Understanding antimicrobial resistance: from measurement to better decision-making

15 April 2026

A resident doctor reviews a patient late in the day. The presence of an infection is uncertain. The guidelines are long and complex, and time is limited. The consultant wants a decision. The patient is expecting treatment.

Does the doctor prescribe antibiotics or not?

This is the reality of antimicrobial prescribing in hospitals. Decisions are often made under pressure, shaped not only by clinical evidence but by time constraints, hierarchy and patient expectations. These decisions matter. Every unnecessary or inappropriate prescription contributes, in small but cumulative ways, to a much larger global challenge: antimicrobial resistance (AMR).

AMR occurs when microbes such as bacteria, viruses, fungi and parasites no longer respond to the drugs used to treat them. It has been described as a “silent pandemic” because it builds gradually – in infections that take longer to treat, in extended hospital stays and in the slow narrowing of effective treatment options.

The scale of the challenge is stark. Global estimates suggest that AMR was associated with 4.95 million deaths in 2019.

Research led by Dr William Waldock, Clinical Research Fellow at our NIHR Northwest London Patient Safety Research Collaboration and supported by the Fleming Initiative and published in Nature npj responds to this wider challenge by exploring how antimicrobial resistance can be better measured across healthcare systems and addressed in clinical decision-making.

AMR is not just a scientific challenge; it is also behavioural and systemic. The knowledge needed to prescribe antibiotics correctly already exists in clinical guidance, alongside diagnostic information. Yet across hospitals and community care settings, this guidance can be difficult to use, inconsistently applied or overridden altogether.

In Dr Waldock’s two recent studies, the researchers set out to address this challenge from two complementary angles: how antimicrobial resistance is measured within healthcare systems and how clinicians can be better supported to make prescribing decisions in real time.

Measuring the problem: why antimicrobial resistance is hard to track

If AMR is such a significant global threat, why is it so difficult to control? Part of the answer lies in how it is measured.

Traditionally, AMR has been tracked through surveillance data – monitoring which bacteria are resistant to which drugs and where those patterns are emerging. While this provides an important picture, it does not always capture how resistance is experienced within healthcare institutions.

In the first study – Development of the antimicrobial resistance burden score through a modified eDelphi – the researchers highlight this gap and propose a new approach.

The study shows that relying on isolated indicators can be misleading. A hospital with high antibiotic use may still be practising strong stewardship, while another with lower reported resistance rates may reflect limited diagnostic capacity or incomplete reporting.

The AMR Burden Score brings these different measures together into one structured view, combining resistance patterns, prescribing practices and clinical outcomes. This allows healthcare organisations to better understand their AMR burden and assess whether interventions are making a meaningful difference over time.

In doing so, it provides a more integrated and interpretable picture of AMR within healthcare systems, allowing patterns to be tracked over time and the impact of interventions to be more clearly assessed.

The decision problem: why prescribing is so difficult

If measuring AMR is one part of the challenge, the other lies in how prescribing decisions are made.

Antibiotic prescribing is rarely straightforward. Clinicians often need to make decisions quickly, sometimes with incomplete information, balancing the risks of under-treating infection against those of unnecessary antibiotic use. While guidelines exist to support these decisions, they are not always easy to apply in busy clinical environments.

The research highlights how this complexity plays out in everyday care, where time pressure, workflow design and differences in clinical judgement all influence how guidance is applied.

As Dr Waldock explains:

“In-hospital antimicrobial prescribing is frequently driven by the urgency of a deteriorating patient. While diagnostics are vital, clinical reality often demands pre-emptive intervention before full data is available. Junior doctors may occasionally have senior guidance, but more often, they must navigate these high-stakes initial prescriptions alone. In such moments, objective and accessible resources to guide the first response are invaluable.”

In this context, prescribing decisions are not made in isolation. They are shaped by interactions between clinicians, patient expectations and wider system pressures. This can create situations where decisions that seem appropriate for one patient in the moment may conflict with longer-term public health interests.

As Dr Waldock puts it:

“This reflects what economists call the ‘tragedy of the commons’ – where individual decisions, whether driven by clinical caution, patient expectation or organisational pressure, can work against the long-term interests of the wider population.”

This helps explain why improving antimicrobial use is not simply a matter of producing better guidance. The challenge is not only what clinicians should do but also how they are supported to make decisions in complex clinical environments.

It is this gap between knowledge and its application that the second study seeks to address.

Supporting better decisions: the role of AI in prescribing

If AMR is shaped by everyday prescribing decisions, the next challenge is how those decisions can be better supported.

In the second study – Enhancing quality of antimicrobial prescribing through ‘Ask Eolas’ (language model): a user-testing and simulation evaluation – the researchers explored how AI can support prescribing decisions in clinical settings.

Ask Eolas is an AI-supported clinical decision tool designed to help clinicians access the right antimicrobial guidance more quickly and accurately. The tool retrieves and summarises reliable clinical guidance while providing clear links back to source material, allowing clinicians to verify its recommendations.

On the value of Ask Eolas in clinical settings, Dr Waldock notes:

“Ask Eolas appears to make the prescribing process much safer and more reliable. Unlike previous tools that could feel like a ‘black box’, this technology is transparent about why it is making a suggestion. This gives clinicians more peace of mind and makes their daily workflow feel much smoother.”

In a structured simulation study, Ask Eolas outperformed both traditional PDF guidelines and existing digital tools. Participants using the system achieved fully accurate prescribing decisions across the study scenarios.

Clinicians also reported higher confidence and lower cognitive workload when using the tool, describing it as clearer and easier to use than traditional guidance formats.

This highlights that improving antimicrobial use is not only about providing the right information, but about presenting it in a way that can be used effectively under pressure.

While these findings are based on a controlled simulation, they provide early evidence that carefully designed AI tools could support safer and more consistent prescribing in clinical settings.

‘Ask Eolas’ interface screenshot (Credit Eolas Medical Ltd).

Looking ahead: towards more responsive healthcare systems

Together, these two studies outline a more connected approach to antimicrobial stewardship, where better data and better decision-making reinforce one another.

The AMR Burden Score provides a more complete view of how AMR is developing within healthcare systems, while Ask Eolas supports clinicians to make more accurate, evidence-based prescribing decisions in real time.

This reflects a wider transformation in healthcare. Rather than relying solely on static guidance and retrospective review, there is growing interest in more responsive systems that can support clinical decisions as they are made.

Looking ahead, Dr Waldock points to a move towards a more “agentic” hospital:

“The agentic hospital is a shift from doctors using tools to doctors leading a team of ‘agents’ in the delivery of healthcare. Instead of a computer just holding your medical records, it’s now an ‘agent’ that supports your care: spotting risks before they happen, coordinating your tests instantly and handling the paperwork so your doctor can spend their time focusing entirely on you.”

There is still more to do. Both studies highlight the need for further validation, real-world testing and continued collaboration across healthcare systems. They also demonstrate what is possible when research is grounded in real clinical challenges and designed with end users in mind – central to the Fleming Initiative’s work in harnessing technology for real-world impact.

