Health Policy SIG Sept-2023: Claire Brereton — A systems approach to children’s health in Least Developed Countries

TITLE: A systems approach to children’s health in Least Developed Countries

ABSTRACT: There are 46 countries classified as ‘Least Developed’, where poverty, food insecurity and violence are part of everyday life. Life expectancy is 20 years less than in rich countries and education levels are low. Two thirds of Least Developed Countries (LDCs) are in sub-Saharan Africa.
If we want to improve the prospects of the poorest people on earth, children’s health is a good place to start. For children in LDCs, their chances of surviving childhood and thriving into adulthood are affected by the absence of things we take for granted; nourishing food, clean air, clean water and sanitation, access to basic health services and schooling. These factors all combine to affect children’s health and wellbeing in a complex reinforcing system.
LDCs have seen improvements in core measures of children’s health status such as infant death rates over the last 50 years but this has now plateaued, despite continuing efforts through aid programmes.
To understand the children’s health ‘system’ in LDCs, I developed a mental model (CLD). This was refined after visiting Solomon Islands, a remote LDC in the Western Pacific. From this I created a dynamic model and calibrated it (with difficulty) for Solomon Islands, to enable experimentation with different aid policy scenarios. There were many challenges; the biggest one being inaccurate and unavailable data. Uncertainty was reduced by building a small Bayesian Network as a comparator. Whilst the resulting model has many flaws, it is the first attempt to create a systems view of children’s health in LDCs and it shows how modelling can be useful, even with limited data. The scenarios produced some surprising and counter-intuitive results.
The presentation will briefly cover children’s health issues in Least Developed Countries. It will touch on the siloed thinking of current approaches to children’s health and will take a look at the models and key insights from the work. It will also show the user interface developed with policy makers in mind, which allows them to see the effects of different investments in children’s health.

BIO: Claire is a ‘mature’ PhD student with a few career changes behind her. Her first ‘real’ job was working for IBM in the UK as a software developer. 20 years later she migrated to Australia with a resume which claimed ‘IT executive’. It was in Queensland that she first became involved with the health sector, setting up IT call centres and digitising health systems. In 2008 she started a consultancy business and offered both project rescue services (digging projects out of holes) and IT governance advice (how to avoid the holes). In 2014 she embarked on a Master of Public Health degree, which opened her eyes to the health challenges which developing countries face. Somehow, this led to a PhD entitled ‘Children’s Environmental Health in Least Developed Countries: a modelling approach to support policy decisions’. Systems dynamics became the core of the PhD but it took a year of investigation before she understood how she could use it in her research. The PhD is almost finished and she is hoping to use the results for good. Claire is a Fellow both of the Australian Computer Society and the Australian Institute of Company Directors.