2018-2019 Alfredo Gutiérrez Dissertation Awardee
MARIA JOACHIM, PhD Candidate, School of Public Health
Interview and text by Kathleen Ortiz-Tenesaca and Nicholas Farrugia, LACS Administrative Assistants
Maria Joachim is the 2018-2019 recipient of the Center for Latin American and Caribbean Studies Alfredo Gutiérrez Dissertation Award for Graduate Students for her dissertation titled “What factors influence successful implementation of Public-Private Partnership Initiatives (PPPs) for health service delivery in Low- and Middle-Income Countries (LMICs)?”
Maria’s research focuses on critically assessing the institutional and organizational factors that influence program implementation in global health. She explains, “I am looking at the case of a specific hospital and a specific partnership, Hospital do Suburbio, in Salvador, Bahia, Brazil where the government has partnered with the private sector to provide urgency and emergency care for a population of 1 million people. Is this organizational model offering quality care? Is this organizational model sustainable financially, politically, and managerially?”
The ultimate question Maria aims to address through her dissertation is how Bahia’s Hospital do Suburbio has managed to implement an administration for effective health care delivery for the last eight years as opposed to constituting another initiative that did not survive past its first years of operation by looking at the external social and political environment as well as the internal environment of the hospital. This question, its exploration, and understanding has ramifications far beyond Bahia to other states in Brazil and beyond Brazil to other Low- and Middle-Income countries that seek lessons for the provision of health care services for their populations and for the strengthening of the health system. These endeavors will surely contribute to narrowing the knowledge gap on the factors that influence hospital partnership implementation but also project implementation more broadly in the field.
Hospital do Suburbio will serve as a case of a hospital public-private partnership, as a case of the importance of politics in health policy, as a case of quality improvement as well as a case of management and organizational behavior in global health.
Early Concerns for Social Inequities: A Meaningful Upbringing in Cyprus
Maria originally hails from Cyprus, where she grew up until moving to the United States to attend Bates College in Maine. Having grown up in a lower-middle income family in Cyprus, a high-income country, she has always been concerned with social inequity and its resulting inequalities and consequences for two rights and privileges: education and health, both of which she holds close to her heart.
Beyond Bates College
Maria attended Bates College in Maine for an undergraduate degree in Biology and foreign languages, and Harvard University for her master’s degree in Global Health and Population. After graduating from Bates in 2003, she worked at a Children’s’ Hospital in Boston for 7 years and volunteered in Peru and Nepal for 1 year working on tuberculosis and family planning programs before returning to Boston for her master’s degree.
Graduate Studies and Research at the University of Michigan
After her exposures abroad and receiving her Masters in global health, Maria realized that the rather dominant discourses regard philanthropy and volunteerism as major aspects of global health are perfunctory. “Without wanting to diminish the role of each, I feel that what the global health field is truly lacking is the application of management and organizational tools,” she explains.
When asked why she decided to study at Michigan, she replied, “I was looking to further develop my skills in health systems by bringing in what I felt I was missing in my training and what is missing in the field more broadly and is was research on management and organizations in global health. I was particularly attracted to the Health Services Organization and Policy program at UM as it seemed like a balanced cross-pollination with the Management and Organizations Department at the Ross School of Business.”
Maria explains that through her experience in global health, she came to the realization that what the global health field is truly lacking is the application of management and organization tools for sustainable and quality health program delivery. In many countries, public services which are meant to be free or almost free of charge are unresponsive to patients’ needs and lack quality controls. This is often the result of a mismanaged public sector, operating under conditions of clientelism and corruption. As a result, financially able citizens seek private health insurance and healthcare services, thus contributing to health inequity and thus resulting health inequalities among social groups. This is even the case with countries which have Universal Health Coverage aimed at providing health coverage for all their citizens, like Brazil.
My project is therefore inspired by social inequity for health and aims to critically assess the factors for successful program implementation for achieving healthcare access and healthcare quality as well as healthcare equality regardless of social status.
Listening to Community Voices vs. the “Armani Suits”
Maria strongly believes that many times community voices are left out of research. Instead, there is a more dominant north-south approach in which stakeholders are predominantly officials and elites, the ‘Armani suits,’ as she jokingly refers to them.
Once, during her time in Brazil, Maria describes that she accepted a lunch invitation to the home of a community member she had been working with. Her local advisor recommended against going, as Maria would be exposing herself to unsafe conditions as an outsider. A friend who had been assisting her with transportation even tried to convince her that she should make up an excuse to not go. It bothered Maria that she would feel such pressure to stay away from the community in which her research was focused.
It was incredible how I felt the closest to my research when I was in the community where it was all happening versus in a Ministry asking the ‘Armani suits’ questions (laughs). These were people that probably never visited the community for which they were drafting policies and we know that separation between the community and those who implement policy often creates resistance and program failure
On Finishing the Ph.D. and her Next Endeavors
In pursuing her Ph.D., Maria’s main mentor and dissertation chair has been Professor Scott Greer in the Department of Health Policy and Management at the University of Michigan. Maria feels she has been blessed with significant mentors in her education path who are “always being an ever-stimulating, growth-generating, supportive and grounding resource to turn to.”
Maria explains that she would like to pursue a career in academia. In an ideal situation, she would be teaching but also conducting research and working with governments on how to use management and organizational tools for better decision making and program implementation.
Research has its numerous challenges and funding is definitely one that students think about all the time. Constantly looking for funding takes a lot of time, while worrying about it imposes a great amount of stress on students, when our main enterprise should be the generation of ideas, advancement in our research and contribution to our fields. Having to search, find and apply for funding from UM and non-UM outlets alike has a lot of unintended consequences on well-being, intellectual thriving as well as well as outputs like publications for PhD students. I am truly grateful for the generous support I received through the Gutierrez award to carry out my dissertation, which would not be possible through my department funding alone. I am truly grateful for the generous support I received to carry out my dissertation and the honor to be selected as the recipient of the 2018-2019 Alfredo Gutierrez Dissertation Award.