What is your background?

I graduated from Aleppo University, Syria, in 2010. I have a bachelor's degree in pharmacy and a diploma in drug discovery. As events in Syria unfolded, I had to make a shift in my career. I began working with non-governmental organisations (NGOs) on humanitarian health projects, delivered to refugees or internally displaced people. I worked for an NGO in Aleppo, my city, for about three years and then I moved on to international NGOs to work on other public health projects with cross-border refugees.

As a pharmacist, most of my job was going to pharmacy delivering and designing projects, which I really enjoyed – that's what drew me to the world of public health. I required some prior academic knowledge of public health that I could apply to delivering projects related to humanitarian conflicts so I joined LSHTM in 2019 after getting a scholarship for the MSc Public Health for Development. The MSc gave me an understanding of public health from an academic perspective, which made me think about pursuing a career as a researcher. I’m now a Research Fellow.

Alongside Syria, why have you chosen Brazil for your research?

Most of my research is on health systems and economics. I started with research on Syria, which explored health system resilience and health system adaptations. I then started studying health economics at LSHTM and joined a brilliant team working on evaluating pay-for-performance (P4P) bonuses in Brazil. I'm very fond of policy evaluation methods and application and that's what sparked an interest in working on this with the team. We have almost finished the project and have published a paper on the influence of P4P bonuses on the quality of primary health care delivered by family health teams in Brazil.

Did the pay-for-performance policy work?

There was evidence to suggest that pay-for-performance as a bonus for healthcare workers was effective compared to investing the same amount of funds into healthcare preparedness, for example, in infrastructure. The question has always been, “If I am giving P4P money, would it be more effective to pay it in rewards to the to the healthcare workers or to invest in healthcare readiness?” It was not previously clear in the literature. In our Brazilian study, the evidence suggested that it would be more effective, in terms of performance changes, if you reward the staff with bonuses.

Are there any ethical implications of that approach to incentivising healthcare workers?

Yes, I think that the relevant issue was efficiency and allocative efficiency. That is, where to put the money and where is it best to put the money equitably. This decision is crucial, especially in resource-limited settings. It may be a total waste of money, or a very effective allocation of money. So that's the ethical implication in terms of where to get the most out of the money in a resource-limited setting. Another ethical issue regarding incentivising healthcare workers is when incentivising certain services, the provision of unincentivised services could be adversely impacted, for example, a reduction of provision.

Are you involved in any other research?

I'm now working on an evaluation of cleanliness interventions in healthcare settings. We are looking at any cleanliness intervention in secondary healthcare that was applied in any low- or middle-income country and conducting a systematic review to see if, or what, interventions are effective to improve cleanliness, in terms of removal of organic matter and reduction in outbreaks of antimicrobial resistance in hospitals, for example.

Where do you see your research going in the future?

In the short term, I'm looking forward to getting the systematic review published, to see what interventions are working and to make policy recommendations based on them. In the long term, I'm looking forward to focusing more on policy evaluation research and its methodology and improving my skills.

I'm also considering a PhD which could bring together some of my experience and knowledge in pharmacy to look at policy related to the pharmaceutical sector or pharmacoepidemiology. It would bring those two worlds together to capitalise on everything I've learned so far – that's the vision.

You have experienced life at LSHTM as both a researcher and a student. Do you have any advice for or prospective students?

I would advise those who are considering joining LSHTM to look at the module specifications and reflect on how they will align with their story. The point is to make sure that you acquire the relevant knowledge you need. When you are at LSHTM, you will have a wide breadth of topics to choose from, but within that there is a lot of variation. Try and make a coherent story that aligns with your background, and links to market needs, so you can place yourself within your area of interest. Make use of those module specifications.

Get in touch with people who are teaching. Do not hesitate or feel afraid to ask questions. Find a mentor or access the school alumni. People are generally responsive and will be happy to speak to you. Try and acquire as much knowledge as you can to guide your decision, that will make a lot of difference once you finish.

What are the three words that you would use to sum up your time at LSHTM so far?

It's inspiring to be at LSHTM. There are a lot of thought-provoking events happening, the people are brilliant and talking to anyone about their work will inspire you.

The second word would be splendid. The people here are from diverse disciplines and backgrounds, everybody has something to add. LSHTM has a splendid network.

As you may have noticed working with some of the people here, they have an openness to share and help, so the third word would be nurturing. The school creates an environment for you to continue your self-development and learning – it's something to really capitalise on. I've been I've been lucky to work with very supportive teams.

Thank you, Nasser. Is there anything else that you'd like to add?

Something that is really advantageous at LSHTM is that they're working hard on equality and diversity and inclusion. That's reassuring, especially for someone from my background. It should be applauded and highlighted, and I will encourage everyone to consider LSHTM.