our top 10 most cited, downloaded and most accessed content in the past year from content published in 2020 and we look forward to another fruitful and innovative year in 2021.
Top 10 Cited Papers
Top 10 Downloaded Papers
Top 10 Altmetric Scoring Papers
This year we have received a lot of enquiries from students and staff, including some of my library colleagues, about how to use e-books : how to read them, how to download, whether you need to use special software to download, and limits on how much you can copy or print being some of the most common questions.
Library e-books are mostly provided via commercial platforms, which offer a plethora a different licence and access models. Some titles permit a single user, others several simultaneous users, and some allow unlimited access. Very few titles offer a permanent download of the whole book. Copyright also comes into play regarding how may pages you can download or print. Some platform providers require their readers to create a personalized account for certain functions such as adding notes.
Last term I was tasked with putting together some instructional videos to demonstrate the main features of our most frequently used platforms; VLe Books and ProQuest Ebook Central.
Recording these videos was a new experience for me and at one point I was reminded of using audio recordings from my notes and exercise books when revising for exams when I was sixteen. Of course, this time I was recording not for my own benefit, but for that of staff and students, so in the delivery I used some techniques that I learned by observation of others, such as those of my colleagues, past and present, in the Information Services Team. My experience of reading out questions at quiz nights and speaking at trade union conferences also came in handy.
I’d like to thank all of my colleagues for providing feedback and advice on making the videos and I hope you find them useful. You can find them in the following places:
https://ble.lshtm.ac.uk/course/view.php?id=88 Moodle : under Finding items in the Library – Accessing e-books.
https://lshtm.sharepoint.com/Services/library/Pages/Resources.aspx Sharepoint (Intranet)
New year, new blog post! For our latest piece, DEPTH researcher Dr Sam Miles reflects on the journey from PhD to first academic job, and offers some advice to ECRs (early-career researchers) pursuing careers in academia. This blog has been adapted from The Royal Geographical Society ‘Postgraduate Life‘ Series, which you can find here.
I was recently invited to write a guest blog for the Royal Geographical Society about my journey to my first academic job. I don’t have all the answers – in the piece below I reflect on exactly why this might be, and my concerns probably resonate with many of you – but I do have some ideas. Many of these came about after discussions with former students, current colleagues and other early-career researchers (ECRs) in the field, and notes of my own taken over the years.
It’s not as simple as a tick-list, though I cannot tell you how much I wish it were. I just hope that these ideas can be helpful to social science students here at LSHTM and in the wider job market applying for postdoctoral or lecturer posts. I was asked to write the kind of blog post I wish I’d read when I was starting to job hunt; with that in mind, here goes.
It’s one of those truisms that finding an academic job is hard. And it really is – it feels somehow unlike finding any other kind of job, and the specific knowledge around academic job hiring processes is something you’re also somehow expected to know, maybe by osmosis. It’s no wonder Imposter Syndrome strikes so many of us. Take for example academic CVs, where longer is better. It goes against every fibre of my being to go over the 2 pages I was always told is the maximum you should fill. Even the listing of education/jobs/experience is differently ordered in an academic CV to CVs in every other job in the world. Job adverts themselves can be confusing in terms of terminology and contract type, or arcane or unclear working conditions, or freighted with acronyms without explanations. On top of this, salary, contract length and expectations of entry-level posts can be vague, missing or intimidating.
It all results in a task that feels unclear and applications that can feel rather uncertain. Usually, that’s through no fault of your own (as evidenced when you’re several applications in, facing radio silence from each institution. Are you even doing it right?) Obviously, the offer of an actual job would answer that question, but academic posts are so competitive that your empty inbox may be more of a testament to a stricken job market than your own application – and the COVID-19 pandemic has made a precarious market even worse. You will often be rejected without any feedback from the hiring institution. The standard response to requests for feedback is that feedback is only feasible at shortlist stage, but it is invariably difficulty to get to shortlist and interview if you don’t gain feedback on what you need to finesse! In the absence of clear direction from institutions, you may need to utilise a few different approaches. I’ll lay out some that I used.
