Exploring Approaches to Accessing Quality Healthcare Services When Needed
- Professor, Graduate School of Economics/
Hitotsubashi Institute for Advanced StudyHONDA Ayako
Published on December 27, 2022
Job titles and other details are as of the time of publication.
(The interview was conducted in Japanese and was thereafter translated into English.)
HONDA Ayako
Ayako Honda is a professor at the Graduate School of Economics at Hitotsubashi University and the Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study (HIAS Health). Ayako holds a PhD in Health Economics from the London School of Hygiene and Tropical Medicine (University of London). She has extensive experience in undertaking health policy and systems research in Africa and Asia.
From 2009 to 2017, Ayako worked at the Health Economics Unit at the University of Cape Town, South Africa, collaborating with fellow researchers to explore health system challenges in low- and middle-income countries (LMIC). She is particularly interested in examining how various stakeholder groups respond to the implementation of policy options, with a focus on healthcare financing policies aimed at advancing universal health coverage. Her expertise lies in applying discrete choice experiments (DCE) in LMIC settings to identify the needs, preferences, and values of healthcare professionals, and to ensure these insights can be effectively translated into policy development.
Universal health coverage (UHC)
My research focuses on universal health coverage (UHC) in Asia and Africa. I conduct issue-oriented research applying social science theories and methodologies to deepen the understanding of various problems that arise in health systems in specific contexts to inform effective solutions.
UHC aims to create systems that ensure everyone has timely access to affordable quality healthcare and medical services, including prevention, treatment, and rehabilitation when they need. Promoting UHC is a key global policy agenda as one of the UN’s Sustainable Development Goals (SDGs). There are many dimensions to UHC, and my research focuses on the three main areas of health financing, human resources, and technology assessment.
Researching UHC in three areas
First, in health financing, I explore policy options to enhance equity, quality, and efficiency in healthcare service delivery, focusing on healthcare purchasing arrangements and how payers transfer pooled resources to service providers. From 2013 to 2015, I participated in a research consortium called RESYST (Resilient and Responsive Health Systems) led by the University of London. Our consortium examined the purchasing function of healthcare financing in 10 Asian and African countries to compare systems and identify issues. Following this, we examined the governance of payment systems and conducted a study on purchasing arrangements with private healthcare providers under publicly funded financing systems.
The second area of my research focuses on securing and motivating human resources for health and medical services. Asia and Africa suffer from a significant shortage and inequitable distribution of human resources involved in service delivery, and to help address this issue, we are exploring the working conditions and working environment of health and medical personnel. In Senegal, for example, there are far fewer health workers in rural areas than in the capital, Dakar, leading to regional disparities in accessing health services. Towards resolving this problem, we worked with the government to study the motivating factors for doctors and nurses to continue working in remote areas. A discrete choice experiment was used to identify policy priorities for motivation, such as contractual arrangements and basic infrastructure development.
My third area of research is health technology assessment. When a new technology or drug is developed, it may not be used effectively if the service is not delivered in ways that people find acceptable. We study people's preferences for healthcare delivery and the acceptability of health services. For example, we are currently conducting research in Zimbabwe, Madagascar, and South Africa to assess patient preferences and to develop practice guidelines for facilitating the uptake of a newly developed point of care testing tool for sexually transmitted infections.
Developing an interest in healthcare systems while in the Philippines
After completing my undergraduate studies, I studied cultural anthropology in the Philippines, where I researched the worldviews of cultural minority communities through the analysis of oral traditions. Living in the Philippines I witnessed situations where people lacked immediate access to medical services when falling ill, and where women could not give birth in safe conditions. This experience sparked my interest in health systems and policies that can improve people’s access to essential health services.
After returning from the Philippines to work at an international organization, I learnt how social sciences, such as sociology and economics, can be applied to the study of health issues. After completing my second master’s degree in Global Health Policies and working as a social development consultant in low- and middle-income settings, I decided to further my studies in health economics and attended the London School of Hygiene and Tropical Medicine to do a PhD in Health Economics. For my PhD project, I conducted research in Madagascar on the impacts of a user fee for healthcare and access to health services for the country’s low-income population. This project involved spending about a year in Madagascar conducting surveys to gather data for evaluating policy interventions, and examining the policy implementation process.
Research aimed at reflecting people’s voices in policy-making
After completing my PhD, I worked in the Health Economics Unit at the University of Cape Town from 2009 to 2017. While working at the University of Cape Town, I had the opportunity to collaborate with a diverse group of professionals and organizations, including health administrators and civil society groups. I am grateful for this experience which allowed me to deepen my understanding of health systems and gain insights from multiple perspectives into healthcare research and how it can influence health policy. I am also grateful for my rich experiences in working with researchers from Asia and Africa on emerging issues in their health systems. I believe one of the roles of researchers is to highlight the voices of various stakeholders in health systems, including patients, healthcare professionals, and governments, and to deliver insights for their voices to be reflected in policy design and implementation process.
