Key Research Interests and Expertise

Social science research on household and community health, and recently focusing on HIV and AIDS. Factors influencing treatment seeking behaviour, illness costs and the economic burden of illness, related individual and household coping strategies, resilience, and the links between illness and impoverishment.  Social analysis of HIV and AIDS, focusing on the social and economic impact of HIV on individuals and households, and people’s self-management of HIV as a chronic condition: their adaptive strategies, self-management and adjustment. Demand-side approaches to health system development, particularly people’s trust in, access to and uptake of health care services, and health policy as social protection policy tool. Primary research experience in Sri Lanka, Uganda, Thailand, Ethiopia and South Africa. Earlier research focused on health policy analysis, particularly health financing and equity, decentralization and organizational capacity, and wider institutional environments that enable or constrain health sector reform processes.

Research Groups: Health and Disease 

Research interests

The economic burden of illness for households

Research expertiseon the economic burden of illness for households, measuring access, treatment behaviour, the costs of illness, strategies adopted by households to cope with costs, and the medium term impact of illness costs and strategies on household livelihood and poverty outcomes.  Developed conceptual and methodological approaches for the analysis of household vulnerability to illness-related impoverishment, and factors affecting household resilience to illness costs.  His work  also includes user trust in health services and its influence on access and uptake of health services.  He has conducted primary research on illness costs, impoverishment and factors influencing resilience in Sri Lanka (ESRC-funded) and worked on similar research in Ethiopia (SCF-funded) and South Africa (Wellcome Trust).  Stevewas a co-investigator on a Wellcome Trust-funded project (2006-8) in rural South Africa, in collaboration with LSHTM and the University of Witwatersrand, that examined people’s access to health care services, and the influence of free PHC, hospital exemptions, pensions and other cash transfers on access to and affordability of health care.  He was then a co-investigator on an ESRC-Hewlett-funded research project (2008-10) in Burkina Faso that measured the impact of obstetric complications on economic, social and health outcomes for women and their families over a 4 year period, working with colleagues at LSHTM and GREFSaD in Bobo-Dioulasso.  

Social aspects of HIV and AIDS, focusing on people’s self-management of HIV on antiretroviral therapy (ART)

Research in rural South Africa also examined people’s access to care for chronic health conditions,  people’s management of chronic illness.  His most recent research has focused on people’s management of HIV as a chronic condition in Uganda when taking ART: their adaptive strategies, their self-management and adjustment, and their work to rebuild lives and livelihoods, to regain order and control.   This work started in rural Uganda in 2005 on a project funded by the Centers for Disease Control, and after publishing this work in 2010 Steve won an ESRC grant to take forward the work in Entebbe, Uganda, using both qualitative and quantitative methods to explore people’s self-management on ART and mental health outcomes.

Health financing policy

Steve’searlier workexamined the revenue and equity impacts of user fees, pre-payment schemes and other risk sharing or health insurance mechanisms, and factors influencing their impact. He has conducted research on the effectiveness of targeted exemptions to the poor and factors influencing exemption uptake and coverage, in South Africa, Thailand, Zimbabwe and Ethiopia and more recently Burkina Faso.  In South Africa the research looked at health services from a social protection and social inclusion perspective, and analysed the synergies of free health care and cash transfers and how these influenced household resilience to illness-related shocks.

Health sector reform

Steve’s earlier research also looked at health service delivery and financing arrangements, and government capacity to deliver reforms to these arrangements. He conducted policy analysis in Sri Lanka and Zimbabwe of decentralization to district management boards or tertiary hospital management boards, and government capacity to design and implement reforms, looking at organizational capacity within Ministries of Health and the wider institutional and political environment that influences reform processes (DFID-funded and WHO-funded research). 

ID: 32001