My dissertation and future book project investigate the development agenda through the lens of community health workers in Malawi. I use an ethnographic approach, with participant observation and in-depth interviews, to explore the politicization of community health, given the surge in popularity of universal health coverage, and its effects on service delivery.
I conducted pre-dissertation fieldwork in Malawi (summer 2018), collecting data through interviews with policymakers and experts. With the support of the Fulbright-Hays DDRA Fellowship, I returned for a year (Jan 2019 – Feb 2020) to engage in my ethnographic work (including participant observation and interviews), observing how “development” is channeled and practiced in community health on the ground.
Through an ethnographic approach, I aim to uncover how community health workers make sense of their roles, acting as a tripartite cog running service delivery operations between communities, the district health office, and external projects. I examine how structural forces, such as central government policies and donor projects, interact with these agents to shape stewardship of the health system and service delivery on the ground. In particular, I interrogate the role of NGO projects in modulating the behavior of the community health team, its priorities, and its decisions. Such dynamics are crucial to the efficacy of community health systems and can provide novel insight into our understanding of global health governance and the domestic governance of health systems in developing countries.
Fischer SE and Strandberg-Larsen M (2016). Power and agenda-setting in Tanzanian health policy: an analysis of stakeholder perspectives. International Journal of Health Policy and Management 5(6):355– 363. [Link to open access article on journal website]
Fischer SE, Patil P, Zielinski C, Baxter L, Bonilla-Escobar FJ, Hussain S, Lai C, Walpole SC, Ohanyido F, Flood D, Singh A, Al-Shorbaji N (2020). Is it about the where or the how? Comment on Defining global health as public health somewhere else. BMJ Global Health. 5:e002567. [Link to open access article on journal website]
Alatise OI, Fischer SE, Ayandipo OO, Omisore AG, Olatoke SA, Kingham TP (2017). Health-seeking behavior and barriers to care in patients with rectal bleeding in Nigeria. Journal of Global Oncology. Online before print, Feb. 1, 2017. [Link to open access article on PubMed]
Knudsen AB, Zauber AG, Rutter CM, Naber SK, Doria-Rose P, Pabiniak C, Johanson C, Fischer SE, Lansdorp-Vogelaar I, Kuntz KM (2016). Estimation of benefits, burden, and harms of colorectal cancer screening strategies: Modeling study for the US Preventive Services Task Force. Journal of the American Medical Association. 315(23):2595-2609. [Link to open access article on PubMed]
Fischer SE. Cote d’Ivoire Civil War: 2002-2011. Case study for the Civil War Settlement Project. February 2018. Political Instability Task Force.
Grande A, with Fischer SE, Sayre J. 2020. Chinese Medical Teams: Knowledge Transfer in Ethiopia and Malawi.Working Paper No. 2020/33. China Africa Research Initiative, School of Advanced International Studies, Johns Hopkins University, Washington, DC.
Knudsen AB, Naber SK, Fischer SE, Rutter CM, Pabiniak C, Kuntz KM, Zauber AG, Lansdorp- Vogelaar I. Cost-effectiveness of a multitarget stool DNA test for colorectal cancer screening of Medicare beneficiaries: Report to CMS from the Cancer Intervention and Surveillance Modeling Network (CISNET). December 2015. Centers for Medicare & Medicaid Services (CMS).
Works In Progress
"Who 'owns' development projects? Theory versus practice in Malawi's health sector"
"Parallel Paths: How the Global Health Industry Undermines National and Community Health Systems"
"Lost in Translation: Health Policy Implementation from Global to Local"
*See CV for full list of publications