AMR may be shaped by decisions made every day. Strengthening how those decisions are supported in clinical settings will be central to any meaningful response.

Rising Faster Than the Sea Levels: Building Youth Resilience in the Philippines

Daniel Teklemariam

24 September 2025

In the Philippines, where typhoons and extreme heat are intensifying, young people are not only witnessing the climate crisis, but they are also living it. The research project Rising Faster Than the Sea Levels is working to understand and support the mental health and wellbeing of Filipino youth as they navigate the climate crisis.

The study is an example of co-developed research done with researchers including Dr John Aruta from De La Salle University, researchers at the Climate Cares Centre and codesigned by the Young Person Advisory Group (YPAG). Sophia Pahulayan, a recent graduate of Dr Aruta’s, is a project facilitator who helped to manage the project and cofacilitate the group discussions alongside young people, a vital linking point between the young cohort and the researchers. This was especially true due to Sophia’s previous research, passion for climate change work, and her ability to speak the local Bisaya dialect in a country with hundreds of dialects and local languages.

Sophia Pahulayana talks about connecting to young people for Rising Faster than the Sea Levels

Involving young people in research

Sophia recruited young people in the area to join the committee which was part of the decision-making process for the research materials and group discussion conversations. This helped to make the project more relevant to the experiences of young people when conducting semi-structured group discussions. This project helped to create spaces where young people can share their experiences of climate change and feel less alone. What makes this more natural free-flowing approach powerful and inclusive is its emphasis on solidarity and active listening. Sophia noted about the young people involved that: “they realised that they’re also basically the same. They may express it differently, but the core of the problem is the same.” The project tailors its methods to local contexts, using dialect and culturally resonant questions to foster trust and connection.

Connecting the climate crisis to our feelings

Sophia explained that the initial prompts were focused on big topics and concepts around climate change and mental health before YPAG realised that the better approach would be to focus on how local changes affected them and those they cared about. While young people may not always have the precise language for climate anxiety, they are deeply aware of how the climate has changed in their lifetimes. “They notice it has gotten different from when they were younger,” Sophia said, “they could still play outside during the summer, but now it’s not the same”. She also highlighted how they wanted the young people to make that connection between the climate crisis they’re seeing to the emotional struggles and the general anxiety they have when talking about the future.

Sophia Pahulayana talks about how Mental Health doesn’t exist in Filipino languages

Validation and Empowerment

For the young people, the project provides a space for validation and empowerment. As Sophia explains, their conversations are deeply intertwined with politics, as they are acutely aware of how government policy and corruption intensify climate catastrophes. They discuss painful memories like the mishandled billions in relief funds after Typhoon Yolanda which severely impacted their developmental years. The typhoon left survivors in their communities without adequate food, housing, or jobs and the corruption after made recovery even harder for the community. To finally voice these frustrations in a supportive environment is profoundly empowering. It transforms a sense of isolated helplessness into a shared realisation: “I’m not the only one thinking this way. I’m not the only one being concerned about this.” This awakening fosters a powerful sense of solidarity, making them feel less alone and more emboldened to empathise and get involved with climate action with their peers, a link which has been highlighted in a study published in Educational and Developmental Psychologist. The study says that “Filipinos who face a greater risk from climate consequences engage in actions that mitigate the climate crisis and prepare for future disasters.”

For Sophia personally, she describes the project as a source of hope and purpose. It allows her to connect with young people on a profound level, facilitating not just discussions but the birth of actionable ideas. Asked what she finds most rewarding about the project, Sophia explained that it is hearing participants say the sessions have given them hope and taught them things they never learned in school.

Time for action

However, this hope is coupled with a driving urgency: “it gives me hope, but at the same time it makes me feel like there’s so much more that we could do”. While processing this emotional weight is crucial, Sophia is eager to take the project to the next level: moving from conversation to concrete action. The goal is to harness this newfound solidarity and sense of agency to help these passionate young people channel their feelings into tangible change within their communities, transforming hope into a resilient force for the future.

The plan is to host spaces like the group discussions where young people and researchers alike can combine the therapeutic benefits whilst also allowing connections with their peers. Young people already working to address the climate crisis need to be provided with a space to collaborate and bring their ideas to life. However, the space also needs to be one where young people can unpack what’s happened to them and deal with the trauma that was ever present when discussing climate disasters like Typhoon Yolanda. Spaces similar to climate cafes can be healthy places to decompress and provide emotional support to young people looking to act against future climate events in their community. Sophia does emphasise that whatever is created must be “tailored to our needs, to the needs of our community and our context.”

Now that the project team has completed the group discussions, they are working on designing interventions. On the 24 September they will be going to Cebu city in the Visayas region of the Philippines to present the preliminary results of the project. This should hopefully open the project to wider connections in the climate action space in the Philippines as a lot of the work takes place in the capital of Manila and few if any of the organisations in this climate crisis hotspot focus on mental health. The project has also just won $30,000 to expand their research in collaboration with John Aruta and Renzo Guinto and Duke University.

Sophia Pahulayana final takeaways from the Rising Faster than the Sea Level project

Rising Faster than the Sea Levels is a project led by Climate Cares Centre funded by AXA Global Research Fund

Severe Malaria Africa: A consortium for Research and Trials

Laura Horga

25 April 2025

This blog post was written by Professor Kathryn Maitland, Professor of Paediatric Tropical Infectious Diseases at the Faculty of Medicine and Director of the Centre of African Research and Engagement at the Institute of Global Health Innovation, Imperial College London. She leads the SMAART Consortium (Severe Malaria Africa: A consortium for Research and Trials).

In much of sub-Saharan Africa (SSA), malaria remains a key cause of paediatric hospital admission, and makes a substantial contribution to under 5-year mortality, estimated at 600,000 annually.

Despite implementing currently effective, fast-acting artemisinin-based combination therapies, the multisite SMAART observational study has shown that inpatient mortality for paediatric severe malaria (excluding hyperparasitaemia with no additional severity features) remains unacceptably high at ~8%. The SMAART consortium was created in 2018 to translate recent advances in platform trial design to improve outcomes for severe childhood malaria across SSA.

SMAART is the only existing multi-site, multi-country collaboration conducting research in paediatric severe malaria on the continent.

SMAART-MAP, a multi-country adaptive platform trial (ISRCTN79071535) is simultaneously evaluating three adjunctive therapies in Phase II trials across SSA, addressing severe malaria complications (seizure prophylaxis, transfusion strategies and renal protection), with biomarker or clinical therapeutic efficacy endpoints based on putative mechanisms of action, to identify the most promising interventions to take forward into a large Phase III/IV mortality endpoint trial. The trial is being run in eight hospitals across six African countries (Ghana, Democratic Republic of Congo, Uganda, Kenya, Zambia and Mozambique).

The SMAART consortium is a multidisciplinary collaboration currently involving partners from SSA, Europe and Thailand with strong track records in delivering high impact guideline-changing treatment trials in paediatric severe malaria. SMAART’s ambition is to improve short and long-term outcomes for children with severe malaria in SSA by conducting better research studies faster, coordinating current and future research more productively, and hence enabling evidence-based continuous updates of disease definitions and treatment guidelines.

