Research expertise

Bruno Marchal is professor and head of the Complexity and Health unit.

Bruno is currently working on urban health systems, health system adaptation to climate change and resilience, and research methodologies for complex issues in health and ecohealth.

After graduating as a medical doctor and obtaining a degree in Tropical Medicine at the ITM, Bruno worked for 6 years in Nyamira District (Kenya) as a medical doctor and hospital director. He joined the Department of Public Health, ITM in 2000 after obtaining a Master in Public Health. He held the position of tutor and coordinator of the ITM’s Master in Public Health course. Between 2002 and 2005, he was a researcher in the IMMPACT project, focusing on capacity strengthening for research and evidence-based policy in Burkina Faso, Ghana and Indonesia. From 2005 to 2011, he led the work packages on Management and on Human Resource Management of REACT, an FP6-INCO programme in Kenya, Tanzania and Zambia. He carried out his doctoral research on the influence of (health workforce) management practices on performance of hospitals in Ghana and Tanzania, using realist evaluation as the main methodology. In 2011, he successfully presented his PhD dissertation on this subject, titled: "Why do some hospitals perform better than others? A realist evaluation." Between 2011 and 2013, Bruno was a post-doctoral researcher at the Health Services Organisation unit, focusing on research on health worker motivation and non-financial incentives, for instance for the International Federation of the Red Cross (IFRC), and on effects of policy implementation (e.g. FemHealth project).

Current research interests

Health systems are social systems and thus complex systems. The current global challenges of climate change and urbanisation are wicked problems because of their complex causal pathways. Ensuring adaptation of health services and systems to the evolving needs of people requires not only research and evaluation methods that address complex causality, but also appropriate models of management, leadership, governance and decision-making.

Thematically, Bruno’s research agenda focuses on urban health systems, local health system adaptation to the climate crisis and resilience. Recent urban health projects focused on the role of urban first line health zones in Flanders and in Kinshasa to the Covid pandemic. With Joris Michielsen, he examines how urban health authorities collect, interpret and use health data in decision-making in Antwerp and Lima. With Kirsten Accoe, he tested health system resilience frameworks in Mauretania. Orawan Tawaytibhongs’ study focuses on resilience of local health systems in Thailand. New projects will focus on the resilience of communities of internally displaced people in Bamako (Mali) and on urban health system adaptation in greater Cotonou (Benin).

Methodologically, Bruno focuses of theory-driven inquiry and specifically realist evaluation and research. (Recent) projects include the Results4TB in Georgia (MRC/ESRC/DfID/Wellcome Trust) and the EU-funded ALERT project in Benin, Tanzania, Uganda and Malawi. Bruno supported/s a large number of research projects with a realist or theory-driven component. Virginia Castellano explores the use of realist evaluation and complexity theory in evaluation and decision-making. Christelle Boyi uses realist evaluation to investigate the implementation of quality improvement strategies to reduce maternal mortality in Benin. Samuel Bosongo is doing a realist evaluation of the capacity strengthening programme of regional health directorates in RDC, while Marsha Orgill examines innovation in two South African districts through realist evaluation.

Teaching expertise

Bruno Marchal is the Course director of ITM's Master in Science Public Health. His teaching assignments include:

• Teaching the topics of Strategic management, Health care organisation performance and Health workforce management, Health System Strengthening and Health Policy and Systems Research in the MSc – Public Health of ITM 
• Coaching of master at ITM.
• Supervision of PhD candidates at ITM and UWC.
• Teaching Health systems in the International MPH of the Ecole de Hautes Etudes de Santé Publique (Rennes) à Paris.