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Dr Rachel Tolhurst

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Rachel has over 20 years’ experience of research, training and partnership on gender equity and health systems strengthening in Africa and Asia.  Her research has focused on social drivers of inequities in health and well-being including intersections between gender equity, poverty and disability, with regard to a wide range of health issues, including TB and lung-health, anti-microbial resistance maternal, sexual and reproductive health and gender-based violence.  Rachel is the Deputy Director of the Centre for Health Systems Strengthening (CHESS) and co-convenor of the Gender and Health Group.

Research

Rachel is the Research Director for the GCRF Accountability for Informal urban Equity Hub (ARISE) (2019-2024), together with Sally Theobald as PI. This Hub will address the intractable development challenge of ill-health, inequity and insecurity in informal urban settlements in Low and Middle-Income Countries (LMICs). More than half of the world’s people live in cities and one in three of these in LMICs live in informal settlements, which pose a wide range of physical and mental health risks, yet receive inadequate services and opportunities to improve their lives.  Our Hub brings together ten partners with a range of relevant expertise and commitment to work with disadvantaged people living in informal settlements. Our research will support them in claiming their rights to health and to build government accountability and capacity to provide them with security and services. By sharing experiences across four countries – Sierra Leone, Bangladesh, Kenya and India – we hope to shape national and global policies and best practices. 

She is also the Health, Nutrition and Well-being domain co-lead for the African Cities Research Consortium (2021-2026), which is a Foreign Commonwealth and Development Office (FCDO) funded programme aiming to use a political settlements and systems analysis approach to  generate insights and evidence that will help improve the living conditions, services and life chances of all city residents, particularly for disadvantaged communities, across 8 development domains in 13 African cities.

Rachel is the Social Sciences lead for the NIHR Global Health Research Unit on Lung Health and Tuberculosis in Africa at LSTM (IMPALA) (2017-2021), and for the Drivers of Antimicrobial Resistance (DRUM) consortium (GCRF) (2018-2021).

Previous research in the last 10 years has included leadership of the gender equitable careers theme on the DELTAS Learning Research Programme (2016 – 2020), in collaboration with the Capacity Research Unit and MRC-funded social science research exploring the drivers of child marriage in Sudan (2014-15). She has led LSTM’s contributions to two EU-funded consortia – INPAC (2012-2016), which aimed to test an intervention to improve post-abortion family planning in China, and MATIND (20111-2015), which evaluated two demand-side financing approaches to improving maternal health in India, and. She was also part of the REACHOUT project, which aimed to understand and develop the role of close-to-community providers of health care in rural and urban areas in Africa and Asia.

Other relevant expertise, professional memberships etc.

Rachel is a serving member of the Equity Reference Group on Immunisation, which aims to generate innovative ideas to accelerate progress on equity in immunisation. Operating as an action-oriented think tank, the group is reviewing evidence across health programmes and other sectors and recommending innovative ways to achieve greater equity in immunisation though policies and programming.

Teaching

Rachel co-convenes qualitative research on Research Module (TROP 934) and Key Themes in International Health and Policy (TROP 937), teaching on social determinants of health, equity, gender and health seeking behaviour to. She supervises Masters student dissertations. She also teaches on DTMH and Short Course on International Health Consultancy.  She has successfully supervised 8 PhDs.

Current PhD students

Quality of life among people with chronic lung disease in LMICs. Irene Ayakaka

Exploring opportunities for addressing intimate partner violence in the context of community-based HIV services in Kenya and steps toward testing interventions at community-level. Beate Ringwald 

Understanding the embodiment of discrimination and stigma among waste picking communities in India, it’s impact on their health and wellbeing and the consequences on agency.Shrutika Murthy

A Critical Assessment of How Urban Development and Relocation Processes Shape Wellbeing of Marginalised People. Smruti Srinivas Jukur

Recent publications: 

    Selected publications

    • Rao V, Saligram P, Rashid SF, Tolhurst R, Steege R, Murthy S, Nakkeeran B, MacGregor M, Patel S, Theobald S, Dean L, Garimella S (2021) Community Engagement, Co-Production or Citizen Action? Lessons from COVID-19 Responses in India and Bangladesh’s Informal Urban Settlements. Journal of International Affairs, in press.