Celebrating Women at IGHI: Driving Meaningful Change in Global Health

Laura Horga

6 March 2025

On International Women’s Day, we shine a spotlight on the incredible women at the Institute of Global Health Innovation (IGHI) who are shaping the future of healthcare worldwide. From pioneering research to innovative policy work, these leaders are tackling some of the most pressing global health challenges —making a real difference in in the UK and beyond.

IGHI group photo — Group photo of IGHI staff at the summer social.

In this blog, we celebrate their achievements and highlight how their expertise and dedication continue to inspire change. Read on to learn about some of these fantastic women at the IGHI and discover key examples of their work.

Professor Bryony Dean Franklin – Visiting Professor at IGHI

Professor Bryony Dean Franklin is visiting Professor in the Department of Surgery and Cancer at the Centre for Prevention and Management at Imperial College. She is Director of the National Institute for Health Research (NIHR) North West London Patient Safety Research Collaboration (NWL PSRC), leading research in medication patient safety and the safe use of technology.

Professor Franklin is widely recognised as a research leader within patient safety, both nationally and internationally. She has specific expertise in evaluating technologies that aim to reduce medication errors in both primary and secondary care. She led a recent revision of the World Health Organization’s Medication Safety Curriculum Guide and has recently contributed to collaborative research and quality improvement studies in Brazil, India and Finland. As Co-Editor-in-Chief of the journal BMJ Quality and Safety she seeks to support and encourage others in publishing high-quality research and opinions that seek to improve patient care the world over.

Jennifer Bennett – Senior Postgraduate Administrator

Jennifer Bennett is a Senior Postgraduate Administrator for the PG Dip and MSc Digital Health Leadership (DHL) Programmes. She is responsible for the day-to-day administration of the programmes, supporting the students from recruitment to award and all the processes in between, working closely with faculty and teaching fellows to make sure the students get the best academic and pastoral support.

Jenny gained a new perspective on the student experience last year when she completed a L3 Team Leader qualification (CMI). She particularly enjoyed learning about leadership and communication models and evaluating how she could apply them to her work. This echoes the workplace assessments which the PG Dip students are doing, applying theory to practice. The PG students on the DHL programmes are all balancing work, study and personal or family commitments and Jenny has even greater empathy for students with looming deadlines! She is pleased to have achieved a Distinction. One of the projects she reflected on was the 2024 refurbishment of the office environment of 1070 at QEQM which has become a more inviting space for collaboration with colleagues.

Recently Jenny has introduced some processes to streamline the administration of benchmarking assessments and bulk uploading feedback to the VLE. She is also looking forward to contributing on further working parties to identify Imperial’s new VLE.

Melanie Leis – Director of Policy and Analysis

Melanie Leis is the Director of Policy and Analysis of the Centre for Health Policy, part of the IGHI. She leads the Centre’s development of analytics tools and policy outputs to support global decision-makers in fields such as patient safety, digital health and mental health.

Melanie leads our partnership with WHO’s Global Patient Safety Collaborative, which provides an opportunity to develop global and country-specific patient safety leadership support and resources. She also leads our collaboration with the charity Mental Health Innovations to deliver policy reports that highlight the key role that digital mental health services play in supporting the UK population. One of the projects she is most proud of is the collaboration with the charity Patient Safety Watch, through which IGHI produces reports on the national and global state of patient safety. The annual launch events of the reports bring together national and global patient safety leaders, including patients. These reports and events ensure that patient safety is at the top of system leaders’ agendas.

Jodie Chan – Public Involvement Officer, Helix Centre

Jodie Chan is a Public Involvement Officer at the IGHI’s Helix Centre, working on projects around safely involving women experiencing homelessness in research, understanding the mental health experiences and support needs of 10- to 13-year-olds, and analysing the impact of long waiting times on patients and the health system.

Jodie works across IGHI to support the meaningful involvement of patients, carers, and public members in research. Within her work, she has a strong focus on deepening and diversifying IGHI’s relationships with its local community and is passionate about supporting community-led research.

She is particularly proud of the relationships she has built with women at the Marylebone Project, a local women’s homelessness service, and of their ongoing work to make research safer and more psychologically informed.

Jessica Shields – Impact Officer, Helix Centre

Jessica Shields is an Impact Officer at the IGHI’s Helix Centre, working across the Centre to keep it running smoothly. Jess works on everything from supporting the scaling up of Helix projects and looking for funding opportunities to communications and coordinating Helix events. Jess also co-chairs the IGHI Wellbeing Working group, heading iniatives to improve workplace wellbeing at IGHI.

Jess is proud to support the Helix team to bring design to healthcare and being involved in the Wellbeing Working Group at IGHI. A particular highlight has been bringing the Helix team together over games and food for the Christmas All-Staff meeting and supporting team members to find funding for projects they’re passionate about.

Dr Jang Ah Kim – Lecturer at the Hamlyn Centre

Dr Jang Ah Kim is a Lecturer at the Hamlyn Centre for Robotic Surgery, Department of Mechanical Engineering. She is interested in researching multidisciplinary approaches to understanding and controlling the interactions between materials and their surrounding environments at the micro/nanoscale. By leveraging this knowledge, she aims to develop innovative and highly precise, minimally invasive strategies for biomedical sensing and robotics, addressing challenges unique to these scales.

The mini lab (micro-nano innovation lab) that Dr Kim leads is built on the belief that big breakthroughs start small. The lab focuses on micro and nano-scale engineering, exploring how light and other physical stimuli interact with materials to push the frontiers of biomedical sensing, soft robotics, and healthcare technologies. The name mini lab itself reflects this vision—written in lowercase to symbolise its commitment to micro/nano-scale research and precision-driven, minimally invasive healthcare solutions, where even the smallest changes can lead to transformative impact. Through this work, Dr Kim and her team strive to bridge fundamental science with real-world applications, advancing the next generation of biomedical engineering solutions.

Although newly established in September 2023, the mini lab has already embarked on exciting foundational research in manipulating micro/nanoparticles and bacterial swarms using light, as well as engineering shape-changing microrobots. These efforts aim to lay the groundwork for novel applications in personalised medicine, such as targeted drug delivery, cellular-level surgery, and local immunotherapy. In the long run, these highly targeted and efficient biomedical solutions could also contribute to addressing broader clinical challenges, including optimising therapeutic strategies and reducing unnecessary antibiotic use, ultimately supporting efforts to tackle antimicrobial resistance—all of which resonate with IGHI’s vision for advancing global healthcare innovation.

Dr Ana Cruz Ruiz — Project Manager, Hamlyn Centre

Dr Ana Cruz Ruiz is the Project Manager at the Hamlyn Centre for Robotic Surgery, where she coordinates centre-wide projects across various Technology Readiness Levels, ranging from basic research to medtech translation initiatives. In addition to this role, she leads the Hamlyn Centre’s Global Surgery working group, which focuses on how frontier technologies—such as AI, robotics, 3D printing, and the Internet of Things—can enhance surgical care in low- and middle-income countries.

