Queen Elizabeth Scholar: Insights from Peter Youssef


– [Host] Thank you everyone. Welcome to our first Queen
Elizabeth Scholarship presentation session
for the Fall 2018 term. I’ll give you a quick little
summary at the beginning here and then we’ll introduce our presenters for today’s presentation. So, here’s a quick agenda. I’ll tell you a little bit
about McMaster Health Forum, a little bit about our current Queen Elizabeth Scholarship programme, a little bit about our new Queen Elizabeth Scholarship programme, and then we’ll introduce the
two presenters for today, Steven and Peter, both of
whom went to South Africa, both worked for the same
organisation, technically, but they did quite different
projects because of the partners that were involved in those projects they were working on. So, who are we here at
McMaster Health Forum? McMaster Health Forum
aims to be the leading hub for improving health outcomes through collective problem solving. We harness information,
convene stakeholders, and prepare action-oriented
leaders, and act as an agent of change by
empowering stakeholders. The Queen Elizabeth
Scholarship programme is run by a partnership between
the Rideau Hall Foundation, Community Foundations of
Canada, Universities Canada, and individual Canadian universities. The purpose is to activate
a dynamic community of young global leaders
across the Commonwealth to create lasting impacts
both at home and abroad through cross-cultural
exchanges encompassing international education,
discovery and inquiry, and professional experiences. Our version of Queen
Elizabeth Scholarship here at McMaster Health Forum
is called Strengthening Health Systems. Our scholars contribute to
strengthening health systems and become part of our
large and growing network of health system leaders. We now have been awarded a new
Queen Elizabeth Scholarship programme which will
last from now until 2021, so the scholars you’ll see today are part of our old programme which is just ending. We are now soliciting applications
for our new programme. So just a note about this new programme. It runs, as I mentioned,
from now ’til 2021. This new programme is called
Queen Elizabeth Scholarship programme in Strengthening
Health and Social Systems. This programme will be similar
in large part to the one that is just ending,
with a few minor changes. So one has to do with the
location of the internships. The old programme we
could only send students to Commonwealth countries. In this new programme we can
send them to Commonwealth plus low and middle-income countries. Because of that our partners have changed. We are using the same partners
we did in our old programme, but we have added two new partners, one in Columbia and one
in Lebanon, and there are two other partners that are
potentially on the horizon. The focus of the internships
obviously has changed a little bit. We are not just focusing
on health systems now, we are also focusing on social systems, and because of that we have
expanded the eligibility criteria so all the programmes
that were eligible previously, both at the graduate
and undergraduate level, still apply, however we’ve added
an undergraduate programme, those in the Arts and Science programme. And the number of
opportunities has changed. Overall in the previous programme
we will, by the end of it, have sent 61 people abroad
or have hosted students. In the new one we will be
sending 24 students abroad and hosting 10, so 34 in
total, so we cut everything in half, basically. So with that said, here are the students that were in our old programme. So our first cohort which
were primarily in 2016, we had eight interns, two
scholars were all outgoing and then three incoming scholars. In our second cohort we
had one incoming scholar, one outgoing scholar and
then 20 outgoing interns. And then our third cohort,
of which our presenters are a part of that are here today, we had 10 incoming scholars,
10 who went away in the summer, and then five who are
currently abroad right now during this fall trip. So at the time of his
internship, Peter was also an undergraduate student in the health science
programme here at McMaster. He has an interest in
the macro level aspects of health care and health systems. During his internship he
hoped to developed his skills in critical appraisal,
while at the same time providing a real-world
context for the importance of evidence syntheses. And just like Steven,
he is still a student here at McMaster and he is also in the Michael DeGroote
School of Medicine. So please give a warm welcome to Peter. – [Peter] Alright, so hey everybody. So my name is Peter, and
just Steven mentioned we were in South Africa
together this summer. Our internship started in May and went until the beginning of August, and we were working for the
Africa Centre for Evidence, and some of the projects
that I was involved with were also either commissioned
by or in collaboration with the Department of Planning,
Monitoring and Evaluation with the South African government. I’ve interspersed a few
pictures of our travels throughout this presentation
for you guys to enjoy. So this is us at Nelson Mandela Square in Sandton in Johannesburg. Okay, so during my time in South Africa I was involved in three main projects. So the first project was working on a map of evidence-informed
decision-making in Africa. So we just want to see, I guess, the quantity of institution
that were involved in this kind of work and what kind of work we were doing, what best were
we involved in, and so on. Those next two projects were done in cooperation with the DPME, the Department of Planning,
Monitoring and Evaluation, and they were both very
large-scale projects. So the developmental state project, I started going in as they
