Juliet Okoroh hopes for the day when no one is impoverished because they have to pay for surgical care. Until then, she is doing her best to bridge the gap between policy and medical care in resource-limited settings by studying healthcare financing.

Okoroh, a 2017-2018 GloCal fellow, is the first researcher to examine the impact of Ghana’s National Health Insurance Scheme (NHIS) on the cost of surgical care.

“Ghana was the first country in Africa to gain independence and with that came progressive efforts such as the NHIS,” said Okoroh. She explained that, although the program was designed to promote universal health coverage, out-of-pocket healthcare costs remain exorbitant, putting families at risk of poverty. With 40% of the population enrolled in the program, Okoroh set out to determine whether enrollment in the NHIS reduces the likelihood of these excessive expenditures for individuals and families.

This issue is not exclusive to Ghana. An astonishing 5 billion people lack access to safe and affordable surgical care worldwide, while 3.7 billion people could face financial catastrophe as a result of seeking surgical care, according to a 2015 study.

“When people cannot afford to pay, they forgo care or show up too late, which can escalate the problem medically, and can also increase the cost of care” said Okoroh. She added that one out of four households in developing countries resort to borrowing money with interest or selling assets to pay out-of-pocket healthcare costs.

“High income countries have somehow figured that the only way to provide sustainable health care is through focusing on strengthening health systems and providing health insurance. We need to focus on healthcare financing as one of the solutions to global inequities in access to care in developing countries,” said Okoroh.

Growing up in Nigeria, Okoroh watched her single mother struggle to afford healthcare – something that stuck with her as she embarked on her career in medicine and later, health policy.

“After immigrating to the US with my mother and siblings at age 10, I was interested in helping communities similar to the one I grew up in,” said Okoroh. She credits the individuals and health workers she met while volunteering with Habitat for Humanity and the Red Cross and studying abroad in Tanzania for inspiring her path into medicine.

Before medical school, Okoroh took a job as a congressional staffer in DC. It was 2009 – during the drafting of the Affordable Care Act – and she observed a clear disconnect between policy makers and people practicing clinical medicine. She went on to study medicine through the UC San Diego School of Medicine PRIME-Health Equity program and later obtained an MPH in health policy.

Okoroh’s GloCal research aligns with her interests in policy and medicine while also highlighting an area of global health that has historically struggled to get the funding and development it deserves: global surgery.

“To paraphrase Paul Farmer, surgery is the neglected stepchild of global health,” said Okoroh, “so I was thrilled to receive the [GloCal] fellowship, after studying this topic for the last five years.” In fact, former GloCal fellow and global surgery advocate, John Rose, encouraged Okoroh to apply for the fellowship. They met while she was a medical student at UC San Diego.

Now, as a surgical resident at UCSF and enthusiastic health policy researcher, Okoroh is grateful for her time spent in Ghana as a GloCal fellow and to the mentors who have contributed to her success. Remembering a particular lesson from one of her mentors, Samuel Essoun, MD, Korlebu Teaching Hospital, Ghana, Okoroh emphasized the importance of thinking outside the box in global health. “Sometimes researchers come in and think they know what is important, but it’s crucial to look at and listen to the actual needs of the people.”

As for Okoroh’s research, her study was published in BMC Health Services Research.  She hopes more researchers explore this topic and encourages surgeons to get involved in global health. “It’s really time that we focus on strengthening our health systems and emphasizing surgical care as a resource,” she said.

Over the next 10 years, Okoroh plans to move back to Nigeria to establish an academic partnership between teaching institutions in the US and Nigeria where she will help train the next generation of global surgeons.

“I have been very fortunate for the opportunity to follow my dreams as far as they take me and still remain connected to the African continent. I would love to support others just like I have been supported by my mentors, Robert Riviello MD, MPH; Hobart Harris MD, MPH; Joel Weissman PhD; Anthony Seddoh PhD and Benedict Nwomeh MD, MPH.”