One of her recent achievements includes organising the Global Surgery Forum at the Hamlyn Symposium 2024, where she co-moderated a panel with Dr Kee Park, Director of Policy & Advocacy at Harvard Medical School. The session, titled “Can Technology and Innovation Help Improve Health Equity?”, addressed the challenges faced by low- or middle-income countries in accessing safe, affordable surgical and anaesthesia care. The panel explored how technology is already helping to address some of these barriers, while also emphasising the need for further collaboration with the engineering community to create scalable solutions.

Ana is passionate about improving health equity in Honduras and in Latin America. Recently, she travelled there to meet with local surgeons, learn about regional needs, and explore ways to collaborate on making surgical care more accessible. She also contributes as a member of the Advisory Council for Honduras’ 2026 National Human Development Report, organised by the United Nations Development Programme.

Georgia Butterworth – Senior Strategy Advisor to Lord Darzi

Georgia Butterworth is a Senior Strategy Advisor to Lord Darzi, supporting the delivery of his wide-ranging portfolio across academic, policy and parliamentary priorities. In this role, she provides strategic advice and coordination across a diverse range of projects, from the Fleming Initiative to the NHS Independent Investigation. Her work is dynamic and varied, often requiring close collaboration with colleagues across the IGHI to ensure alignment across its centres.

One of the best things about my role is seeing the great achievements of the different centres in the IGHI and thinking about how we bring it all together for greatest impact. I find it really exciting to contribute to shaping the future of health and care through the IGHI, and inspiring to work alongside many exceptional women in this field.

Jessica Newberry Le Vay – Climate Change and Health Policy Fellow

Jessica Newberry Le Vay is a Climate Change and Health Policy Fellow in the Climate Cares Centre, working on the interconnections between climate change and mental health. Jess recently worked on the Connecting Climate Minds Global Research and Action Agenda, bringing together the perspectives of 960 experts across 100 countries to set out global priorities for climate change and mental health research and a vision for implementing and translating that research to action. Jess was also recently part of developing the People’s Petition, a global collective climate justice call submitted to the International Court of Justice in December 2024 that amplifies the testimonies of 18 witnesses from communities experiencing and responding to the worst impacts of the climate crisis, including impacts to physical and mental health.

Jess currently leads The Compass Project: Guiding minds and inspiring action through climate change education, working with young people and educators in schools and universities to ensure climate change education can equip and support young people with the resilience, knowledge, skills and agency to take climate action and live in an uncertain future.

Dr Emma Lawrance – Climate Cares Centre Lead

Dr Emma Lawrance is the Climate Cares Centre Lead and Mental Health Lead at the IGHI. Emma also leads the Wellcome-funded global initiative Connecting Climate Minds, which has involved over 1000 people across 100 countries to date. She holds an AXA Climate and Health Fellowship to more deeply understand the experiences of young people in the climate crisis in different cultures, what this means for their mental health and wellbeing, and to co-design and evaluate support that can build agency and resilience.

Emma is a recognised global leader in the emerging climate and mental health field, building awareness and capacity across sectors and countries to acknowledge and act for a climate of health and wellbeing. She is an author of key research and policy papers on the topic, including: the first global policy brief; leading reviews of the field as a whole, relevant interventions, and temperature and mental health; studies with young people in the UK, Caribbean and the US (under review), and the Global Research and Action Agenda for climate change and mental health. She has presented globally, for instance at the World Economic Forum, four UNFCCC COP conferences, the World Congress of Psychiatry, OECD and the European Commission and been featured in international media, including Die Zeit, Guardian, Al Jazeera, Sky News, BBC, Forbes, Reuters and others.

She believes in the power of community, and in connecting people and ideas to foster resilience to thrive in a changing world and to create a safer climate for our mental health.

Dr Laura-Maria Horga – Communications and Events Officer

Dr Laura-Maria Horga is a Health Communications and Events Officer at IGHI. She delivers communications and engagement projects across IGHI’s seven research centres of excellence, supporting the Institute’s mission to tackle global health challenges.

Laura has contributed to key projects, including the National State of Patient Safety Report 2024, which gained prominent media coverage for highlighting critical maternity care issues; the Mental Health Innovations Report, which explores digital solutions to meet growing mental health needs (Shout service); the Great Exhibition Road Festival; the Julia Anderson Training Programme; Connecting Climate Minds; the Digital Health Leadership Programme; and many others.

She is currently leading the organisation of IGHI’s annual in-person event, Demo Day, which helps staff learn more about the different workstreams at IGHI, connect with colleagues, foster collaborations, and celebrate the Institute’s achievements.

Laura is also a certified Mental Health First Aider at Imperial College London.

Dr Ivet Angelova – Research Associate

Dr Ivet Angelova has recently joined the MedTechOne programme at Imperial College London as a MedTech Specialist. Her journey into healthtech began with a PhD in Chemical Engineering, where she focused on developing genetically encoded biosensors for monitoring Botulinum Neurotoxins—a project that deepened her passion for turning scientific discovery into practical healthcare solutions.

Shaping the future of healthcare means not only driving research and innovation but also ensuring it reaches those who need it most. As part of MedTechOne, Ivet is currently working towards building a knowledge base that equips early career researchers (ECRs) with the tools to translate medtech discoveries into real-world impact. This resource is shaped by the needs and feedback of researchers across IGHI, the Hamlyn Centre and the wider Imperial community. Covering everything from regulations and quality standards to commercialisation and team building, this resource is designed to help bridge the gap between research and commercialisation. Additionally, she is co-leading the launch of the MedTech ECR Network at Imperial, creating a space for emerging medtech leaders to connect, collaborate, and thrive.

Ivet said “This International Women’s Day is a chance to celebrate the women driving healthcare forward, breaking barriers, and shaping a future where innovation is inclusive, impactful, and accessible to all. I am grateful to be part of a community filled with inspiring women whose work and determination continue to push the boundaries of what is possible in medtech and beyond.”

Cohort 7 Trainees – Julia Anderson (JA) Training Programme

Caitlin Murphy is as a JA Behavioural Science Trainee in the Fleming Initiative team. She is working in a patient / public facing project focusing on the use of antibiotics and encouraging individuals to finish a course of antibiotics if prescribed.

Arlette Albert is another JA Behavioural Science Trainee in the Fleming Initiative team. She is working part-time alongside Caitlin to develop her skills in qualitative research, behavioural science, patient engagement, and co-designing interventions.

Miranda Watson joined as the JA Trainee in Digital Health. She is working in the Patient Safety team to develop her skills in translating evidence into measurable interventions to improve patient safety in virtual care. She is involved in reviewing the literature, extracting data, and critically appraising available literature to identify safety indicators relevant to virtual consultations.

Health Policy MSc: Insights from a Second-Year Student

Laura Horga

22 November 2024

The Health Policy MSc at Imperial College London is led by the Institute of Global Health Innovation.

Jazz Walker, a Year 2 Health Policy Master’s student and Biological Capabilities Policy Advisor at the UK Health Security Agency, attended our recent in-person student workshop and shares her experience of the MSc programme.

