Professor Dr Till Bärnighausen is the Director of the at the Heidelberg University Hospital. The medical expert teaches at Harvard and the Africa Health Research Institute (AHRI) in South Africa. . In our interview he speaks about the ways in which research can contribute to global health, as well as the enormous present-day challenges in the field.

You were originally a general practitioner. What prompted you to become an epidemiologist and to focus on issues related to global healthcare?

It was a passion that developed slowly. As a general practitioner you are very closely in touch with the healthcare system and the community. In the 1990s I conducted one of my first research projects in the area of global health, as a DAAD scholarship holder at the Tongji Medical College of Huazhong University in Wuhan. This is something I am grateful for to this day. The topic of the study was healthcare for so-called informal workers in China. Millions of people from rural areas come to the city to work, but they are not registered there and therefore not covered by insurance. As part of an international postdoc programme of the German federal government and the federal states, we examined ways in which these people might be integrated into urban healthcare systems. The project eventually resulted in an oft-cited paper.

What made this project so relevant for your further career path?

To this day, I continue to explore the fundamental question of how healthcare systems can be changed and improved. The Medical University where I worked at the time has a long-standing German tradition, as professors from the University of Heidelberg were involved in founding it. I am now coming full circle on a personal level, too: I was recently made the faculty representative for the medical institutes’ higher education cooperation projects, and my former mentor is now the dean at Tongij, so I will be seeing her again.

How do research results influence political decision-making and therefore the implementation of global health programmes?

In healthcare system research we have close links to politics, and about a third of our work is scientific policy consultation. National and municipal ministries, as well as transnational organisations, contact us to ask us to conduct research for them. We evaluate and test new health intervention and treatment systems in large-scale randomised controlled studies, we analyse costs and benefits, and we also develop new evaluation methods. In all of this we always take social factors into account, too. For example, we analysed the healthcare system of the city of Dar es Salaam in Tanzania. There was strong cost pressure in healthcare for people with HIV, and new solutions were considered. We explored, whether home-based carers (HBC) might be able to take over some of the tasks of nurses who are much better paid, without affecting treatment quality.

And?

It worked. The much more cost-efficient community healthcare approach has been a national programme for ten years now. 70 percent of patients choose to be treated in their own home, and are even happier with this option. This is an important issue, especially in times like these, where global players such as the United States Agency for International Development (USAID) are withdrawing and everybody is frantically looking for radically new solutions. Our research that’s been going well in Tanzania can be adapted for other states with similar healthcare systems, such as Uganda and South Africa.

You have been focussing on HIV for 20 years. However, in your research at the HIGH you have been increasingly addressing climate change, too, for example with special roof coatings designed to reduce heat stress in Burkina Faso.

The HIGH has grown a lot over the past seven years, from 40 to now 200 researchers. We have been addressing the major public health challenges across various levels, and the are among these aspects. The technology is often already there, and we look into how it can be applied, the ways in which it works, what it can do, and whether it can be used cost-efficiently. 

What is the role of international networking in this context?

Our alumni are based at the major global health institutes around the world. These trust-based networks of international partners that have grown over the course of decades are a true asset for our work. We are in a position to use research to change the world for the better.

How do you continue your work following the radical financial cuts?

The United States’ large-scale support for treating HIV, tuberculosis and malaria, as well as for promoting the health of mothers and children was eliminated from one day to the next, when USAID was closed down. As researchers we are able to highlight alternatives and new forms of treatment that can be realised with far less money. Home-based carers are one example of this. The documentation of disease is another contribution we can make, and our first study here is already completed. We interviewed the leaders who had developed the programmes that were now terminated, and had managed them for decades in some cases. In a second step, we are seeking to understand the subjective realities of people who are no longer getting their HIV medication. We are looking into the effect this has on their optimism about the future, and their plans for their own and their children’s future. In this research we are exploring tragedy, but it might encourage other funding bodies to get involved.

How can social enterprises contribute in this situation, and could it be the case that they are becoming even more important?

Social enterprises have always been strong partners in global healthcare, and at the HIGH we cooperate very closely with an excellent startup from Berlin. Social entrepreneurs are important, as they are frequently pioneers in their respective fields. This is why I hope that the European Commission’s new initiative that is dedicated to the issues of entrepreneurship and competitiveness will translate into a boost. My impression is that this has been on the rise in Germany for a while now. People who are so good they could work anywhere in the world choose to stay here and dedicate their efforts to building up social enterprises.

Because it’s meaningful work?

Yes, exactly.