Recent MA Graduate Addresses Women's Health in Uganda

Recent MA Graduate Addresses Women's Health in Uganda

Katherine Donato's interest in international health began when she was an undergraduate at Georgetown University in Washington, D.C. But it was her desire for more quantitative answers to issues of development that lead her to take courses in economics. 

This past summer, Donato, who graduated from Duke’s Economics Master’s program in December, worked in Uganda with the Progressive Health Partnership (PHP), a non-profit founded by Duke undergraduate students. In the following interview Donato shares her experience in Uganda and at Duke:

There are many issues that affect economic development.  Why did you want to focus on health?

Health was appealing to me because improving health outcomes can directly improve lives. And it’s amazing to me how many opportunities there are to easily improve the quality of life for people in developing countries by implementing basic health initiatives. The science behind a variety of interventions, from hand washing to antiretrvoirals is conclusive, and it is the economist’s job to figure out the implementation.

Is there an area of health you are especially interested in?

I am especially interested in maternal and child health. The project I worked on in Uganda was a safe motherhood initiative, which strives to provide women with comprehensive healthcare during pregnancy and delivery. 

Can you describe how you got involved with PHP?

I originally heard about PHP through the Duke Global Health Institute. I met with some members of PHP’s leadership and was really impressed with how they run their organization, especially by their focus on rigorously evaluating their own programs’ effectiveness. This is very important because you want to be sure that the benefits of your project outweigh the costs. Through a grant from the Duke Global Health Institute, I was able to spend 8 weeks working on projects with PHP over the summer in Uganda. 

What exactly did you do in Uganda?

I began my work for Uganda long before setting foot in Africa. Last spring I developed a baseline survey to administer to women who came to the government health center for antenatal care. We asked women an array of questions geared towards getting information about the women’s backgrounds, previous pregnancy outcomes, and knowledge and opinions of various health issues. 

For instance, we would ask questions like “how is malaria transmitted” and “where did you deliver your last baby?” These questions gave us a sense of what needed to be done in terms of education and in knowing what choices women have made in the past. The goal is to conduct a follow-up survey of the women after they give birth to see if their knowledge level and experiences surrounding pregnancy and birth have changed. 

There was a service component and a research component to the women’s health initiative. I was involved with the research and logistical portion. One of our team’s big projects was to set up an electronic medical record system.  The previous record system was just a big book in which the midwives would make handwritten records line by line. Hence, everyone who came in was treated like a new person, because the midwives could not quickly retrieve past information about the patient. 

As part of the medical records, we also recorded women’s cell phone numbers. This way, the health clinic will be able to send the women text messages with things like follow-up appointment reminders. The Ugandan government recommends that women have four antenatal care visits, but unfortunately few women make it to all of them, so we’re hopeful that the text message reminders will increase take-up rates at the government health center. 

Other text messages provide women information as they reach each stage of pregnancy. This way, they have a better feel for what is a “normal” discomfort associated with pregnancy and what might be a more serious problem that needs to be addressed by a health professional. Text messages may also include helpful tips like the importance of good hygiene. If we can prove that these text messages are effective, it is an inexpensive program that can be replicated in other developing regions. 

Another part of our program involves sending text messages to community health workers when women in their community should be going to the health center for antenatal care. The PHP team developed a comprehensive training program for these community health workers, so we’re hopeful this extra resource for women out in the villages will help improve health outcomes.

How will you determine whether or not the text messages are effective?

We randomly divided women into three groups. In the first group, women will receive the text messages directly that remind them about upcoming appointments and provide relevant health information. The second group will also receive text messages and, in addition, have their community health worker follow up with them. And the women in our quasi-control group will not receive any texts or community health worker follow-ups. Hopefully we can quantify the effectiveness of using text messages to get more women to attend their antenatal care visits and deliver their babies in a health center.

How would you describe your daily experience in Uganda?

The Ugandans were incredibly welcoming. Within a week of my team’s arrival, our Ugandan partners hosted a goat roast to welcome us. We lived in Mbarara in a hostel about an hour away from the subcounty where we worked, so during our commutes we got to know our Ugandan partners and translators well. Once in the villages, we were often offered food and invited to sit and talk. 

What would you say was the biggest challenge of working in Uganda?

Working with the language was the most difficult. The language of the region is Runyankole but there is no consistent method for spelling. I would work with multiple translators to ensure that questions were being translated to say exactly what I was asking in English, but this was at times a very lengthy process to ensure that my precise meaning was being conveyed.   

Do you have any more projects planned with PHP?

After returning from Uganda, PHP invited me to join their board. I am now the chief research officer of the organization so I am still very involved with them. I am looking forward to receive data on the effectiveness of our project in a few months, and will lead a team in the analysis. Hopefully, we will be able to get a sense of how effective our work has been and where we can improve. 

How did your economic training at Duke prepare you for this work?

Economics trains us to think in terms of cause and effect. In this situation, we wanted to design a program in a way where we would later be able to analyze what aspects were effective and which ones were not. There were a lot of potential causes and effects we had to consider along the way in order to be sure that we could get conclusive data at the end of our project. 

What is the biggest lesson you will take back to your studies from this work?

First of all, it has been a great experience conducting my own research. I learned a lot of things from simply going to the place where my research would be implemented. 

Field research is much more volatile than regular research - we did a lot of initial research and went in with a plan, but only by going to the country can you see that things are quite different from what you had initially assumed. There was a lot of logistical work to be done, people to train, and government leaders to persuade of our project’s worth. 

We also found ourselves spending a lot of time talking to the locals about what they feel the needs of their community are. It is not uncommon to go to a location with what you think is a great strategy, but to realize when you get there that there is a much more glaring problem to address first.    

You will be graduating with a Master's in Economics in December. How has this project shaped your plans for the future?

I have been applying to both Health Policy and Economics doctoral programs. For the economic programs, I am looking at schools that are strong in development economics, and I hope to continue working on similar projects.

Learn more about the Master's program at Duke Economics.