Not unlike the games he enjoys playing with his young son, Dr. Rudolf Knippenberg finds that healthcare systems are puzzles to be solved. As a new visiting professor to CGPH, Dr. Knippenberg contends that while identifying successful techniques to solve problems may vary, common principles and similarities are routinely evident in the game winning strategy.
Across countries and regions, Rudolf has seen nations move through the same stages and trajectories in healthcare development -- albeit from different directions. As a public health professional and a doctor who has seen first-hand the impact of poor maternal, newborn and child health care, he has guided the identification and implementation of effective strategies and policies for global public health programs and health care systems strengthening in South and East Asia as well as Sub Saharan Africa.
For nearly four decades, Rudolf has devoted his career to alleviating the burdens of disease and malnutrition in most disadvantaged children, first as an Emergency Surgeon/Obstetrician in Zambia and then as a public health professional working for UNICEF and now NYU.
During his 29-year tenure with UNICEF, Rudolf played numerous roles, from Chief of Health in Benin (West Africa) via Regional Health and Nutrition Advisor in West & Central Africa and the East Asia & Pacific Region to Principal health Advisor at UNICEF headquarters in NY.
In Africa and Asia he facilitated strategic planning, monitoring and evaluation of large scale maternal & child health programs and strengthening national health systems. Most notably, he conceived UNICEF's support to the Bamako Initiative, which moved Sub-Saharan African countries to scale up decentralized community based decision-making, cost-sharing and monitoring of Primary Health Care in the context of realistic national drug policies and the supply of low cost generic essential drugs.
In his most recent position as Principal Global Health Advisor at UNICEF, he designed and managed the field-testing of monitoring systems for health equity in over 20 countries. He learned a great deal from observing what worked for a given country and replicating it. Through this type of monitoring, problems within the health care system are resolved through trial and error until the government and communities achieve the most efficient results within their resource constraints. Based on an analysis of key bottlenecks in coverage of health & nutrition interventions such as geographic, financial or socio-cultural access barriers or poor quality of care, corrective strategies and policies to improve maternal, newborn and child health and nutrition are selected, implemented, monitored and adjusted.
This approach works regardless of the country's historical design of its health system -- whether provision of healthcare is public or private, centralized or decentralized. "Often the human resources and institutional memory are already in place, but due to political or man power turnover, there is often a lack of consistency in management -- therefore the system often lacks systematic follow-through," said Rudolf. "No matter how well constructed, without consistent management and monitoring, a health care system cannot thrive."
In order to facilitate a wider application of this "bottleneck analysis" Dr. Knippenberg has developed jointly with the World Bank, a modeling and budgeting tool called "marginal budgeting for bottlenecks". This tool has been applied in over 50 countries for national planning, budgeting, leveraging partnerships and development of investment cases. In 2009 Dr. Knippenberg led the use of this tool for the costing of Health System Strengthening in 49 high burden countries by working group 1 of the Taskforce on Innovative International Financing for Health Systems and in 2010 for the UNICEF analysis of the 'cost-effectiveness of an equity focused approach", which became the under-pinning of UNICEF's equity refocus, together with the monitoring systems for health equity described above.
Recently, Rudolf has focused on refining the bottleneck analysis methodology and tools to facilitate the analysis and modeling of "equity" in the context of the "sustainable development goals" and of public health responses to global epidemics such as the 2014-15 Ebola epidemics in DR Congo and West Africa and the currently evolving ZIKA epidemic.
As a professor of Global Public Health, Dr. Knippenberg offers students the insight he has gained from practical field experience and the feedback he has received from capacity building and analytic support to national Ministry of Health and UNICEF staff in three continents. His approach is practice-driven. He teaches students quantitative steps to apply concepts in health system management within different countries and contexts. Translating concepts and principles into practice, he teaches courses for both professionals looking to enhance field experience with theory and students looking to break into the field. He is developing a series of on-line courses to first provide students with the concepts and principles needed, then help students in obtaining the data required to measure, analyze and model these concepts and finally in translating these concepts, measures and models into equity focused decision making, monitoring, management, costing and financing of global public health programs and national health systems.
"His experiences in the public health field will enhance our breadth of knowledge and research experience in health," said Dr. Bernadette Boden-Albala, Associate Dean of Research and Program Development. "We're excited to have Rudolf as part of our team."
Dr. Knippenberg has served on various participatory advisory panels to discuss public health partnerships, such as: International health Partnership (IHP+), Harmonization for Health in Africa (HHA), Roll Back Malaria (RBM), Stop TB, and Partnership for Maternal, Newborn and Child Health (PNMCH). He was a Guest Editor of The International Journal of Health Planning and Management for the issue, "Sustainability of Primary Health Care including immunizations in Bamako Initiative Programs in West Africa: an assessment of 5 years Field Experience in Benin and Guinea." He is a member of Delta Omega. He is also the author of many journal articles, book chapters, reports, manuals, and technical guidelines.
Dr. Knippenberg was awarded a Medical Degree from State University Utrecht and a diploma in Tropical Medicine from the Royal Tropical Institute in Amsterdam and was also certified in general medicine through the US VQE and ECFMG in the 1970s. In the 1980s, he received both a Master's in Public Health and a Doctorate with a focus on International Health from Johns Hopkins University.