CASE STUDIES

Ezra Jerome

2016

Affiliation: New York University

South Africa has among the heaviest HIV and tuberculosis (TB) disease burdens in the world. While there was previously a great amount of HIV denialism in the political sphere and a paucity of funding for both HIV and TB treatment, antiretroviral treatment (ART) and TB treatment are now available for free in the country. Much of this treatment is initiated at the primary care level. However, despite direct costs being covered for treatment, clinical inefficiencies remain and HIV/TB patients are faced with a range of bottlenecks to care. 

Qualitative analysis of case management at the primary care level at Mediclinic-Medforum Hospital and the wider network of providers in Pretoria was undertaken in 2016 in order to focus in on barriers to initiating and adhering to HIV/TB treatment.

Activities:

• Developed and administered surveys and conducted key informant interviews in order to identify potential bottlenecks to care, with an emphasis on HIV and TB patients (from a provider’s and patient’s perspective). 
• Developed and ascertained feedback on potential interventions to eliminate identified bottlenecks to care.
• Developed an open-ended survey focused on case management and organizational operations (with a focus on HIV and TB patients) and administered in person to 4 staff members at primary care clinic.
• Triangulated qualitative data and contextualized themes with available literature leading to recommendations presented to the clinic.

Emergent themes:

• A lack of trust between HIV patients and non-clinical staff members.
• Absence of harmonization between paper-based and electronic medical records.
• Lack of  communication outreach for patients paying out-of-pocket.
• Social factors leading to poor medication adherence.

Recommendations:

• Making the  intake form more patient-friendly for more accurate collection of patient data.
• Integrating a barcode or biometric scanner for easy recognition of basic demographic data leading to easier identification of transient patients.
• 2-way SMS reminders for medications and appointments, particularly for out-of-pocket patients.
• Connecting high-risk patients (e.g., mobile workers and patients with compliance issues) with a social worker to help navigate the continuum of care and assist with engaging specialized NGOs. 

Ezra Jerome

2020-2021

Affiliation: UNICEF (Expert on Mission/Secondment)

The Collective Service is "a collaborative partnership between the International Federation of Red Cross and Red Crescent Societies (IFRC), United Nations Children’s Fund (UNICEF), the World Health Organisation (WHO), with support from the Global Outbreak Alert and Response Network (GOARN), and key stakeholders from the public health and humanitarian sectors. 

The Collective Service aims to deliver the structures and mechanisms required for a coordinated community-centered approach that is embedded across public health, humanitarian, and development response efforts. This will ensure expert-driven, collaborative, consistent and localized RCCE support reaches governments and partners involved in the national response to COVID-19 and beyond."

Activities:

• Developed a donor landscape and cultivation strategy;.
• Created interview guides and lead interviews with members of WHO, UNICEF, IFRC, and thought partners.
• Mapped donors to RCCE; researched funding mechanisms; and supported planning and execution of a high-level donor roundtable event. 
• Provided overarching resource mobilization strategic guidance in weekly Collective Service planning/coordination calls and ad hoc.

Ezra Jerome

2019-Present

Affiliation: Independent (collaboration with NYU,  Arbaminch University, and Federal Ministry of Health, Ethiopia)

Mycetoma is a chronic, granulomatous, inflammatory infectious disease caused by true fungi (“eumycetoma”) or filamentous bacteria (“actinomycetoma”) which affects the subcutaneous tissue and carries a high rate of morbidity. It is characterized by the progressive formation of tumor-like swellings filled with small granules that contain aggregations of the causative pathogen. As the disease progresses, causative agents can colonize the bone tissue, forming a large, mutilating lesion and necessitating limb amputation. Mycetoma is truly a “disease that begins where the road ends,” where the most affected populations are the subsistence farmers, fishers, and shepherds whose survival depends on their abilities to work. Chronic, severe infections like mycetoma can devastate entire families. 

Acting as project sponsor in collaboration with alma mater NYU's Applied Global Public Health Initiative, the  core project team drew  on the large pool of mycetoma literature, surveillance protocols, and control evidence base generated by the Mycetoma Research Center and members of the WHO Global Mycetoma Working Group. 

The project team  leveraged Ethiopia’s strengths in NTD surveillance and control (particularly, skin NTDs like podoconiosis and scabies) and its robust Health Extension Worker Programme to develop and execute a pilot surveillance and control system to reduce the burden of Mycetoma in  the South Ethiopia Regional State . This integrative approach was in lockstep with the strategic framework established by WHO. The focus was on integrating mycetoma interventions into Ethiopia's existing public health programs, including primary health care, surveillance and programs targeting skin diseases.

See 2024 American Public Health Association (APHA) poster   

Ezra Jerome

2011-Present

Affiliation: Archangel Airborne

Long-time member of international NGO, Archangel Airborne, an organization of aviators, clinicians, and multidisciplinary experts which provides disaster response, development, and medical/logistical support to underserved areas domestically and internationally. Named Director of Public Health in 2018; appointed Secretary, Board of Directors in February 2023.

• Contributions include developing a monitoring and evaluation framework for rollout and linkage of WASH and clean burning stove interventions to case management and health outcomes
• Focused on developing a community health worker (“agent de santé communautaire polyvalent”) cohort in partnership with a local public primary health facility in Cap Haitien and building a sustainable funding pipeline to support programmatic growth.

• Ensuring private microclinic (locally owned/managed) is properly absorbed into wider community health ecosystem to reduce duplication and adopt a true health systems strengthening approach. Additionally, endeavoring to improve operational efficiency and quality of care through the adoption of telemedicine modalities, inventory system, referrals, scope of services offered, etc.