November is ‘Intern Spotlight Month’ here at Health Action International, when we shine a light on the interns who make tremendous contributions to our team and the work we do with their fresh perspectives, new ideas, intellect and vivacious spirit. Each week throughout the month of November, we’re introducing you to one of our interns from the past year who’ll explain the research they conducted during their internship, as well as what they gained from it. This week, allow us to introduce you to Anneke Johnson, from USA and the Netherlands.

During her time at Health Action International (HAI), Anneke Johnson completed a report about antimicrobial resistance (AMR)— one of the world’s fastest-growing public health risks—as a requirement to obtain her Master of Science in Biomedical Sciences from the Vrije Universiteit in Amsterdam. One reason for the rapid increase of AMR is the irresponsible prescription of antibiotics. For this reason, many behaviour change programmes have been launched to educate doctors to rationally prescribe antibiotics. As part of our background research for the Health Systems Advocacy (HSA) Partnership, Anneke examined similarly-structured programmes, with multiple partners, in sub-Saharan Africa. Her research sought to determine which programmes were most successful, and the reasons for their success.

Why were you interested in your chosen topic?
The rise of AMR was always an area that interested me from a biological point of view. Even when I transitioned from pre-med to public health, I retained a deep interest in the topic. I wanted to broaden my understanding of AMR, and therefore chose to explore the ways in which we can tackle AMR from both an organisational and macro perspective.

What did you discover in your research? 
During the course of my study, I found that the successful partnerships I evaluated all possessed four characteristics. First, they had a ‘champion’ who really motivated those involved to keep the programme going. In addition, the partnering organisations worked together in equal measures and contributed different resources to the joint programmes. And all partners also had an equal balance of power.

What was your most surprising or interesting finding?
To be honest, I hadn’t considered the effect that a ‘champion’ could have on the success of a programme, but through the course of my interviews, the concept emerged all on its own. At least one interviewee from each of the partnerships I interviewed specifically—and without being prompted—mentioned how crucial the contribution of the ‘champion’ was to keeping their programmes running and successful. It was an interesting conclusion that I never expected to find.

Why did you want to do your internship at HAI, and what did you gain from it?
I wanted to intern at HAI because I recognised and respected the reach that my work may have there. Working in a large scale lab or organisation, my work may have fallen between the cracks and been filed as just another student report. But the small scale and interdependence between staff made me feel like I was welcome, and that my work was important. The connections I made there are ones that I would like to keep going forward—possibly even for my next student research project. HAI exposed me to new methods of research and thinking, which I had little experience with prior to interning there. It also helped with my personal and professional development. These are all things that I greatly appreciate.

An abstract of Anneke’s research findings are presented below. More information on HAI internships is available here.


The Effect of Inter-organisational Cooperation on Education-based Behaviour-change Programmes Against Antimicrobial Resistance
Antimicrobial resistance (AMR) is a growing threat to global medical security and healthcare systems. To battle this problem, many organizations collaborate on behavior change programs (BCPs) aimed at changing the prescribing behavior of healthcare professionals (HCPs) in order to reduce the contribution of human error to the development of resistance. It is well known that organizational characteristics can have influence of individual behavior, and that the characteristics of a relationship can have an influence on the success of the joint project, however there is a knowledge gap for this topic in a public health context. This research examines the crossover between those two topics through evaluating what characteristics of organizational cooperation are linked to successful AMR program. The present study is a multiple-case study that evaluates 6 AMR programs in the Southern African region; a desk study was conducted to select programs eligible for the study and perform an initial round of analysis of organizational characteristics, followed by interviews with staff members from each program to evaluate the contribution of coordination, relationship formalization, frequency of interaction, interdependence, organizational compatibility, participation, relationship satisfaction, differences in scope, type, and size, respectively, of involved organizations, balance of power, balance of resources, cultural environment, and clear goal-setting to success. The study found that four factors were common to all successful programs: equal balance of power between partnering organizations, balance of devoted resources, and participation, plus some degree of interdependence. These characteristics are largely in agreement to the characteristics research commonly has identified as vital to stable partnerships in the business world as well, dismissing the argument that because public health and enterprise are different areas that different kinds of cooperation is necessary. In order to maximize the potential for success in public health collaborations, partnerships need to be formed on a more calculated basis, taking these four factors into account. If partnerships are constructed more carefully and more according to the presented formula, more energy can be devoted to the activities and actions of the BCPs rather than to the functioning of the partnership, enabling us to focus as much as possible on curbing the spread of AMR.