were finishing that up, so I was involved with data
extraction for great literature. And then the National Spatial
Development Framework, the project that we were just beginning as I was ending my internship, so my work on that was in
the very beginning stages of that project, and then
the project will take a year longer to be completed. So this is, we did a bike tour in Soweto, which is a southwestern township just outside of Johannesburg. It was previously, it is now a place of, it has
been culturally revitalised, and it was very nice to see, I guess see the locals there, and the conditions they were living in, and I guess also the historical
significance of that. So for the first project
that I was working on, the map of Evidence-Informed
Decision-Making in Africa. So the end goal was to create a visual map of evidence used in Africa. And so as a part of this, my capsule supporter compiled a list of institutions that used or were a part of evidence informed decision-making based in the African continent. And then after that we
needed to take that list and have it hopefully in a way
that was searchable visually, based off of several parameters, so that we could see
that information visually in a way that was very easily accessible. So we started this using a Google search, and we used several
terms to be able to find these institutions. As a part of AID, which is
African Centre for Evidence, they also run something called
the Africa Evidence Network, which I will mention briefly. But this is basically it’s
a network of institutions and individuals who have an
interest in evidence synthesis and evidence-based
decision-making in Africa. So they also had a database of people that we cross-reference while we were probably getting this data. And so early on while we
were extracting the data, we realised that there
was sort of a mismatch. So for example, while I was
doing the Google search, about 70% of the institutions that came up were South African, whereas in the AEN there was only about 40%
South African institutions. So we knew that our
search wasn’t effective and that it wasn’t really
gathering all the key pieces that we wanted to, so
we did a second search with more words so we could see, more search terms as
you can see down there. And still we couldn’t find all the data, all the institutions that
we thought were out there that we knew were out there, just based off of, I guess my supervisor had a very extensive knowledge
of what was out there, because that was his
discipline and his field. So we went through the AEN
and gathered some data there, we also did a little bit of
a great literature search and consulted some other experts to make sure that our list was
as comprehensive as possible. Now, at the end of that our list was maybe a little bit too comprehensive, so we needed to be a little more stringent and narrow it down on
our inclusion criteria. So although at the beginning we had it so that we would include any
African-based organisation whose core mandate was
evidence-informed policy-making, we needed to be a little bit more strict on what we were excluding,
just for practical reasons, and make sure that the
map would be showing what we want it to show. So I guess I’ll go through two opposites of different kinds of institutions, which are the last real criteria. So for example, we wanted to make sure that the institution
had that core function of evidence-informed
decision-making or policy-making. So if you look at some
government departments, they are definitely
involved in policy-making, but unless they specifically mention the use of evidence,
or evidence synthesis, then they were excluded. And on the flip side, a
research centre and units who were just involved
in research synthesis, and not necessarily
mobilising that research through policy-makers,
those were also excluded. So we ended up with a list
of about 250 institutions. After our more rigorous screening, we ended up with a list
of 90 institutions. And from the institutions we
then started to extract data. And we extracted data from a
variety of different things. So obviously we wanted the
name of the organisation, but we also wanted some more information, some of it was for practical reasons, so for example a website, or
the latitude and longitude, those things were more
for functional features of how we wanted to present the data, because we wanted to put it on a map. Other things, such as the country the institution was operating
in were important because, as you’ll see in a second,
most of the institutions are clustered in metropolitan areas, but they often cover a wide range of areas that also span many countries. So it was very common to see, for example, institutions who work,
although they were based, for example, in South Africa, their work really covered
all of sub-Saharan Africa, or Southern Africa, or
Practical Africa and so on. We also gathered some other information, such as the sector,
level of policy-making, that was based on the
descriptions of those institutions and what they describe
themselves as wanting to do. So in our final list it
was very easy to tell that most of the research
that is being done, and most of the work in
evidence-informed decision-making that was being done was
done in South Africa, and that was something that we expected, and that we knew going in. And you will see this again,
visually, in a few slides. In terms of sector, I
was surprised by this. So I was expecting health
to be the largest sector, I guess maybe that’s biassed because of my own background in health, but the largest sector was
in monitoring and evaluation, and ensuring that programmes that governments have put in place are sorta being assessed for
their impact continually. In terms of level of policy-making, most of the institutions
