Health Systems Analyst Tallies the ROI for Humanitarian Interventions

Juliana Bol had just started working as a research and development chemist in North Carolina, looking for ways to improve the ethanol fuel industry, when events halfway around the world turned her career around. Now an expert on global strategies for rebuilding health systems, Bol counts herself among the 1.5 million members of the South Sudanese diaspora—her grandfather left Sudan in the 1950s to Kenya, where she and her mother were born.

In 2005, a comprehensive peace agreement promised to rebuild what five decades of conflict in South Sudan had destroyed and Bol resolved to pitch in. “There was a lot of excitement about going back home,” she recalls. “I’d never been because the country had been in conflict since I was born.”

Public health seemed more relevant to the effort than chemistry and in 2007, Bol enrolled in the Columbia Mailman School’s Program on Forced Migration and Health (PFMH) in the Heilbrunn Department of Population and Family Health. The practicum requirement was a deciding factor. “The entire department worked really hard to get me an internship in South Sudan,” says Bol, who was a gender-based violence intern in 2008 with the International Rescue Committee in Rumbek, Lakes State.

In 2022, Bol returned to PFMH as an assistant professor. While she’s worked around the world since graduating in 2009, her scholarship focuses on strategies for optimizing public health outcomes in resource-constrained settings, particularly in South Sudan.

What brought you back to Columbia Mailman?

It was a marriage of academia and implementation that drew me here. As a public health professional from 2010 to 2014, I had questions around the work we were doing, approaches we were using, whether working through donor-funded nongovernmental organizations was the most appropriate way to improve health systems. The PhD was an opportunity to answer those questions. Between starting and finishing my PhD, the idea of going back to South Sudan and working on strengthening health systems, it really wasn’t an option anymore. In PFMH, there’s a lot of focus on not just the academic side, but implementation and how programs are delivered in post-conflict settings.

You teach public health and humanitarian action. What do you bring to the field? 

As someone who comes from a family of refugees, the message I’m trying to deliver in this classroom is that even people who are affected by conflict, displaced by natural disasters, have a level of agency that has been ignored in public health. As the next generation of humanitarian workers, I want to be at the forefront of my students’ minds the principle that even while people are in a vulnerable position, they still have agency in the decisions they make. I want my students to challenge the system.

What schools of thought inform your scholarship?

I want to bring in different ways of analyzing routine data, looking at fields like economics and econometric methods. I’m taking lessons from contract theory in the private sector—the subject of the 2016 Nobel Prize in Economics—and applying them to the public sector in South Sudan. The findings have implications not just for South Sudan, but also accountability for NGOs. The United States is the biggest funder of NGOs and development aid. Understanding the mechanisms that might improve the performance of NGOs is critical for the entire sector.

You received a faculty award to evaluate the maternal and child health outcomes achieved by the South Sudan Health Pooled Fund. What questions are you asking?

I’m looking at contract types in South Sudan, comparing local entities, international NGOs, and county health departments in South Sudan and analyzing how much funding they received for their specific programs and whether their performance is related to their funding. International NGOs get three times more funding than the public sector. I want to know if their performance is the same. If it is, it’s not the money.

What possibilities emerge through your focus on accountability and efficiency?

It is the responsibility of humanitarians to make systems better and reduce waste. There are a lot of inefficiencies in how humanitarian aid is implemented.  What we do isn’t missionary work or charity, and the people at the other end are affected by how well we do our work. We need to hold ourselves to higher standards.