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."