work at the national level. That is, they’re working
with national governments and federal governments as
opposed to more local areas. So back to the goal, we
compiled all of this data, but really what we wanted to do was we wanted to have a map of evidence-informed decision-making. So we did a search of a
buncha different softwares that we could use, at
the end of the day though we decided to use Google Maps, and we put all of the
institutions as pins, based off of their location, on this map. And you can click on the
a map pin for example, here I’ve collected a pin for the Africa Centre for Evidence, and there you’ll have information on that. You can access the website there, you can see a description
of the kind of work they do in the sector that
they’re involved in and so on, and this is completely searchable. Okay, so while we were in South Africa we had the opportunity to
go to Kruger National Park and do a safari, and we got
to see all these animals, which was very exciting. So we saw elephants, we saw zebras. We went on this sunrise
hike which was very early, but very enjoyable. Alright, so the second project
that I was involved with was the developmental state project. And as I mentioned
before, I was joining this at the end of the project,
so the bulk of the work had already been completed at this point. So, to start off with
explaining this project, I’d like to sort of explain the concept of the developmental state, because certainly this was something that was very, very new to me. So this is something that stems from the political science literature, and was a phenomena that was observed in the East Asian Tigers, Hong Kong, Singapore, South Korea and Taiwan in the second half of the 20th century. And basically these countries were able to take the initiative to create policies that directly promoted the
development of that nation. So I put macroeconomic development because originally the term was used in an economic context
and to sort of promote economic growth in those countries. But now I think the literature has grown to include just development in general. So really just taking an initiative to create policy that, in the long run, will intentionally promote
the development of the nation. Now, so what we were trying to do is we were trying to see how we can apply the developmental success
stories of the Asian Tiger in a country like South Africa. And that definitely did
prevent some issues, and some of you will very explicitly know ’em from the beginning. For example, most of these countries had sort of communist or
authoritarian government during that time, whereas South
Africa is now a democracy. So there is a lot of literature debating whether or not a democratic government can be a developmental state. So basically the government wanted to see how the South African
government can take initiative in its own development. So I was involved in doing the
great literature extraction for this, but we originally
started with 410 articles. We excluded everything that
did not have to do directly to the developmental state. So for example, there were some articles that were referring to
psychological developmental state, so we were focusing on the
political-economic content of the developmental state, and we also needed to make
sure that it was accepting the developmental state recommendations to how South Africa in particular can become a developmental state. So at the end of that
there were 109 papers that I extracted data from. And the data that I extracted, based off the extraction
tool we were using, was in 10 different categories. And these categories, as you can see here, they’re very broad,
they’re very different. And unsurprisingly, most of the papers revolved around economics, however there were a few papers around the general public services, a few on housing, a few on education. Now for me, I think this was
a very interesting project. So for me, whenever I had been thinking about development previously, it had always been in some
sort of specific context, for example education, or health, ’cause of my background in health. So I think this project really shows you how development is
really interdisciplinary, as well as interconnected. So all these things
sort of go hand-in-hand, so these 10 different factors all sort of affect each other
and influence each other, and really give a holistic
picture of development. I also think it was, at
the beginning, a challenge, but I think also very rewarding for me to be able to be exposed to a breadth of different kinds of literature. So when I was doing the extraction for it I was reading lots of papers in economics, in political science and
education, and that was something that I had not been exposed to before. And I think that that was important because I can see now, now
that I have this understanding of development being
very interdisciplinary, very interconnected, thinking
about my own career in health, about how it’s important to be able to go through other disciplines and enter data on literature in other disciplines, to be able to inform all of
the in the health sector. Oh yeah, yeah, so that
brings it back to my own, I guess, career and
background in health sciences. So this is Table Mountain in Cape Town. We hiked this on a very exhausting day. When we got to the top
it was a cloudy day, so we couldn’t see anything, so it was sort of very
anticlimactic after all that work. Close to Cape Town they
also have penguins, which was very exciting to see. I was surprised that
South Africa had penguins, but I had known, the students even sent me a link of penguins in South Africa, and I was really excited
to go see the penguins. Alright, so the last project
that I was involved with is the National Spatial
