November 8, 2013

Prabhjot Singh, an assistant professor of international and public affairs, wears multiple hats. An expert in community health systems, he is the director of systems design at the Earth Institute; outside of Columbia, he’s a practicing doctor at Mount Sinai Hospital. His work in health systems design has spanned sub-Saharan Africa as well as Columbia’s own backyard, Harlem.

Professor Singh was recently named a PopTech Science Fellow for 2013, a recognition given to socially engaged leaders in various research fields who are committed to innovating and collaborating for progress. He recently spoke with SIPA News about his work in building healthier communities.

Could you explain the work you do as a health systems designer?

The focus of my work is figuring out how to deliver healthcare to actually reach vulnerable or low-income populations across the world. This kind of problem is most keenly seen in poor, rural populations in sub-Saharan Africa, but it’s also seen right here in New York City, in neighborhoods like Harlem. So the question we’re dealing with is: How do we actually deliver on the promise of healthcare?

One thing that I’ve seen across the world, which has been incredibly inspiring, is how it’s possible to rapidly train people, over four to five weeks, on specific protocols in some settings that allow them to make life-saving diagnoses, or treat chronic illnesses over time. This is important as a systematic step ... By training community health workers, we are finding the right way to build infrastructure for healthcare to reach everybody.

This is what my team at the Earth Institute is doing with the “One Million Community Health Workers” project in sub-Saharan Africa. This work is supported by organizations like the African Union, UN agencies, and health ministries across the region.

I understand that you’re working closely with the telecommunications industry.

One of reasons why this is important is that community health workers are enabled by mobile phones. This happens in several ways.

First, having mobile phones means that they are no longer isolated when going to households and forming natural networks. Second, they can use their mobile phones to consult and follow specific protocols to diagnose and monitor anything from a child’s fever to malaria, to pneumonia … This simple process can address up to 40 percent of mortality in children under the age of five across sub-Saharan Africa. Third, this communication system provides decision support. Mobile phones help community workers to contact more clinically skilled people who can help make decisions about diagnoses or treatments.

The last point is that this leads to political support for community health workers, because this can mean more employment opportunities, especially for young people.

How does that relate to your work in Harlem?

These features I just mentioned are exactly what makes community health workers so timely and important for the United States in the context of healthcare reform. The scenario is that most Americans will have health insurance in the next several years — but this doesn’t guarantee that they will be connected to health systems and properly treated. Will we be able to manage chronic medical conditions like diabetes, and will we be able to manage them well?

Something that’s been echoed by experts is that the United States has a hospital-heavy health system, where people either get to hospitals or don’t get treatment. In poor places in the world, there is now sophisticated knowledge about how to build community health systems. This is something we can learn and translate to reforms in communities like Harlem, in the United States.

City Health Works, a social enterprise that was incubated at the Columbia Business School, teamed with my group at the Earth Institute to launch a scalable and financially sustainable design for community health worker networks, beginning in Harlem. Basically, the network would allow reaching out to people of the community to focus on things like wellness, chronic disease management, and mental health.

What do community health workers focus on?

In the Harlem context, there are a number of things the health worker does. Three of those things are: early risk detection, help with self-management of medical conditions by helping to set goals and showing people how to achieve them, and finally, making sure they are plugged into the primary healthcare system.

Now, from the business perspective, the operation has to be smooth, and financially has to make sense in a complicated health context. The goal, then, is to make sure insurance companies and hospitals pay for these services ... which can be a real employment opportunity for community members. So there is interest from politicians too, who see this as an opportunity for employment programs, especially in these neighborhoods where underemployment and unemployment are very high.

Along the way, I’ve really gotten to know Columbia’s backyard neighborhoods, where groups are intertwined with churches and socially oriented organizations, and social innovators are highly active. The network that we found has really welcomed us and enabled us to think holistically about health in Harlem.

How did the opportunity to connect your work abroad with your work here in New York come about?

I’m a doctor at Mount Sinai, and I see patients in Harlem. As much as I’m committed to the work being done in Africa, in many ways I saw the same conditions, sometimes worse, in my patients.

I’ve learned over the years that I like to work in the community where I live. I live in Harlem, where there is a high degree of need. I had the skills to address those needs, and the opportunity came up as I worked with Manmeet Kaur, a Barnard and Columbia Business School graduate, who founded City Health Works. My group at the Earth Institute became a strategic advising arm for the enterprise. We worked on refining a pathway to scalability, and looking at the broader implications for health community workers across the country.

Does this work tie into what you’re teaching at SIPA?

Yes, I teach a course on global health practice. It does tie into what I’m teaching. I always include the [United States] — and Harlem — in the same discussions about sub-Saharan Africa. There’s no such thing as global health if it doesn’t include a country like America.

I want to show my students … that there are systematic ways to deliver healthcare. If you get past the politicization, there are some basic patterns that work with efficiency and community buy-in, all across the world. It’s important to include place like Harlem [in the course], especially because it allows us to actually go into Harlem, literally a 10-minute walk away from here.

You are also a practicing doctor. How do you juggle all of your multiple roles?

In many ways, they’re the same thing. You can think of me as doctor, in that I see first-hand the problems that users -- patients, doctors, administrators of healthcare -- have on a day-to-day basis.

As a policy professor at SIPA, I can take step back and think about the macro-perspective, and think about where this fits into the broader picture. As implementer and designer, I have the ability to then develop solutions. It would not be possible if these were separate things.

The policy work gives context and allows the whole thing to resonate in settings and places where we’re currently doing it. This then allows different levels of exchange that push the policy community to think more in operational detail.

What can we expect to see in this space in the future?

We’re really starting to connect with the tech startup community in New York. We’re spending a lot of time building robust technology that can help effectively bring healthcare to the community. At City Health Works a lot of time is spent in this so we can start building the next generation of infrastructure for community health workers.

Over the next months, or the next few years, we will need people like ethnographers, designers, and ideally they would also have a policy perspective in mind. We would really welcome SIPA students in particular, who have a policy interest and perspective. We need to be thinking through design implications of scaling up tech systems.

SIPA students come with incredible work experience from diverse fields, and in the past we really benefited from having SIPA students work with our team at the Earth Institute to build City Health Works. This kind of work is what’s coming up over the next few months and the coming year.

— Doyeun Kim MIA ’14