Durham, NC - Manoj Mohanan works with small armies of researchers who conduct surveys, crunch numbers and analyze large quantities of data to determine if a given health care policy is effective, and why.

Mohanan, who joined Duke's Sanford School of Public Policy this fall as an assistant professor, said he's learned over the years that consumer behavior often defies the intention of health care incentives put in place by governments, foundations and private health care providers.

Why, for example, would a pregnant woman in rural India prefer to pay an informally trained midwife when she could see a formally trained obstetric gynecologist for free?

Mohanan's research will aid the government of India, which does provide free obstetric care and large subsidies to pregnant women in different parts of the country.

The government's goal is to increase the number of hospital births and reduce the number of often risky home births; and Mohanan's goal is to determine why pregnant women would choose one option over the other.

"The idea is not merely to look at the impact of program x, y or z," he said, "but what are the key behavioral factors that lead to the impacts we see or sometimes do not see."

In a separate study, Mohanan is working with the Bill & Melinda Gates Foundation to determine the effectiveness of social franchising and telemedicine in the Bihar state of India, an impoverished region where, he said, health indicators are often worse than in many parts of sub-Saharan Africa.

The Gates Foundation project targets four diseases -- childhood diarrhea, childhood pneumonia, tuberculosis and a mosquito-borne illness known as kala-azar - by opening medical franchises largely reliant on telemedicine.

The telemedicine capabilities allow health care providers in rural Bihar to transmit vital information, such as blood pressure, heart rates and EKG results, to doctors in New Delhi and to consult with them via webcams and cell phones about patient care.

Mohanan's job is to oversee a Gates-funded study aimed at gauging the success of both the franchising concept and the telemedicine approach. To do that, he and co-investigators designed a survey for an estimated 100,000 households.

"They want a real thorough evaluation," Mohanan said, "because four years down the road, if someone says, 'Did it make a difference?' we need to be able to say something meaningful about it."

Mohanan knows from first-hand experience about the gaping holes in health care delivery systems. As a medical resident in the radiology department of a major public hospital in Mumbai, "I had the unfortunate responsibility of asking poor patients to come back for their CT scans and MRIs when they could afford to pay the subsidized fees, while others with political clout and a lot more resources received free care," he said.

Those and other experiences, he said, "continue to motivate me to seek a better understanding of how health care is provided and used and how it can be improved."

Mohanan was studying radiology when he decided to change course and focus instead on making a difference at the policy level. He enrolled in the Harvard School of Public Health, where he received master of public health and master of science degrees in 2000 and 2004, respectively.

In 2009, he received a Ph.D. in health policy (economics) from Harvard's Graduate School of Arts and Sciences and promptly came to Durham, initially landing with the Duke Global Health Institute (DGHI) before transferring to the Sanford School earlier this year.

Monahan lives in Oval Park with his wife Joanna Maselko, an assistant professor in the Department of Psychiatry and DGHI, and their 4-year-old daughter, Nithya Mohanan. He said they chose the area because of its proximity to the park, and they like Durham because of its manageable size, the "great and growing" dining options and their friends and neighbors.

"The opportunity to be part of a vibrant group of researchers in development, health and applied economics," he said, "combined with Duke's interdisciplinary focus and its solid commitment to working in global health were all part of why we chose to come to Duke."

Manoj Mohanan talks with residents of rural Bihar, India, about their health care decisions.