      Garimella S, Murthy S, Whittaker S and Tolhurst R (2021) 'Pandemic Policy Responses and Embodied Realities among ‘waste-pickers’ in India' in Lenore Manderson, Nancy J. Burke and Ayo Wahlberg (Eds) Viral Loads: Anthropologies of urgency in the time of COVID-19. (Chapter 11) UCL Press: In press.

      Kimani J, Steege R, Makau J, Nyambuga K, Wairutu J, Tolhurst R (2021) Building forward better: the need for inclusive support to livelihoods in Nairobi’s informal settlements during periods of shock. Building a Better World – the crisis and opportunity of Covid-19I: IDS Bulletin Vol. 52 No. 1 March 2021, pp 37-44.

      Liani ML, Nyamongo IK, Pulford J & Tolhurst R (2021) An intersectional gender analysis of familial and socio-cultural drivers of inequitable scientific career progression of researchers in Sub-Saharan Africa Global Health Research and Policy, 6:30. https://doi.org/10.1186/s41256-021-00213-3.

      Fang J, Tang SL, Tan XP & Tolhurst R, (2020) Achieving SDG related Sexual and Reproductive Health targets in China: what are appropriate indicators and how we interpret them? Reproductive Health,17:84 https://doi.org/10.1186/s12978-020-00924-9.Wilkinson A and contributors (2020) Local response in health emergencies: key considerations for addressing the COVID-19 pandemic in informal urban settlements. Environment & Urbanization, 1–20. DOI: 10.1177/0956247820922843.

      Lora WS, Desmond N, Obasi A, Kumwenda M, Taegtmeyer M, Tolhurst R & MacPherson E (2020) “I wanted evidence that my status had changed, so that is why I tested”: experiences with HIV self-testing among female sex workers in Malawi, AIDS Care, 32:sup2, 206-213, DOI: 10.1080/09540121.2020.1739212

      Lester R, Haigh K, Wood A, MacPherson E, Mahewswaran H, Bogue P, Hanger S,  Kalizang’oma A, Srirathan V, Kulpani,D, Mallewa J, Nyirenda M, Jewell CP, Heyderman R , Gordon M, Lalloo DG, Tolhurst R, Feasey NA (2020) Sustained reduction in third-generation cephalosporin usage in adult inpatients following introduction of an antimicrobial stewardship program in a large urban hospital in Malawi. Clinical Infectious Diseases, ciaa162, https://doi.org/10.1093/cid/ciaa162.

      Aktar B, Alam W, Ali S, Awal A, Bayoh M, Chumo I, Contay Y, Conteh A, Dean L, Dobson S, Edstrom J, Elsey H, Farnaz N, Garimella S, Gray L, Gupte J, Hawkins K, Hollihead B, Josyula KL, Kabaria C, Karuga R, Kimani J, Leyland A, te Lintelo D, Mansaray B, Macarthy J, Macgregor H, Mberu B, Muturi N, Okoth L, Otiso L, Ozano K, Parray A,  Phillips-Howard P, Rao V, Rashid S, Raven J, Refell F, Saidu S, Sobhan S, Saligram PS, Sesay S, Theobald S, Tolhurst R, Tubb P, Waldman L, Waritu J, Whittaker L, Wurie HR, The ARISE Hub (2020) Safeguarding in global health research programmes: Practice, process and positionality in marginalised urban. BMJ Global Health 5:e002253. doi:10.1136/ bmjgh-2019-002253.

      Chopra M, Bhutta Z, Chang Blanc D, Checchi F, Gupta A, Lemango ET, Levine OS, Lyimo D, Nandy R, O'Brien KL, OkwoBele J-M, Rees H, Soepard J, Tolhurst R & Victora CG (2020) Addressing the persistent inequities in immunization coverage. Bulletin of the World Health Organisation, BLT.19.241620.