Here’s what my own journey looked like: In the final year of my PhD, I applied to several lectureships. The applications I submitted were for posts that normally required a PhD, completed or near-completion. I took this to mean that they were open to nearly-there or newly-minted PhDs as much as anyone else, but have since recognised that the field of candidates is routinely so huge that many will have progressed a long way beyond this milestone. From asking more established colleagues at my institution, talking with early-career-researchers at a conference that spring, and looking out for the hiring announcements of successful candidates (people increasingly share job successes on Twitter), I realised the reality was that new PhD finishers rarely get these jobs. The market is crowded with brilliant and highly-qualified candidates. Vacancies are limited (and by some accounts, dwindling further).
It is now much more common for PhD finishers to work on one or several assistantships or postdoctoral posts before lectureships become a possibility. Even then, that post is often fixed term.
During my own job hunt, a Research Fellow post at the London School of Hygiene & Tropical Medicine (LSHTM) caught my eye. It required a PhD in public health or related discipline, including social sciences. Alongside my own research covering some (but certainty not all) elements of sexual health via a PhD researching the mapping of queer male relationships on location-based dating apps, I made sure I researched reproductive health, which was the other component of the post and an area where I was less experienced. The specification emphasised qualitative methods, which matched my experience, and co-produced research outcomes with communities. My doctoral research was participant-centred and I had been reflecting on making a safe space for sensitive topic discussions, but I wanted to develop this more in future work. The LSHTM post would specifically engage participatory research, so I took my knowledge of participatory action research (PAR) from my own work and brought myself up to speed on co-production and PPI (patient/public involvement) in health.
I revised (and revised, and revised) my academic CV, highlighting teaching experience as well as research outputs to date. I wrote a targeted cover letter which addressed each of the candidate specification requirements listed in their ‘essential’ list for the vacancy. I addressed each criterion only briefly, keeping the letter to the point, but then noted down longer answers to consider for a potential interview stage. The hiring panel requested academic and non-academic writing samples, so I included a published article but also a blog I had written about the Pulse nightclub shooting in Florida and its impact on LGBTQ space. I was shortlisted for interview(!) and prepared obsessively. I read articles, chapters and media pieces from the hiring team, and took them up on their invitation to produce a slideshow to present in the job interview. I tried to make sure I could highlight the ways in which my research experience matched their goals and I matched up every item in the person specification to a demonstrable activity, role or expertise. This is so key:
You need to show how you fulfil each and every ‘essential’ criteria to progress to shortlist. If you cannot show this, or don’t effectively communicate how you show this, your hiring panel will not be able to ‘get to’ other elements of your application that are lower ranking in priority.
And… I got the job! It was only a one-year contract, but with hopes of renewing this pending funding. That happened at the end of year one, and then again six months later, and again a few months later. Three years later, and I’m still hanging on. We are now embarking on a very exciting project, after which point I will again need to think about new grants, funding and tenure.
This brings me to precarity. One thing I was asked to reflect on in my blog post was worries I had when applying for academic posts. To be honest, it’s not a past tense concern: I’m funded for now, but then I’ll need to generate grant money for future posts. What started as a temporary position became less precarious, but I’ve yet to secure a permanent position, and know strikingly few ECRs who have managed it. Over half of all UK lecturers are now on fixed term contracts. I worked for several cash-strapped NGOs before my PhD and yet have never experienced precarity like I see in academia.
It’s not a personal failing of mine – nor of my colleagues, my line manager or even my Faculty. It’s the predictable result of the neoliberalisation of universities. ECRs are good value and high output, and the incredibly high requirements of REF and general institutional reputation require in turn workers who can relentlessly publish lots of high-quality, peer-reviewed research. In this context, the idea of ‘slow’ co-production in research sadly becomes a luxury, even as my colleagues and I have shown its value.
Some final tips:
The London School of Hygiene and Tropical Medicine (LSHTM) is seeking to appoint a senior academic as Brass-Blacker Professor in Demography. This is an exciting opportunity to join a well-established and highly regarded group of demographers and population scientists embedded within a world-leading School for public and global health. This is an endowed Chair, funded through a bequest to the School by John Blacker. The role offers an opportunity to shape the future of demography at LSHTM, taking forward the research agenda and teaching programme of a discipline so vital to current global health concerns.
