Grant cancellation marks the end of an era in global health

The closure of the United States Agency for International Development (USAID) signaled the end of a quarter century of global health work at the Tulane Celia Scott Weatherhead School of Public Health and Tropical Medicine on the MEASURE Evaluation and the associate and follow-on awards that followed. 

MEASURE Evaluation

When Dr. Anastasia Gage first came to Tulane University as an associate professor in 2001, she brought with her three years of experience working at USAID overseeing the Demographic and Health Surveys Program, a distinct but related initiative focused on improving global health and development through data. (Note: In that role Gage was seconded to USAID by the Public Health Institute and Western Consortium for Public Health.) MEASURE Evaluation at the time was focused on providing technical assistance to countries in population health and nutrition program evaluations, but soon after Gage arrived at Tulane, they shifted to Phase II focused on building in-country capacity. 

“They wanted to actually train people on what methods they can use to know if their projects were effective,” said Gage. “A slogan under Phase II and III was that the best evidence of our success is when we no longer have a job!”

Gage secured USAID funding starting in Phase II and continuing through Phase IV to develop capacity at global institutions. In Ethiopia, she initiated a series of three-week workshops for junior to mid-level managers on monitoring and evaluation. Gage and her team helped institutions like Addis Ababa University and the Addis Continental Institute of Public Health to determine how to develop and hold these workshops, from securing faculty to finding space to determining fee structures if needed. Sometimes they brought in partners from organizations like the Ethiopian Public Health Association. Initially, Tulane conducted the workshops, which focused on population health and nutrition as well as HIV/AIDS programs, but over time, Tulane reduced its effort, and the Ethiopian institutions began managing them. 

Based on her success in Ethiopia, Gage moved on to Nairobi and Kenyatta University, which wanted to introduce a monitoring and evaluation concentration in their Master of Public Health program. 

“It started operating in 2010 or 2012, and it's still operating today,” said Gage. “I taught one of the intro courses, and now two of my students who were in that first cohort are university professors with PhDs. I published a paper with one of them just last year.”

Historically, Gage says, it’s been the West leading technical assistance programs on behalf of low- or middle-income countries. But the benefit of MEASURE was the capacity building piece, and now Kenyatta University is applying for its funding through organizations like Takeda and the Gates Foundation, with Tulane in a collaborator role. 

In another example, says Gage, many of the universities that have received assistance through MEASURE Evaluation joined together to create a non-governmental organization, Global Evaluation & Monitoring Network for Health or GEMNet-Health. “They provide technical assistance south to south,” said Gage. “But now, of course, a major donor is no longer there.”

Data for Impact

Initially, there was a plan to advance MEASURE into a Phase Five, but instead USAID developed three separate associate awards to continue to improve global health. Tulane has been part of two of these awards. Data for Impact extended the focus on evaluation while the U.S. President’s Malaria Initiative (PMI). PMI Measure Malaria focused on developing capacity for countries to use data and information systems to address malaria. 

With Data for Impact Tulane initially took on a six-year evaluation project in the Democratic Republic of Congo, led by David Hotchkiss and Janna Wisniewski. The Celia Scott Weatherhead School already had a robust family planning project ongoing in the DRC and had helped launch the Kinshasa School of Public Health, so the school already had extensive contacts and a base of operations in the central African country. 

Associate Professor Dr. Eva Silvestre, who was the principal investigator for Tulane’s portion of the Data for Impact project, highlights what a great learning opportunity it was for students. “We were able to support a lot of student workers on different activities which gave them the opportunity to be knowledgeable about USAID priorities and international health.”

While some students applied those hands-on skills globally, many ultimately used the skills in public health careers right here in the United States. 

Gage echoes this thought. “A lot of the African countries have learned a lot from the U.S. They have developed and they are still developing systems to deal with the challenges that they have. But we have a lot of places in the South, in New Mexico and Arizona” with similar challenges, she says. Parts of the U.S. suffer from the same problems as low-income countries, and what’s learned abroad can be useful right here.” 

Of course, the results of Data for Impact were locally important to the countries involved. “We were able to provide really high-quality results for decision makers in country,” said Silvestre. Using data, they were able to demonstrate whether a health intervention was impactful or not.

The program was ongoing during the global COVID pandemic. “We had to come up with different methods, different ways to do the work,” Silvestre points out. “That was another really great show of our capacity to deliver what we were contracted to do under really difficult circumstances.”

GH PEARL

In 2023, Tulane had been awarded $5.4 million to advance the next stage of USAID global health work: the Global Health Program Evaluation, Analysis, Research, and Learning project, or GH PEARL. Silvestre and Dr. Janna Wisniewski, were co-principal investigators on the project. 

Originally planned to continue through 2028, Tulane was poised to provide research, evaluation, capacity building, and evidence generation for decision-making in a variety of priority countries where the university has past experience like the DRC, Nigeria, Ethiopia, and Ghana, among others. With the closure of USAID, however, the program was abruptly ended. 

According to Silvestre, there were two activities of GH PEARL that researchers were able to mostly complete, both focused on malaria in Cambodia and in Cote d’Ivoire. 

The number of faculty, students, and alumni who played a role in MEASURE and the awards that followed is extensive. 

“People have devoted their lives to this,” said Silvestre. 

Still Silvestre and Gage both plan to soldier on. 

“I can’t do anything else,” Silvestre said. “I just have to keep doing what I believe in and what I love. Some days are going to be a lot harder than others.” 

“The field evolves,” said Gage. “There will always be a need for public health because improving one’s health also means changing one’s behavior, and behavior change requires a lot of convincing and a lot of patience….It may change, but it’s going to continue.”