      Shu Chen , Lei Guo, Zhan Wang, Wenhui Mao, Yanfeng G, Xiaohua Ying, Jing Fang, Qian Long, Qin Liu, Hao Xiang, Chenkai Wu, Chaowei Fu, Di Dong , Jiahui Zhang, Ju Sun, Lichun Tian, Limin Wang, Maigeng Zhou, Mei Zhang, Mengcen Qian, Wei Liu, Weixi Jiang, Wenmeng Feng, Xinying Zeng, Xiyu Ding, Xun LeiI, Rachel Tolhurst, Ling Xu, Haidong Wang, Faye Ziegewei, Scott Glenn, John S. Ji, Mary Story, Gavin Yamey, Shenglan Tang (2019) Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis. PLoS Med 16(11): e1002975. https://doi. org/10.1371/journal.pmed.1002975.

      Dean L, Tolhurst R, Nallo G, Kollie K, Bettee A, and Theobald S (2019) Neglected Tropical Disease as a ‘Biographical Disruption’: Listening to the Narratives of Affected Persons to Develop Integrated People Centred Care in Liberia. Neglected Tropical Disease as a ‘Biographical Disruption’. PLOS NTDs, Vol 13, Issue 9, e0007710. https://doi.org/10.1371/journal.pntd.0007710.

      Dean L, Obasi A, Elsony A, Fadul S, ElHassan H, Thomson R, and Tolhurst R (2019) He is suitable for her, of course he is our relative”: a qualitative exploration of the drivers and implications of child marriage in Gezira state, Sudan.  BMJ Global Health, 2019;4:e001264. http://dx.doi.org/10.1136/bmjgh-2018-001264.

      Marta Feletto, Alyssa Sharkey, Elizabeth Rowley, Nikki Gurley, Antara Sinha ERG (Champions Anuradha Gupta, Rachel Tolhurst) (2018) A gender lens to advance equity in immunization. Equity Reference Group for Immunisation Discussion Paper 05.

      Jiang H, Xu J, Richards E, Qian X, Zhang W, Hu L,Wu, SC, Tolhurst R. and INPAC consortium (2017) Opportunities, challenges and systems requirements for developing postabortion family planning services: Perceptions of service stakeholders in China. PLoS ONE 12(10): e0186555. https://doi.org/10.1371/journal. pone.0186555.

      Che Y, Dusabe-Richards E, Wu SC, Jiang Y, Dong XJ, Li J, Zhang WH, Temmerman M, Tolhurst R and the INPAC consortium (2017) A qualitative exploration of perceptions and experiences of contraceptive use, abortion and Post-Abortion Family Planning services (PAFP) in China. BMC Women’s Health, 17:113. DOI 10.1186/s12905-017-0458-z.

      Dean L, Tolhurst R, Khanna R, and Jehan K (2017) ‘You’re disabled, why did you have sex in the first place?’ An intersectional analysis of experiences of disabled women with regard to their sexual and reproductive health and rights in Gujarat state, India.  Global Health Action, 10(sup2):1290316. http://dx.doi.org/10.1080/16549716.2017.1290316.

      Ewing V, Tolhurst R, Kapinda A, Richards E, Terlouw DJ, and Lalloo DG (2016) Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikhwawa district of Malawi. Malaria Journal 15:521. doi:10.1186/s12936-016-1559-0.

      Ardrey J, Desmond N, Tolhurst R/Mortimer K* (*joint senior authors) (2016). The Cooking and Pneumonia Study (CAPS) in Malawi: A nested pilot of Photovoice participatory research methodology. PLoS ONE, 11(6): e0156500. doi:10.1371/journal.pone.0156500.

      Sidney K, Tolhurst R, Jehan K, Diwan V, and De Costa A (2016) ‘The cash transfer is important but all women anyway go to hospital for childbirth nowadays’ - a qualitative exploration of why women participate in a cash transfer program to promote institutional deliveries in Madhya Pradesh, India. BMC Pregnancy and Childbirth, 16:47 DOI 10.1186/s12884-016-0834-y.

      Tolhurst R, Richards E, MacPherson E, Kamuya D, Zalwango F and Theobald S (2016) ‘Capacities to exercise strategic decision-making agency: exploring the gendered production of health within intimate partnerships and households’, in M Vargas de Freitas Cruz Leite and J Gideon (Ed) International Handbook of Gender and Health. London, Elgar.