The closing date is 1st March 2021.
For more information, please visit:
Rakesh Parashar, Ankita Mukherjee (Oxford Policy Management, Delhi)
In this blog series we are giving a voice to practitioners, implementers and policy-makers involved in national COVID-19 responses in low- and middle-income countries. These posts seek to facilitate timely cross- learning by sharing opinions, insights and lessons on the challenges and actions taken by those on the COVID-19 front line.
Lost in the discourse and politics of containing the pandemic through strict implementation  of COVID-19 guidelines, producing vaccines, creating public awareness, and an endless push and pull on the drugs to treat COVID-19, we seemingly have neglected something- the everyday people. Health systems are made for people, yet this pandemic is worsening social inequality. People living through the pandemic are more likely to fall sick and without health cover they face severe financial hardship. In a low-resource setting – amidst limited income, no health protection, and caring for the family -availing health services is a conscious decision, and often a low priority.
Any discussion on universal health coverage is incomplete if private health payments are not accounted for, yet this is largely missed during the biggest pandemic of modern history. Many additional families are now more likely to face catastrophic health expenditures (CHE) due to COVID-19-related expenses. Seven months into the pandemic, we are yet to estimate the additional productivity costs of COVID-19 incurred by different population groups. Therefore, we remind the global health community to prioritise health financial-risk protection of families, failing to do so could potentially derail the economic-wellbeing and impact their future. In this blog we highlight the case of India which has recorded the second-highest reported cases of COVID-19 globally by November 2020.
The case of India
India is one of the countries that spends the least on healthcare. The enormous disparity in the wealth distribution between an urban and rural wage-earner adversely reflects their healthcare-seeking behaviours. The poor cannot afford to fall sick as it will only make them poorer- even in public facilities. 60% of the healthcare expenses in India are met by out of pocket expenditure (OOPE) by Indian families. OOPE in India is ranked as one of the global highest with the major contributors being private healthcare service providers and cost of medicines. Before the pandemic, 55 million Indians were pushed annually below the poverty line due to such OOPE. In April 2020, India’s employment rate plummeted to 27% (vs 39% in April 2019) with a loss of 21 million salaried workers between April-August, invariably affecting the poorest.
The only way to access free or inexpensive health care in India is through the public health system, which can, unfortunately, cater to only about 30% of population needs at its current capacity. The COVID-19 burden was initially borne by the public hospitals; however, it negatively impacted the health service provision of non-COVID cases. Eventually, with incapacitated and overcrowded public hospitals, most of the large private hospitals also started providing COVID-19 treatment. The private hospitals and laboratories notoriously capitalized on the services provided and initially charged about USD60 for Sars-CoV-2 testing, USD1400 per day for ICU occupancy, and USD110 for ambulance services in some Indian states . Although the government later capped the price, these services remains a luxury for many. While the Out-patient department continue to be under-utilised, In-patient department (IPD) fees for all illnesses have increased due to the mandatory use of personal protective equipment (PPE). Moreover, some private hospitals have been accused of charging disproportionately inflated prices for PPE leading to remarkably high medical bills. The failure of many private insurers to cover the cost of PPE for IPD hospitalizations, means that families must bear this cost.
Has the government found a solution?
Clearly not. The national health protection scheme of India, still in its infancy, is attempting to cover COVID-19 testing and treatment for families registered below poverty-line. However, the number of beneficiaries availing these services are not publicly disclosed. These numbers are likely to be very low given the poor utilization of scheme in the empanelled large private hospitals where the hospitalization costs could often be greater than the national health cover provided. This clearly indicates that most patients availing treatment for COVID-19, especially the ones with ICU or longer hospital stays, would pay hefty OOPE, many of whom would . Consequently, the vulnerable may avoid utilising healthcare services, unless critical, due to the fear of CHE and abject deprivation.
In effect, the financial cover, especially for those visiting private hospitals for COVID-19 treatment, has not been thought well by the government. Like India, many Low- and Middle-Income Countries (LMICs) are facing a similar challenge and this is a significant issue to have been overlooked by the mainstream global health discourse.
