Clinical Professor of Global Health
As a public health professional and a physician who witnessed the negative impact of poor maternal, newborn, and child healthcare, Dr. Rudolf Knippenberg has guided the identification and implementation of effective strategies and policies for public health programs and healthcare systems strengthening in South and East Asia and Sub-Saharan Africa.
During his tenure with the United Nations Children’s Fund (UNICEF), Dr. Knippenberg facilitated strategic planning, monitoring, and evaluation of maternal and child health programs in over twenty countries. He supported UNICEF's Bamako Initiative, which intended to increase community-based decision making, cost sharing, monitoring, and access to primary healthcare and low cost essential drugs. With the World Bank, he developed the Marginal Budgeting for Bottlenecks (MBB) tool to simulate the costs of service delivery models and thus inform governmental budgeting and policies for health and nutrition. The MBB tool has been used to measure cost-effectiveness and health system strengthening in over 50 countries. He is refining the MBB tool to analyze and model equity in the context of the Sustainable Development Goals and public health responses to global epidemics, such as Ebola and Zika.
He has served on various advisory panels, such as Roll Back Malaria, Stop TB, and Partnership for Maternal, Newborn, and Child Health. He is also the author of various journal articles, book chapters, reports, manuals, and technical guidelines.
Dr. Knippenberg’ practice-driven approach provides students with the concepts and skills to utilize quantitative data to analyze health programs and systems. These measures can then be translated into equity-focused decision making, monitoring, management, and financing of global public health programs and national health systems.
MD, Medicine, State University Utrecht, Utrecht, NetherlandsDiploma, Tropical Medicine, Royal Tropical Institute, Amsterdam, NetherlandsMPH, International Health, Johns Hopkins University, Baltimore, MDDrPH, International Health, Johns Hopkins University, Baltimore, MD
Areas of research and study
Cost-effective Health Programs and PoliciesEconomic EvaluationPublic Health Systems
Analysis and modeling of the Ebola West Africa epidemic and containment strategiesKnippenberg, R.
Reproduction number of Ebola falls below critical threshold in LiberiaNyenswah, T., Cummings, D., Read, J., Lessler, J., Rodriguez-Barraquer, I., Bawo, L., … Peter, D.
Journal titleNew England Journal of Medicine
Technical guidelines for strategy reviews of equity refocus in maternal, newborn & child health & nutrition in India, Bangladesh, DR Congo, Nigeria, ZambiaKnippenberg, R.
Technical guidelines on key strategies for Ebola containment based on DR Congo experienceKnippenberg, R.
Progress report on progress in implementing Monitoring of Bottlenecks (MoRES) in 27 "work-stream countries"Knippenberg, R.
The comparative cost-effectiveness of an equity-focused approach to child survival, health, and nutrition: A modelling approachCarrera, C., Azrack, A., Begkoyian, G., Pfaffmann, J., Ribaira, E., O'Connell, T., … Knippenberg, R.
Journal titleThe Lancet
Progress on child mortality and undernutrition has seen widening inequities and a concentration of child deaths and undernutrition in the most deprived communities, threatening the achievement of the Millennium Development Goals. Conversely, a series of recent process and technological innovations have provided effective and efficient options to reach the most deprived populations. These trends raise the possibility that the perceived trade-off between equity and efficiency no longer applies for child health - that prioritising services for the poorest and most marginalised is now more effective and cost effective than mainstream approaches. We tested this hypothesis with a mathematicalmodelling approach by comparing the cost-effectiveness in terms of child deaths and stunting events averted between two approaches (from 2011-15 in 14 countries and one province): an equity-focused approach that prioritises the most deprived communities, and a mainstream approach that is representative of current strategies. We combined some existing models, notably the Marginal Budgeting for Bottlenecks Toolkit and the Lives Saved Tool, to do our analysis. We showed that, with the same level of investment, disproportionately higher effects are possible by prioritising the poorest and most marginalised populations, for averting both child mortality and stunting. Our results suggest that an equityfocused approach could result in sharper decreases in child mortality and stunting and higher cost-effectiveness than mainstream approaches, while reducing inequities in effective intervention coverage, health outcomes, and out-ofpocket spending between the most and least deprived groups and geographic areas within countries. Our findings should be interpreted with caution due to uncertainties around some of the model parameters and baseline data. Further research is needed to address some of these gaps in the evidence base. Strategies for improving child nutrition and survival, however, should account for an increasing prioritisation of the most deprived communities and the increased use of community-based interventions.