Why did you apply for the Health Policy MSc programme?

Jazz: I applied for the programme mostly for career progression reasons. I’d gone through education—originally, I did an English degree—and then I got into health policy.

One aspect that drew me to it is that, particularly in the policy world, you don’t often gain experience outside of your job’s specific focus. It’s really difficult, especially in busy areas, to get opportunities to branch into other fields.

Personally, I found the finance and economics section quite interesting. Due to the way my career has progressed, I’ve always kind of avoided working on those areas. But this programme provided a nice, non-pressured way to learn about those elements of the job without needing to seek permissions for work shadowing. My organisation is keen to promote learning and development, but I personally haven’t found their traditional pathways very effective for learning this type of information.

I found the Health Policy MSc programme more helpful because it requires you to work on a problem statement, rather than just absorbing theory that’s delivered to you, with no practical application. It provides a way to demonstrate how you’d approach and apply these examples in real situations. Those are the key things I value: gaining skill sets I can’t acquire in my job. It’s been very interesting, and I’m pleased to be able to work with people from diverse backgrounds on the course.

How is the programme going so far? What did you enjoy the most or found most impactful?

Jazz: I think it’s going really well so far. I particularly enjoyed last year’s module on Health and Society, as it connected to my work at the time, which was related to threat relevance. Having an entire module focused on various threats helped me better understand the organisation I was working in. This was especially useful because my employer is funding my studies to help me bring broader awareness to other areas I might work in.

Gaining these learnings and insights pushed me to apply more of them in my work. This has enabled me to present stronger ideas by incorporating those considerations and working through them, and has strengthened my relationships with analysts in that area. I can now demonstrate that I’m using the same assessment criteria they would use, saying things like, ‘I evaluated this’ or ‘I’d recommend approaching it this way’ or ‘This is how I’d like to see the results—does that align with the right approach?’ Having their agreement has further helped build these connections.

How do you think this programme will further help you in building your career?

Jazz: I think simply being recognised for doing the Master’s has already been really helpful for my work. It’s helped me connect with industry and academia, showing them that there’s genuine dedication behind what I’m doing. In an environment where people often jump between fields, having a solid foundation in the subject area is really valuable.

Pushing myself to think critically and write papers in a more traditional, academic style has also been useful. I had definitely fallen out of practice with writing academic papers, so it’s been great to get back into that process and focus on building a stronger evidence base. Rather than just relying on the specialised technicians in my organisation, I’m doing self-directed research again. This has been particularly helpful in areas I’m working on, as it’s taught me how to evaluate sources more critically. It’s not just about thinking, ‘Well, it’s in an academic journal, so it must be true,’ but about noticing potential biases that might affect credibility.

I think this stronger evidence base, along with the ability to perform desk research and self-reflection, will be incredibly useful for my future career.

Have you experienced any challenges so far? And if so, how has the academic team supported you?

Jazz: The academic team has been very helpful throughout the course. Particularly at the start, when I was working on two tasks simultaneously in my job, being able to reach out and express that things were challenging gave me the reassurance I needed to manage things through. They explained the possibility of getting a short extension, or if I needed a longer one, they could guide on providing evidence of what I was working on. Their support has been invaluable!

I found the drop-in sessions especially useful, knowing I could jump in and ask, ‘I have one question; my mind can’t quite get where I’m going with it. Am I thinking about it right?’ Getting confirmation and advice on where I might need to push further or focus more on that track was really helpful.

The way the lessons are structured is also refreshing compared to other universities I’ve attended. They truly listen, and you can see that reflected in how the course has evolved.

For example, I appreciated having the opportunity to reflect through the course’s reflective learning journals in my first year; however, I found it challenging to keep up with them due to time constraints. What’s great is that the academic team listened to our feedback, acknowledging the timing pressures, and made adjustments accordingly in our second year. Unlike other academic settings where you’re simply told to ‘just do it,’ it’s nice to be in a place where they listen and adapt the course as it progresses.

What advice would you give to new applicants?

Jazz: I think it’s important to consider your timings. Planning ahead on how you’ll approach each part of the course can make the assessments less challenging. If you tackle the work gradually, following along with the unit organically, it will make a difference. Personally, thinking about how I’ll apply what I’m learning to the assessments has been beneficial.

Also, remember to take time for yourself. It’s important to keep up with your reading, but too much pressure can be overwhelming. The required and optional readings are already outlined for you, so focus on those, and spend extra time on topics that interest you or could enhance your essays.

Learn more about the postgraduate Health Policy MSc.

Innovative children’s hospice opens in Italy with support from IGHI

Gianluca Fontana

21 June 2024

“Arca sull’albero”, a new children’s hospice in Bologna, Italy, was inaugurated last week, marking a significant milestone in children’s palliative care. The hospice, funded by Fondazione Hospice Maria Teresa Chiantore Seràgnoli, is a testament to innovative, user-centred design and care. Researchers and designers from the Institute of Global Health Innovation (IGHI) and its Helix Centre played a pivotal role in its development, ensuring the incorporation of lessons from international best practices and of user-centred innovation.

Aerial view of "Arca sull’albero" children’s hospice in Italy. Credits: Enrico Cano — Aerial view of “Arca sull’albero” children’s hospice in Italy. Credits: Enrico Cano

Access to children’s palliative care is a human right. According to the United Nations Committee on the Rights of the Child, “children are entitled to quality health services, including prevention, promotion, treatment, rehabilitation and palliative care services.’’ However, 8 million children around the world need specialist palliative care, but only 10% of them actually receive it. Even in otherwise developed health systems like Italy’s, provision of paediatric palliative care is limited.

The new children’s hospice

“Arca sull’albero” is one of the first and most innovative children’s hospices in Italy. It stands out as unique in several key ways. Its architecture, designed by Renzo Piano Building Workshop, merges functionality with a serene, home-like atmosphere, providing a comforting sanctuary with natural light and open spaces.

"Arca sull’albero" children’s hospice in Italy. Credits: Enrico Cano — “Arca sull’albero” children’s hospice in Italy. Credits: Enrico Cano

The hospice’s care protocols align with global best practices, ensuring the highest standard and continuity of care. Focus on user experience is paramount, with every detail meticulously designed to make the stay comfortable and stress-free for children and their families. Additionally, the hospice’s governance and management processes aim to maximise effectiveness and openness to innovation.

Isabella Seràgnoli, from the Fondazione Hospice Maria Teresa Chiantore Seràgnoli, said:

“The children’s hospice represents concretely the concept of care. Palliative care is not only about treating physical pain, but also psychological pain, and requires attention to the situation of the person and their family. For this reason the hospice is an open and permeable place, a home where social relations and affection are possible and in which to experience beauty.’’

Collaboration with IGHI

The IGHI team has been involved from the project’s inception. Leveraging its extensive expertise and research, IGHI informed the hospice’s strategy and its approach to innovation, ensuring that “Arca sull’albero” not only meets but exceeds global standards in children’s palliative care.

