Improving access to care where it’s needed most

A Harvard DrPH Graduate Profile by Noah Leavitt, Harvard T.H. Chan School Office of External Relations

How can health care be delivered to those who need it most?

Photo Credit: Craig Laplante

That’s the question driving the work of Gabriel Seidman, DrPH ’17, one of the first graduates of the new Doctor of Public Health (DrPH) Program at the Harvard T.H. Chan School of Public Health. The DrPH Program is focused on leadership—and teaches students how to translate public health knowledge into results.

For Gabriel, that means increasing access to care in developing nations, something he views as a fundamental social justice issue.

He was first drawn to the field of public health by learning about the HIV/AIDS epidemic in both the United States and sub-Saharan Africa. For Gabriel, the epidemic helped him understand to what degree health outcomes and access to health care are functions of political, social, economic, and cultural forces, and not just medical or clinical issues. Over time, his focus broadened to include a wide array of public health issues. “You’re treating childhood diarrhea, childhood pneumonia, HIV/AIDS, malaria.  These are all diseases that we have drugs for,” Gabriel says. “It’s not the kind of thing where we don’t know how to treat these diseases. The science exists.”

But often the resources or infrastructure to deliver that care does not exist, and—as Gabriel learned—external forces influence whether or not people get access to life-saving medicine and health care. During his time at Harvard Chan, Gabriel had the chance to do fieldwork examining ways to improve how health systems operate and are financed—both of which play a critical role in accessibility of care.

Unexpected path

Gabriel’s journey is not one he expected to take before pursuing his DrPH.

Before arriving at Harvard Chan he worked as a consultant for Boston Consulting Group, working mostly with for-profit pharmaceutical companies and global health organizations. He was strongly considering a Master of Business Administration (MBA). Gabriel realized that would be the comfortable choice—but not necessarily the best path for his career.

“When I was a little kid, I was learning to play chess, and I remember someone telling me that if you wanted to get better at playing chess, you had to play with people who were better than you,” Gabriel recalls. “When I was looking at business schools, I was going to be the person with the most global health experience.  I knew I wanted to work in health care and I felt like going to an MBA program, there weren’t going to be people who had more experience than me that I could learn from or be mentored by or get pushed by.”

Before arriving at Harvard Chan, Gabriel already had a solid base in the health care field, but he wanted to learn more technical and analytic skills focused on public health—and more specifically, how to effect change in areas where it’s needed.

At the Harvard Chan School, Gabriel has been pushed—and strengthened—by the diversity of his classmates. In the second year of the DrPH Program each student gets a “peer coach” from their cohort. Gabriel’s peer coach, Jessica Flannery, had been doing field epidemiology work on disease eradication in South Sudan—different from the office-based analysis that Gabriel was used to. “She lived in South Sudan for four years, so she can actually talk to me about, ‘OK, when you have to drive a truck three hours outside the capital of the city and you go to a health center, this is what it’s actually like.’”

The working relationship (they’re still in touch frequently) furthered Gabriel’s interest in improving health care infrastructure in low-resource countries. One example: the nation of Lesotho, where Gabriel completed his DELTA Doctoral Project.

Learning the meaning of leadership

The DELTA Doctoral Project is the culmination of the DrPH Program; students complete field work with host organizations, with the specific goal of making a public health impact—whether that be working to implement programmatic or policy changes, documenting the success of prior interventions, or  developing strategies for change that have a  high probability of adoption and implementation.

Gabriel’s DELTA Doctoral Project took him to Lesotho, where he worked with Partners in Health on a large-scale project aimed at reforming the health care system across the country. The overall goal: increase access to primary health care services by restructuring the system’s management, service delivery, and financing.

It was during this DELTA Doctoral project that Gabriel had the opportunity to put some of his newly learned leadership skills to the test—while also developing a deeper understanding of what leadership looks like in the field.

“I came to the [DrPH] Program not really knowing what leadership meant, and I think a lot of times, people equate the word with being the most senior person in the organization,” Gabriel says. But at Harvard and in Lesotho he learned that leadership really meant working through a difficult situation and helping a group—or in this case, a nation—move forward with its goals.

In Lesotho, Partners in Health (PIH) was working closely with the country’s Ministry of Health to implement its reform. And the implementation process was not all smooth sailing. At the time, the government was undergoing a regime change, which created political unpredictability. “On top of that, PIH had to provide technical assistance to the government without overstepping their role as technical advisers,” Gabriel says. “The reform had to be owned by the Ministry of Health, so PIH had to balance advocating for the continuation of the reform in order to improve population health outcomes without appearing to push any specific political agenda or agenda of their own.  Major political reforms are difficult in general because people are used to doing things a certain way, and asking them to change how they work is always difficult.”

Other areas of friction included giving more responsibility to decentralized District Health Management Teams, and the possibility of uprooting staff and asking them to move to other parts of the country. But Gabriel says the potential benefits made the friction worth it, “There’s evidence to show that strengthening the district health management team would be beneficial for public health, and the Ministry of Health’s ultimate goal is to improve population health.” Gabriel learned that true leadership means making difficult decisions in the interest of making improvements on a large-scale.

“I think before coming to Harvard, I would have felt that if things are hard and painful like that, that’s bad,” Gabriel says. “But one thing that I learned is the fact that difficult is not bad. It can actually be good, because people can learn from that.  In order to improve population health you have to make those difficult decisions.”

That was a lesson Gabriel didn’t necessarily expect to learn. He came to Harvard Chan preparing to gain a deeper understanding of the technical aspects of global health, such as the global health landscape and the financial barriers to accessing care. But he also ended up with a greater understanding of how to deal with and manage hard transitions that people and organizations face.

Gabriel’s knowledge in this area has been strengthened by his relationships with DrPH faculty—who are established leaders in the global health field. He has worked closely with his advisor, Rifat Atun, professor of global health systems, and Peter Berman, former faculty director of the DrPH Program. Both Atun and Berman are experts in the financing and delivery of health services in developing countries. Seidman also received from mentorship from his doctoral thesis committee. The group, which was chaired by Rifat, also included Joia Mukherjee, Joseph Rhatigan, and Jesse Bump. Both Joia and Jesse have worked at PIH, illustrating a key benefit for Gabriel: faculty in the DrPH Program are not just researchers—they’re focused on implementing programmatic changes. “I was able to find more than just the research expertise that I needed,” Gabriel says. “I was also able to find the programmatic expertise that I needed.”

A rapidly changing field

Today Gabriel is again working with the Boston Consulting Group, focusing on two areas: health care and international development, both of which are directly tied to what he studied.

Gabriel admits that he isn’t sure what’s next for his career—mainly because public health is always rapidly evolving. “When I came to Harvard, I had never heard of Ebola.  The Ebola outbreak started the summer that my program started,” Gabriel recalls. “I’d never heard of it, and this is not something I ever thought I’d be working on.  Then by spring of my first year – so that was spring of 2015—my most intense class, I was doing a project exclusively focused on Ebola.”

Gabriel says that wherever his career takes him, it will be rooted in addressing that fundamental issue of access to care—whether that’s working to address health insurance issues in the United States, or returning to Africa to help countries such as Lesotho improve the care they’re delivering.