Researcher in Focus: Darius Erlangga

The Global Health Economic Centre (GHECO) is a diverse and multidisciplinary group of academics working on health economics research. Our members work in collaboration with partners across the globe, drawing on their experience and expertise to improve health worldwide.

Darius Erlangga, Research Fellow and former general physician, shares details of his current projects, experience and motivations for joining LSHTM.
Darius Erlangga

You recently returned from conducting research in Abuja, Nigeria. What were you doing there?

We were meeting our collaborators. I am currently involved in two projects, one of which is about corruption and health facilities in Nigeria and Malawi. This project has been going on for over two years but because it started during the pandemic we haven't been able to meet our collaborators in person until now.

This year we decided to go to Nigeria. It feels different, the progress that I made from meeting colleagues in person for just two days was probably worth another four months of virtual meetings. When you're in person you get input very quickly compared to communicating via email. We are planning to do a household survey to ask families about their experiences of rule breaking in health facilities, for example, if they see something inappropriate, like doctors being absent, or whether health workers ask for extra payment, so it's very important that we get the questions right. All of that is difficult to get right in an email exchange.

Especially with such a sensitive topic, right? I'm sure that lots of people are very reticent to talk about things like corruption.

Absolutely. We were there making sure that the survey tools that we developed are appropriate for the context because we don't want to impose our knowledge on our collaborators. We wanted to learn from their experience and turn that experience into a very contextual survey tool. It's a co-production endeavour but co-producing is challenging. If you don't meet them in person, it can become a very top-down approach, which isn’t something that we want. You need to build up the connection, you need to pick up the right parts out, understanding what they can offer, what I can do to help, and how can we achieve the goals together as a team, rather than me telling them what to do.

How many surveys do you aim to complete?

We are conducting the research across three sites, one in North Nigeria, one in South Nigeria and one in Malawi, and we are aiming to get eight hundred responses from each site. So around 2400 in total. It's quite nice to have a medium-sized study. We won't be able to do very fancy regression modelling with it, but this is a sensitive topic and I believe not many other people have explored it before. I hope it will be a good way to explore the connections between corruption, social capital and social economic status in this area.

What is the other project that you are working on?

The Lancet Global Health Commission on Financing Primary Health Care, was the reason why I joined school two years ago. We were trying to formulate some recommendations on how best to finance primary health care systems that are centred around people.

Primary health care is underfunded and people still view primary health care as just basic care for poor people. We want to change that mindset and make sure that primary health care is viewed as an essential part of universal health coverage.

To make it work, you need to have certain financing arrangements that allow the provider at the health facilities to receive money and a means of protecting resource allocations from the government. Whether it's federal, central, or local, we need to ensure that those resources are reaching the health facilities on the frontline, without any delay.

We also acknowledge the importance of political economy analysis - how it plays out between so many actors in the government, external donors, and civil society organisation. We need to make sure that to roll out the reform, there needs to be an open forum for better health financing. An agreement needs to be struck between the many actors, because all actors have different needs, and our job is to navigate these different needs to make sure that we can channel funding through effectively.

We have already written a report which launched in The Lancet Global Health in April. Since then, and to the end of 2022, we're focusing on dissemination. We’ve already presented our findings at several international conferences including the Annual Health Financing Forum, organised by the World Bank in Washington, DC. It was attended by health financing experts and policymakers from low- and middle-income countries (LMICs) so it was quite a good way to make sure the findings are utilised.

Where do you see that research going in the future?

We are still trying to find the right angle to move forwards with the financing project. We have already fulfilled our objectives at the global level and produced the report that can be utilised by many LMICs. But now we are thinking about either finding a more niche agenda at the global level or helping countries at the country level to so that they can translate our recommendations into practice. And we are in communication with several low-income countries to see how we can best offer our support to strengthen their primary health care financing. I think it all really depends on our conversations with the country’s people, because we don't really want to push our agenda, it's more about finding out what they need and seeing if we can offer our expertise to match their needs.

You're originally a GP so you must have a lot of first-hand experience in health care. Do you miss it?

I do miss seeing patients, I just don't miss how I used to get money out of it. I think that's probably the reason why I didn't want to practice because the whole system is different. I think if I was a GP here in the UK, I wouldn't mind continuing my practice within the NHS - it's very different compared to my old practice. For me, I just didn’t feel that it was what I want to do for the rest of my life so that's why I decided to move into research career, especially health financing.

Was it those frustrations as a GP that led you to health finance?

Absolutely. I wanted to know how to incentivise doctors to do their jobs, I think that's what motivates me. From the beginning, I was really interested in economic evaluations but I think after many years of doing a PhD, I really want to know what the incentives for health workers are and explore what incentives, other than financial incentives, countries can implement to nudge health workers do a better job.

What attracted you to LSHTM?

Not many universities are known for health financing. There are many universities that have very good health economic centres, I did my PhD at the University of York and everyone in economics knows York so that’s a no-brainer, but for health financing, it's very rare. One of the best places to do research on health financing is LSHTM. I think one of the pioneers is Dame Anne Mills actually, our Deputy Director and Provost - she's such a leading figure in health financing. The reputation is amazing and there are so many connections. It’s a great network with lots of support.

What three words describe your time at LSHTM?

Productive, Connected, Inspiring.


Learn more about Darius.

LSHTM Scholarship Fund

Every year, LSHTM donors, alumni and friends donate to help widen access to education through the provision of scholarships.

Scholarships are transformational, have the capacity to change the lives of the students who receive them, and alleviate the financial burden of study for talented and motivated recipients.