Development Framework. So basically, the
government has identified that 20 years after the end of apartheid, that spatial inequality remained
persistent in South Africa. In fact, some of the figures
that they were showing suggested that there
either had been no change in spatial equality and
in sort of the segregation that exists, and they
often gave the example of two neighbourhoods in Johannesburg, one is Sandton and the other
one is called Alexander, and Sandton, if you search
it one of the key words that you will hear about,
or see used to describe it is opulent, and then Alexander is really, like they really told us avoid that area, and that it was a danger,
it had high rates of crime, and it really is a high
contrast in between I guess, it’s a good example of the inequality that continues to exist,
and it’s very evident because they’re so close together. So the NSDF, the National
Spatial Developmental Framework, it’s something that they are, it’s a project that they are spent in, the government is starting
to implement or work on now. And they are hoping to create a framework to inform spatial policy in line with the national development plan. South Africa has this
national development plan to achieve certain goals by the year 2030, and so this is sort of falls under that, and is hoping to support
the national development of South Africa, specifically
in terms of spatial policy. So what I was tasked to do for this was to look at a data set
that they had previously used for another evidence map
that they had created on human settlement. So this had to do a lot with housing. So because of that it was
very spatially oriented. So I was tasked to look at this literature and see what kind of data
sets they were using, and where they drew on the data. And I think we were surprised
by the results a little bit. So there were 142 articles
in this evidence map, and overall there was
not that much evidence, not that much spatial evidence. So a big bulk of the evidence
was qualitative in nature. A good chunk of the studies had no reference to external data. Some of them were just policy reviews, written I guess more by academics, and were more theoretical in nature. And only 22% explicitly
referenced external data sets that they based their research on. So I think it’s difficult,
and one of the challenges that we had hypothesised was that because the spatial data
is difficult to collect, one of the easier ways you
could have a spatial project is to conduct a case study, and we found that in the literature, that there were a lot of case studies. But these case studies were
often based on qualitative data. And while qualitative
data is definitely useful, the literature was definitely
skewed toward qualitative data and there were no quantifiable
outcomes or regiments to base decisions on. This data also was mainly segregated into two broad categories. So there were very high
level economic data, so for example their South African census and other large, large projects like that that collected data at a very high level. And the problem with this is
that this doesn’t really help, for example, municipal
governments when they are looking at their own development
projects, or also provinces. So the data wasn’t segregated
by levels of space. And the other one was household surveys, so household surveys, a lot of these were by consulting
companies or specific NGOs that were looking at development for a project that they had done. So to address this goal,
what we were trying to do is create a database of spatial data that was also represented spatially so that policy-makers could access this and they, for example, they had a question about inequality in education, or inequality in different schools in the area around Johannesburg, that they can consult this data and look at maybe some
different stats on a map and be able to see that. But the problem that we realised is that there is just simply
a lack of spatial data. And I think this is something that they are actively working on. So this project was very
interesting to work on because I got to attend a few meetings at their Parliament building, and there there were many officials from different levels of government, as well as some Statistics South Africa about how they’re collecting data and how I guess the future
of their censuses might work, or what changes they can do so
that they can further inform. So it was very good to see, I guess, the process of research and
how it can take a while, especially it can take a while
to create effective change when you’re dealing with something where it’s difficult to have that data. So this picture is taken
from the Garden Route which is along the southern
coast of South Africa. Alright, so those were the three projects that I was involved with, and I think the main takeaways that I take from my time in South Africa, as James mentioned I really
wanted to gain an understanding of how the politics and
history of the country really affected health,
and also as I learned, development and other factors as well that were all interrelated. And I think that during my time there it was very eye-opening
to see how pervasive that inequality was. And also it was important for me to see that South Africa is really a nation that is really starting to bloom. Everyone’s sorta talking about politics. I’m talking to Uber
drivers and everyone had, or was involved, or had something to say, which I thought was very positive, and I really learned from everyone that I interacted with
during my time there. And most importantly, I think
it was a very good opportunity and I made some great friends that I hope to stay in
touch with, so thank you. (light applause)




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