Investing in health for Africa. The case for strengthening systems for better health outcomesKnippenberg, R.
Technical guidelines for decentralized monitory of equity bottlenecksKnippenberg, R.
Narrowing the gaps to meet the goalsKnippenberg, R.
Health systems for the millennium development goals: country needs and funding gaps: background document for the task force on innovative international financing for heath systems; working group 1: constraints to scaling up and costsKnippenberg, R.
Investing in maternal, newborn and child health: the case for Asia and the Pacific; Maternal, newborn and child health network for Asia and the PacificKnippenberg, R.
Technical background paper on ACSD strategies for All Africa Reps meetingsKnippenberg, R.
Technical background papers on YCSD strategies for all Asia Reps meeting 2009Knippenberg, R.
Technical guidelines for marginal budgeting for bottlenecksKnippenberg, R.
Lessons learned from evolving health care systems and practicesKnippenberg, R.
Marginal budgeting for bottlenecks; in review of costing tools relevant to the health MDG's; meeting report-technical consultationKnippenberg, R.
Strengthening community partnerships, the continuum of care and health systemsKnippenberg, R.
A strategic framework and investment case for reaching the health related millennium developmental goal in Africa by strengthening primary health care systems for outcomesKnippenberg, R.
A strategic framework for reaching the millennium development goal in Africa through health system strengthening and implementation at scale of high impact and low cost health and nutrition interventionsKnippenberg, R.
1 year after The Lancet Neonatal Survival Series-was the call for action heard?Lawn, J.E., Cousens, S.N., Darmstadt, G.L., Bhutta, Z.A., Martines, J., Paul, V., … Fogstad, H.
Journal titleThe Lancet
A strategic framework fro reaching the millennium development goal on child survival in AfricaKnippenberg, R.
National plan for acceleration of immunization coverage through revitalization of the PHC system in GuineaKnippenberg, R.
Newborn survivalLawn, J., Zupan, J., Begkoyian, G., & Knippenberg, R.
To retain or remove user fees? Reflections on the current debate in low- and middle-income countriesJames, C.D., Hanson, K., McPake, B., Balabanova, D., Gwatkin, D., Hopwood, I., … Xu, K.
Journal titleApplied Health Economics and Health Policy
Many low- and middle-income countries continue to search for better ways of financing their health systems. Common to many of these systems are problems of inadequate resource mobilisation, as well as inefficient and inequitable use of existing resources. The poor and other vulnerable groups who need healthcare the most are also the most affected by these shortcomings. In particular, these groups have a high reliance on user fees and other out-of-pocket expenditures on health which are both impoverishing and provide a financial barrier to care. It is within this context, and in light of recent policy initiatives on user fee removal, that a debate on the role of user fees in health financing systems has recently returned. This paper provides some reflections on the recent user fees debate, drawing from the evidence presented and subsequent discussions at a recent UNICEF consultation on user fees in the health sector, and relates the debate to the wider issue of access to adequate healthcare. It is argued that, from the wealth of evidence on user fees and other health system reforms, a broad consensus is emerging. First, user fees are an important barrier to accessing health services, especially for poor people. They also negatively impact on adherence to long-term expensive treatments. However, this is offset to some extent by potentially positive impacts on quality. Secondly, user fees are not the only barrier that the poor face. As well as other cost barriers, a number of quality, information and cultural barriers must also be overcome before the poor can access adequate health services. Thirdly, initial evidence on fee abolition in Uganda suggests that this policy has improved access to outpatient services for the poor. For this to be sustainable and effective in reaching the poor, fee removal needs to be part of a broader package of reforms that includes increased budgets to offset lost fee revenue (as was the case in Uganda). Fourthly, implementation matters: if fees are to be abolished, this needs clear communication with a broad stakeholder buy-in, careful monitoring to ensure that official fees are not replaced by informal fees, and appropriate management of the alternative financing mechanisms that are replacing user fees. Fifthly, context is crucial. For instance, immediate fee removal in Cambodia would be inappropriate, given that fees replaced irregular and often high informal fees. In this context, equity funds and eventual expansion of health insurance are perhaps more viable policy options. Conversely, in countries where user fees have had significant adverse effects on access and generated only limited benefits, fee abolition is probably a more attractive policy option. Removing user fees has the potential to improve access to health services, especially for the poor, but it is not appropriate in all contexts. Analysis should move on from broad evaluations of user fees towards exploring how best to dismantle the multiple barriers to access in specific contexts.
Accelerating child survival and development: a results based approach in high uindre five mortality areas: final report to CIDAKnippenberg, R.