Anger and fascination for the “know-do gap” – the gap between knowing and doing - led Stefan Swartling Peterson, Chief of Health at Unicef, into global health. He became Professor of Global Health and now he has been Chief of Health at Unicef for almost 3 years - and is constantly focusing on moving from knowledge into action.
He sees strong health systems as key to prevent infections and spread of antibiotic resistance. “Strong health systems, where a midwife is able to wash her hands before she delivers you, but also where drugs and supplies are available and the health worker has been paid and supervised are key”, he says.
Read interview where Professor Swartling Peterson elaborates on the access-excess relation to antibiotics, implementation research methods, strong health systems and future work of Unicef.
What motivated you to become Public Health Physician and Professor of Global Health?
– I was struck by how we DON’T translate knowledge to action – we have sufficient knowledge to prevent 2/3 of 5.5 million annual child deaths and 300 000 maternal deaths. And we can even afford it. But it does not happen. So the anger and fascination with this “know-do gap” led me to public health.
What motivates you and keeps you going, working with global health for children? It is a complex, long and a slow process.
– I think we can do so much for children globally, by relatively small means. The problem with public health, though, is that people who DID NOT get a disease usually don’t thank you. They may even blame you for immunizing them or pasteurizing their milk.
– So you do have to go see program results, and ‘before-after’ situations, and also celebrate your own milestones, such as passing a declaration in the UN, publishing your paper, or changing a guideline. Most of all, though, helping capable people to make a difference, that is what motivates me.
What is your overall view on excess use of antibiotics and lack of access to antibiotics in relation to the increasing spread of bacteria resistant to antibiotics?
– We lose more kids from lack of access to antibiotics than from resistance. Therefore we need to balance improved access to drugs for those in need, at the same time as we reduce excess, irrational use of antibiotics among those who do not need them.
– Preserving the efficacy of existing drugs is key, even as we need new ones. Because they are the affordable ones. This will require strong health systems.
How do you reason around access and antibiotic resistance – how can we get antibiotics out to those who need them while at the same time making sure they are not used in the wrong way?
– We need strong health systems, that people have access to – financially, geographically, socially. That are able to PREVENT infections (clean delivery, immunization, breastfeeding etc) and that are able to DIAGNOSE and TREAT infections rationally.
What options or strategies do you see for improved access and improved “appropriateness” of use?
– Again, strong health systems, where a midwife is able to wash her hands before she delivers you, but also where drugs and supplies are available and the health worker has been paid and supervised are key. Then we need diagnostics and protocols and guidance. BUT ALSO enlightened consumers. Supply side measures will not be enough – we will need to get the demand side, people in general, educated on the benefits and risks, individually and collectively, of antimicrobials and antibiotics.
What tools would be needed at international and multilateral level in order to strengthen national systems to ensure access without excess?
– We need investments in both health systems AND human capacity development. And appropriate methods. Interventions need to be tailored to, and evaluated, in local health systems. In collaboration between policymakers, implementers and local researchers. The latter need to have their capacity built in implementation research methods, and program support – domestic as well as international – needs to budget for embedded research and learning.
What is your opinion on rapid test of malaria – and the unintended consequence that these tests might lead to more use of antibiotics?
– This is beyond opinion now – we have a good evidence base that singular use of rapid diagnostic test for malaria promote irrational use of antibiotics. As well as increase likelihood of children with pneumonia getting correct treatment. Thus we need integrated diagnostic and management of the febrile child, such as through integrated management of childhood illness (IMCI) and Integrated Community Case Management (iCCM), and not vertical disease management.
Does Unicef have any plans for further innovation projects aimed at solving practical problems with access to antibiotics that can also help improve rational use?
– UNICEF is already preventing lots of infections through water, sanitation and hygiene (WASH), breastfeeding and immunization. We also advance globally integrated fever management through integrated management of childhood illness and integrated community case management at facility and community level, which put diagnostics and appropriate alternative treatments at disposal of health workers and parents. We work on improving access to newborn sepsis treatment at community and facility level. Those are social innovations. We also work on digital health tools for community health workers such as “UPSCALE” in collaboration with partners.
What role do you see for Unicef regarding contributing to enhanced development in countries with inadequate resources, in addition to the humanitarian support you already do?
– Unicef’s role is to work with and assist governments to bring methods and capacity to tackle local problems, including children’s preventive and curative health.
What are you most proud of in regard what you have accomplished in your role at Unicef so far?
– We have now introduced embedded implementation research in programming as a feature in our strategic plan, and have, in collaboration with Wellcome trust, and I hope soon Sida, started national processes to tackle access/excess problems with antibiotics in a series of low income- and lower- and middle income-countries.
What would you like to accomplish in the future?
– I want to contribute to closing the “know-do” gap – by applying implementation research methods to program delivery. The “new normal” should be to embed research in programming. For learning and course correction. “Fix the airplane as you are flying it, and don’t wait for the crash end-line evaluation”.
What do you like to do when you are not working?
– Hmm. Actually a hard question these days… Go for a walk, or sometimes even a jog. And work practically with my hands, for visible, concrete results.