Designers from the Helix Centre engaged with children and their families, including siblings, to understand their needs and put them at the centre of IGHI’s research efforts in this area. They also designed prototypes of innovative solutions that informed the plans of Fondazione Hospice Maria Teresa Chiantore Seràgnoli for the new hospice.

Gianluca Fontana, Deputy Director of IGHI, said:

“It is rare to be able to play an active role in the creation of a new healthcare provider. I am proud of the work of many IGHI team members in researching and designing solutions in children palliative care. I am extremely grateful to Fondazione Seràgnoli for the trust they put in us and for their support of our activities in this space.”

A team from IGHI’s Centre for Health Policy led the development of the report, “The children’s palliative care provider of the future: A blueprint to spark, scale and share innovation”. The report emphasises the importance of innovation in children’s palliative care, advocating for adopting new technologies, interdisciplinary collaboration, and a patient-centred approach. Through interviews with 51 experts in 27 countries, the project identified 9 key features of innovative paediatric palliative care providers:

- - People
  - Culture
  - Leadership
  - Vision
  - Organisation
  - Partnerships
  - Services
  - Technology
  - Place

“Arca sull’albero” exemplifies these characteristics, setting a new standard for children’s hospices in Italy and beyond. The report also revealed the opportunity for dedicated advancement of excellence and innovation in paediatric palliative care worldwide. With the support of the partnership between Fondazione Hospice Maria Teresa Chiantore Seràgnoli and the Institute of Global Health Innovation, Global Treehouse Foundation was established and is now working in partnership with innovators, funders, providers and entrepreneurs to address the global lack of access to children’s palliative care.

Laura Dale-Harris, Founder Director of Global Treehouse Foundation, added :

“Arca sull’albero is a model of where the global children’s palliative care field can grow – deep local roots with families, children, and communities – partnered with innovators and expertise like IGHI. We are excited to welcome Arca sull’albero to the community of entrepreneurial children’s palliative care providers around the world.”

The opening event

At the inauguration last week, Gianluca Fontana from IGHI took part in an event alongside Renzo Piano, the building’s renowned architect, paediatric palliative care experts Professor Julia Downing, CEO of the International Children’s Palliative Care Network, and Dr Renee McCulloch from Great Ormond Street Hospital and University College London. The speakers presented the latest development in paediatric palliative care globally to an audience of paediatricians and nurses from the Emilia Romagna region.

Gianluca Fontana speaking at the inauguration event. Credits: Jonty Roland

Renzo Piano described his vision for the architectural project, an “ark on the trees where children and families can find relief surrounded by the magic and natural beauty of the woods”. Professor Downing presented a global overview of the development of paediatric palliative care services. Dr McCulloch shared her experience working in research and clinical practice in the sector. Gianluca Fontana spoke about the key features of the paediatric palliative care provider of the future.

Renzo Piano speaking at the inauguration event. Credits: IGHI

The future

IGHI is committed to improvement and innovation in paediatric palliative care and in the health of children more broadly. Beside the continued collaboration with Arca sull’albero and Global Treehouse Foundation, researchers at IGHI and Helix have a number of early stage projects working with children and young people, particularly around mental health and rare diseases, for which they are interested in exploring opportunities for further collaboration and funding.

Making connections for climate change and mental health

Omnia El Omrani

25 April 2024

Connecting Climate Minds Global Event recap

The Connecting Climate Minds (CCM) Global Event in Barbados involved 70 in-person participants and more than 600 virtual participants. Together, we celebrated the initiative’s first year of work led by seven regional communities, youth, Indigenous Nations and Peoples, and small farmers and fisher peoples.

At the Global Event:

The Connecting Climate Minds Hub was launched – an innovative digital platform designed as a collaborative space for researchers, policymakers, educators, and community groups to share their knowledge, resources, and experiences on the climate-mental health nexus including the CCM outputs.
The global event featured keynote sessions delivered by prominent experts in climate change and mental health, along with the marketplace, regional spotlight sessions, and breakout sessions to discuss the Global Research and Action Agenda.
“Need for measurement and data” on climate-related mental health impacts, “community” and “co-creation” were the key recurring themes highlighted by participants.
The first Global Research and Action Agenda on climate change and mental health was discussed and will be finalised for launch in July.
The global event also launched the key CCM outputs, including ten regional and community research and action agendas, lived experiences, case studies and toolkits. The CCM community discussed opportunities to support the capacity of the Regional Communities of Practice to fulfil the imperative agendas created through the project.

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Inaugural IGHI Education Community event a success!

Laura Horga

19 April 2024

The first IGHI Education Community event took place on the evening of Thursday, 11 April 2024. Organised by the Student Wellbeing in IGHI Postgraduate Education (SWIPE) team, in collaboration with St John International, the event welcomed guests in the surrounds of the Museum of the Order of St John’s historic Chapter Hall.

IGHI Education Community Event – The role of the third sector in health systems: focus on the order of St John

IGHI students and staff, alongside guests from the Order of St John, had the privilege of hearing an engaging and eye-opening series of talks from esteemed speakers from both the International Order of St John and St John Ambulance England.

The evening began with a short presentation by Susan le Jeune d’Allegeershecque, Secretary-General of St John International, which provided a whistlestop tour of the history of the Order and its operations in the present day.

She was followed by James Radford, Chief of Staff at St John Ambulance England, who discussed St John Ambulance’s position and role within the UK health system and its interactions with the NHS. Mr Radford stressed the importance of relationship building and the benefits for an organisation of creating a clear identity and staying true to it.

Mr Richard Lee, Chief Operation Officer of St John Ambulance England, delivered the final talk of the evening. Mr Lee’s presentation focused on the role St John Ambulance played during the COVID pandemic and provided an enlightening explanation of how the organisation mobilised, trained, and deployed close to 30,000 volunteers to deliver COVID vaccinations within an 8-week timeframe.

The presentations were rounded off by a panel discussion, facilitated by Joe Kerr, during which the speakers shared their thoughts on lessons learned from the pandemic, the impact of changes in the political landscape on third-sector planning, and the experience and lessons learned by transitioning from a 36-year career within the Foreign Office to a senior leadership role within a third-sector organisation.

Drinks and a networking session followed, providing guests with the chance to partake in refreshments, chat, and enjoy the splendid atmosphere of the Chapter Hall.

The SWIPE team wish to thank St John International, St John Ambulance England, and the Museum of the Order of St John, for their help in organising this event. Future IGHI Education Community Events are in the process of being planned, so keep your ears to the ground and make sure to join us for the next event!

Julia Anderson Careers Event 2024: Inspiring sixth formers with career insights and opportunities to transform global health

Laura Horga

11 March 2024

In February we hosted the Julia Anderson Training Programme (JATP) Careers Event 2024 at Institute of Global Health Innovation (IGHI), a fantastic evening for sixth form students to learn more about our Julia Anderson programme and the IGHI, and get inspired for their future careers.

JATP trainees with IGHI staff — Credit: Rolando Charles

Sixth formers from different London state-funded schools travelled to The Invention Rooms, at Imperial College London’s White City Campus, to participate in the event. They got the chance to learn more about the opportunities at IGHI, hear some of our staff members’ career journeys, as well as interact with some of the fantastic workstreams we work on to improve people’s health.