The financial burden related to COVID-19 treatment can bar many families to seek care and can be an important reason for poor containment of the pandemic. This can lead to an excess wage loss, morbidity and mortality resulting in a vicious cycle of economic loss and a rising inequality. We hence argue that the governments should cover the COVID-19 treatment costs and offer financial protection to families at risk of CHE. Essentially, the governments should regulate and provide cover for OOPs incurred on direct and indirect costs of COVID-19 care such as transport, wage loss, OPD expenses, indoor expenses, tests, and medicines etc., while continuing the search for the highly contested vaccine and cure. The global health community must develop coherent strategies through necessary collaborations to mobilize resources and develop policies before many more of the everyday people are pushed towards or into poverty. The poor are already facing the brunt of the pandemic due to overcrowded public hospitals resulting in delayed availability and sub-optimal level of care that cost lives. More research is thus required to understand the social determinants of COVID-19 transmission, including financial barrier to COVID-19 care, especially in the in low-resourced settings.
 Includes enforcement measures to prevent transmission such as lockdown, curfews, fines for disobeying physical distancing or wearing masks, etc by the government.
 ‘Spending ≥40% of non-subsistence as out of pocket expenditure or ≥10% of household income; how-ever the cut-offs are variable per country
 Ambulance charged an average of up to USD 15 before COVID; respiratory illness such as TB tests cost about USD23; and ICU per day occupancy in private hospital were charged ~USD 410 and USD20 in public hospitals
Well, it’s 4 weeks to Christmas and that means that it’s 5 weeks until the first funders commit to Plan S! On 1st January 2021, Wellcome Trust and Bill and Melinda Gates Foundation will officially be Plan S-ers.
What follows is a quick reminder of what this will mean to researchers at LSHTM, what you need to know, and some handy tools to help you out.
The big news is that yesterday, 18th November 2020, cOAlition S’s long-awaited Journal Checker Tool (JCT) has launched! I’ve had a quick play on it, testing out imaginary publishing scenarios, and so far it’s easy to use and to interpret the results.
It gives all the possible ways of complying with Plan S, taking into account both your funder and your affiliation, giving you a tailored response: transformative agreement, fully open access journal, or self-archiving using rights retention.
The Rights Retention Strategy is cOAlition S’s strategy to allow self-archiving (green open access) to form a compliant option for Plan S funders. They have written to publishers and notified them that, if you inform them on submission that “the AAM resulting from [your] submission carries a CC BY public copyright licence” then you can deposit the accepted manuscript in a repository (for example LSHTM’s Research Online) for immediate open access from the publication date.
If the journal objects, cOAlition S say they’ll argue the case so you won’t have to.
They’ve even made a handy PDF summarising this and giving an example of the statement you provide upon submission.
We held a drop-in session for Open Access Week 2020 and recorded it. It goes into Plan S specifically at LSHTM, and answers some questions from viewers on that day. We’ll be holding more of these in the coming months and are also happy to answer questions via Service Desk, or come along to departmental meetings etc if you’d like an opportunity to pick our brains!
You can watch the recording here and we’ll also put it on Service Desk.
The Wellcome Trust is continually updating their page: Complying with our open access policy
UKRI have announced that they will be following Plan S from January 2022 so they state that “you should follow the RCUK policy on open access and REF 2021 open access policy until further notice. No changes will be made to the REF 2021 open access policy” You can keep up with them here.
The Wellcome Trust have said that 1st January 2021 is the cut-off date for submissions so anything submitted before this date will still be subject to the current open access policies. This means that if you are hoping to publish in a hybrid journal which is not under an LSHTM transformative agreement (at time of writing we have signed up to agreements with Wiley and Sage, but use the journal checker tool for more up-to-date information) then it’s time to think about submitting!
Familiarise yourself with the Journal Checker Tool, and other tools like DOAJ (the Directory off Open Access Journals, which could come in handy for ideas of where to publish) and Sherpa/Fact, the Funders & Authors Compliance Tool.
Chat to us! Ask us anything on Service Desk, schedule a phone call, or get us along to a departmental meeting. We’ll also be in touch with any more drop-in sessions we run.