About the Julia Anderson Programme and next cohort recruitment

The evening started with Sophie Pieters, IGHI Operations Officer and JATP Programme Lead, welcoming the attendees and introducing the JATP programme, including the eligibility criteria and the new trainee roles available in the summer.

The Julia Anderson Training Programme gives people with limited or no work experience the opportunity to join an impactful stream of work at IGHI, Imperial College London’s. The paid programme gives trainees the opportunity to grow their network, boost their CV and develop applicable workplace skills and knowledge.

Sophie announced the three upcoming roles for the next cohort in July, specifically Analytics and Events Trainee, Public Involvement Trainee and Educational Research Trainee (the first two are open to those with no university). On 14 March, a webinar will be held to provide people with more information on the programme, the training positions on offer and useful advice for the application. Students were highly encouraged to sign up for the webinar.

Career talks from IGHI staff and trainees

Next, some of the IGHI staff and current trainees delivered individual presentations highlighting their career journey, challenges, and other valuable insights from their experience.

“I found the job I loved although didn’t know it existed. It’s okay if you don’t know what you want to do.’’, said Eleni Daniels, Patient Safety Research Centre (PSTRC) Manager at IGHI, who has a background in biomedical sciences and worked in advertising before finding her dream job in a patient safety field.

Image: Eleni Daniels giving a presentation about her career journey. Credits: Rolando Charles

Amish Acharya, Scientific Advisor to Professor Ara Darzi at IGHI, talked about his ‘unconventional’ career path from medicine, followed by PhD in Behavioural Science, to his current role, where he is contributing to creating research projects and supporting the progress of scientific work. Amish advised:

“Exams don’t represent who you are and what you can do. It’s never too late to change your path, don’t be afraid to try different things – this can often make you more adaptable and rounded as a person.’’

One of our current Julia Anderson Trainees, Tania Domun, a graduate of Population Health and Medical Sciences with a Master’s degree in Public Health, shared her experience so far as a JATP trainee in Behavioural Science and the benefits of joining the programme:

Tania Domun sharing her experience as a current JATP trainee. Credits: Rolando Charles — Tania Domun sharing her experience as
a current JATP trainee. Credits: Rolando Charles

“JATP allows you to develop your skills and support you with the next steps in your career. It’s challenging when you don’t have a mentor or people to help you navigate your professional path. The programme does exactly that, by focusing on you as an individual. It’s a lot about your passions and not your previous work experience. This makes it a unique programme.’’

She also talked about the Imposter syndrome: ‘’I’ve realised many people, including me, deal with this syndrome – don’t let these feelings stop you from applying for the programme. This is the best time to explore possibilities and build new skills.’’

Lastly, Clarissa Gardner, Senior Design Researcher at TPXimpact and Honorary Research Fellow, spoke about her career journey as a ‘learning process’ and how she came about setting the JATP programme, after doing a MSc in Health and Design at IGHI:

‘‘Your job title doesn’t matter as much as your ability to help others and inspire positive change. I recognised the diversity of people at IGHI, so I proposed this programme to create work experiences for people.’’

Interactive activities showcasing IGHI Centres’ work

After these inspiring talks, we organised interactive activities led by each of the IGHI Centres. During these sessions, attendees had the opportunity to engage with the different workstreams at IGHI in small groups and interact with IGHI staff members.

The Hamlyn centre hosted a ‘create your own surgical robot’ activity. Sixth formers were challenged to conceptualise the design of a robot, then turn their drawings into 3D images using specialised software. Hamlyn centre representatives also explained the benefits of surgeons using surgical robots compared to traditional surgery methods, highlighting how they enhance precision during procedures. The participating team included Brandon Davies, Learning Technologist, Nazia Bharde, Project Officer, Robert Merrifield, Medical Design Associate and Salzitsa Anastasova-Ivanova, Facilities Manager.

Brandon Davies briefing students on how to design a surgical robot. Credits: Rolando Charles

At one of the Helix Centre stands led by Jodie Chan, Patient and Public Involvement and Engagement Officer, and Clare McCrudden, Policy Fellow from the Change Lab, students had the opportunity to discover how the public can influence research priorities, methodologies, and dissemination for healthcare improvement. They were encouraged to brainstorm alternative names for ‘antimicrobial resistance’ and open the ‘can of worms’ around healthcare data through an interactive activity, sparking further discussions on its benefits and risks.

Image: Clare McCrudden talking about antimicrobial resistance with sixth formers. Credits: Rolando Charles — Image: Clare McCrudden talking about antimicrobial
resistance with sixth formers. Credits: Rolando Charles

They also learned about one of the upcoming JATP roles – Public Involvement Trainee – who will help to involve local youth groups and schools in a project aimed at better understanding the mental health needs of children across the UK and identifying how services can better support them.

The second Helix Centre stand was led by Matthew Harrison, Senior Design Associate, Alex Dallman-Porter, Designer Healthcare Products, and current JATP trainee, Andrew Watt. People were invited to participate in a grip strength assessment activity, during which they were asked to squeeze a ball-shaped dynamometer (‘squegg’) in their hand to measure their frailty levels and compare with their peers. Additionally, the stand showcased a sleeping mat used for measuring heart rate and respiratory rate, along with other environmental sensors designed for individuals with dementia.

Jessica Newberry Le Vay, Climate Change and Health Policy Fellow at the Climate Cares Centre, hosted an interactive session about exploring climate emotions and imagining what future they want to see. The students were challenged to think about the following questions: ‘’How does climate change make you feel?, What stories do you hear about the future?, What would you want the future to look like?’’

People were able to discuss their responses to these questions and see what other people have put. They explored actions that can improve both mental health and the climate, building hopeful and constructive narratives around climate change.

Eleni Daniels from PSRC also had a stand on patient journey. She encouraged students to reflect on healthcare experiences of themselves, their family members, or friends, and to consider how these experiences could be further improved. People shared their thoughts and experiences, engaging in a dialogue that allowed them to open up and explore patient journeys from the GP to hospital settings.

Feedback from sixth formers

We were impressed by the amount of positive feedback we received from the sixth formers. Some examples below:

“I’ve discovered that you don’t need to know exactly what you want to do at this age. It’s more important to be open to learning and taking on new opportunities and experiences.”

“Many internships and training programmes require individuals to meet specific minimum requirements. It’s fantastic to discover that the JATP program doesn’t have such requirements, giving people the chance to gain those skills and build experience.”

Sophie Pieters, JATP Lead, and Holly Merton, JATP trainee, chatting with the sixth formers. Credits: Rolando Charles

“I found the event very engaging and fun. It made me think about my future career, the steps I want to take next and the sort of support I should be seeking. I am keen to apply for this programme!’’

On the day feedback indicated that, among our participants, 90% were inspired for their career after attending the event. According to our post-event online survey, 92% of our participants expressed their willingness to recommend JATP to a friend, while 83% of respondents indicated their intention to apply for JATP in the future.

We are looking forward to seeing people applying for the JATP programme and taking advantage of the tremendous opportunities at IGHI to advance in their careers. The event was made possible by the EDI Seed Fund and we are very grateful for their support.

Ukraine: Better care for children with complex long-term health needs

Alexandra Shaw

29 February 2024

Our third blog post for the two-year anniversary of the invasion of Ukraine addresses the importance of prioritising better care for children with complex long-term health needs.

This is part of a series of blog posts sharing insights from our Ukraine Health Summit, hosted in partnership with the British Red Cross to further efforts in supporting the delivery and restoration of health services in Ukraine. This piece is written by Alexandra Shaw, Institute of Global Health Innovation, Imperial College London, with colleagues.

[Ukraine Health Summit: attendees chatting] — Ukraine Health Summit: attendees chatting

In Ukraine, many children continue to be cared for in institutions. Estimates vary widely and suggest that between 90,000-200,000 children reside in these institutions, and approximately 20,000-50,000 of them have disabilities.^{1 2}

Children have a range of disabilities including congenital abnormalities of the nervous and cardiovascular systems, foetal alcohol spectrum disorders, genetic disorders and chromosomal abnormalities, visual impairments, cerebral palsy and epilepsy.³Factors impacting institutionalisation include poor infrastructure for children with disabilities, including education and community-based therapy services. There is a lack of crucial services, including rehabilitation and palliative care, and support in the community, making caring for a child with complex health needs even more challenging. Social challenges also drive institutionalisation including poverty, social stigma and the lack of support means families are left isolated.³ An estimated 90% of children placed in institutions have parents or family but are placed in institutions because of the challenges of caring for them in the community. Other factors include the inability of parents to care for their children, neglect or substance abuse.²

Impact of institutionalisation

In 2019, the 74th UN General Assembly adopted the resolution on ‘Rights of the child’ which urges that family and community-based care should be promoted over placement in institutions, and that children with disabilities should enjoy all human rights and fundamental freedoms on an equal basis with other children, including access to a family life.4 Children living in institutional environments can suffer significant harm including the impact on their quality of life, their ability to adapt to society, mental health and overall development.5 Facilities often fail to meet basic needs, address individual requirements and provide emotional and social stimulation.

Institutionalisation can lead to poor physical and mental health outcomes, stunting and a lack of development from inadequate nutrition, and infectious disease. Children who have been institutionalised can be left with difficulties processing and integrating sensory information, poor language development, damaging behaviours and significantly shortened life expectancy.6 Staff to child ratios are often inadequate, leading to inappropriate methods of restraint, and a lack of supervision means children are not provided with adequate sanitary care, or assistance with feeding.²

Reform and impact of war

Before the war, the government had adopted the National Strategy on Reform of the Institutional Care System (2017-2026), however there have been delays in implementation and children with disabilities have been excluded included in these reforms.7 The war has made the situation for children with complex long-term health needs even more desperate. Whilst children with more mild disabilities are being evacuated, many children have been moved from facilities in the east of Ukraine to inadequate facilities in the west. This had led to overcrowding, further reduced staff ratios, and a lack of medical records leaving staff looking after children with no background information about their condition and care needs.8

In some cases, children have been returned to their families without support or guidance to ensure the child’s health needs are adequately met.¹ The European Commission has provided 230 million in humanitarian aid to the Ukrainian government which brings an opportunity to ensure disabled children benefit from the assistance provided to Ukraine.⁹

[Ukraine Health Summit: Dr Ulana Suprun] — Ukraine Health Summit: Dr Ulana Suprun

Moving forward

There is still progress to be made to improve care for children with complex health needs in Ukraine. A unified approach is required which clearly defines the responsibilities and powers of government authorities and local organisations to apply standards to protect children’s rights and care. Key recommendations include:

1. Reform for the provision of community based care

Change of policy and legislation, alongside political commitment, to prevent future institutionalisation and protect the rights of children, particularly those with disabilities.
Implement programmes to develop long-term family-based environments for children currently living in institutions.
Develop services to support children and families in the community including early intervention, social care support systems, family-based care, rehabilitation services, social services and paediatric palliative care.
Enable a holistic approach to care for children with complex health needs, including the role of education, sport, family and culture.

2. Paradigm and cultural change campaign

Launch a comprehensive and sustained campaign to enable a shift in attitudes and paradigms across all professions and the workforce.
Implement policy and a public campaign to encourage a societal shift in the way children with complex long-term health needs are viewed.
Enable the empowerment of families to advocate for their own children and specialist needs.

3. Development of health and social care workforce

Implement educational programmes to increase the size of the workforce in the areas of medical rehabilitation services, paediatric palliative care and social services.
Upskill professionals and expand access to continuing development for staff working across paediatric health and social care.
Develop capability in the community for family members, carers, social workers, rehabilitation staff, and other allied professionals such as speech and language therapists to support children in the community.

4. Strategic allocation of reconstruction funding

Develop a strategic plan to guide the allocation of reconstruction and support funding for children to be cared for outside of institutions.
Enable collaboration across different ministries which oversee education, social care and health to bring a more unified effort towards reducing the number of children living in institutions.
Prevent the reconstruction and rebuilding of institutions and instead invest in foster care, family and community-based services.

References

Ukraine war response: Children with disabilities. UNICEF; 2022 (https://www.unicef.org/emergencies/ukraine-war-response-children-disabilities, accessed 18 February 2024).
No Way Home: The exploitation and abuse of children in Ukraine’s orphanages. Disability Rights International; 2015. (https://www.driadvocacy.org/reports/no-way-home-exploitation-and-abuse-children-ukraines-orphanages, accessed 18 February 2024).
Behind the mask of care: A report based on the results of the situation analysis of baby homes in Ukraine. Hope and Homes for Children, USAID, UK Aid; 2020. (https://www.hopeandhomes.org/publications/a-report-based-on-the-results-of-the-situation-analysis-of-baby-homes-in-ukraine/, accessed 18 February 2024).
Rights of the child: resolution adopted by the General Assembly. 74th UN General Assembly; 2019: United Nations.
Slozanska H, Horishna N. Functioning of boarding schools negative impact on pupils. Social work and education. 2021;8:18-41.
Huseynli A. Implementation of deinstitutionalization of child care institutions in post-soviet countries: The case of Azerbaijan. Child Abuse Negl. 2018;76:160-72.
Rosenthal E, Kurylo H, Ciric Milovanovic D, Ahern L, Rodriguez P. Protection and safety of children and disabilities in the residential institutions of war-torn Ukraine: The UN Guidelines on Deinstitutionalization and the role of International Donors. International Journal of Disability and Social Justice. 2022;2(2).
In Ukraine, children with disabilities live in horrific conditions. Handicap International; 2022 (https://www.hi.org/en/in-ukraine–children-with-disabilities-live-in-horrific-conditions#:~:text=The%20situation%20of%20disabled%20children,risk%20of, accessed 18 February 2024).
The forgotten victims of the war against Ukraine: European Network on Independent Living; 2022 (https://enil.eu/the-forgotten-victims-of-the-war-against-ukraine/, accessed 19 February 2024).