About

Nancy Scott, DrPH, MPH is an Assistant Professor of Global Health at the Boston University School of Public Health and a faculty member of the Center for Global Health and Development (CGHD). She has over 12 years of experience in global public health program design, implementation, and mixed-method process and impact evaluation. Her research interests include evaluating public health programs and translating that evidence into programmatic and policy-relevant products in the areas of maternal and child health, prevention of mother-to-child transmission of HIV (PMTCT), and social support for orphans and vulnerable children (OVC). Dr. Scott teaches courses in monitoring and evaluating global public health programs, focusing on implementing and evaluating complex programs in resource-constrained environments, and conducts short courses for public health practitioners in South Africa and Tanzania. She has spent five years residing in Zambia managing the CGHD’s research and service delivery portfolio and continues her work across sub-Saharan Africa, primarily in Ethiopia, Namibia, South Africa, and Zambia.

Research topics

• Political Science
• Medicine
• Nursing
• Public relations
• Geography
• Immunology
• Gerontology
• Finance
• Environmental health
• Marketing
• Business
• Family medicine
• Psychology

Selected publications

• Addressing Inequities in SARS-CoV-2 Vaccine Uptake: The Boston Medical Center Health System Experience

  Annals of Internal Medicine · 2022 · 31 citations

  • Political Science
  • Medicine
  • Environmental health

  Academic medical centers could play an important role in increasing access to and uptake of SARS-CoV-2 vaccines, especially in Black and Latino communities that have been disproportionately affected by the pandemic. This article describes the vaccination program developed by the Boston Medical Center (BMC) health system (New England's largest safety-net health system), its affiliated community health centers (CHCs), and community partners. The program was based on a conceptual framework for community interventions and aimed to increase equitable access to vaccination in the hardest-hit communities through community-based sites in churches and community centers, mobile vaccination events, and vaccination on the BMC campus. Key strategies included a communication campaign featuring trusted messengers, a focus on health equity, established partnerships with community leaders and CHCs, and strong collaboration with local health departments and the Commonwealth of Massachusetts to ensure equitable allocation of the vaccine supply. Process factors involved the use of robust analytics relying on the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). The vaccination program administered 109 938 first doses, with 94 703 (86%) given at community sites and 2466 (2%) given at mobile sites. Mobile vaccination events were key in reaching younger people living in locations with the highest SVIs. Challenges included the need for a robust operational infrastructure and mistrust of the health system given the long history of economic disinvestment in the surrounding community. The BMC model could serve as a blueprint for other medical centers interested in implementing programs aimed at increasing vaccine uptake during a pandemic and in developing an infrastructure to address other health-related disparities.

  DOI

• “Patients are not the same, so we cannot treat them the same” – A qualitative content analysis of provider, patient and implementer perspectives on differentiated service delivery models for HIV treatment in South Africa

  Journal of the International AIDS Society · 2020 · 42 citations

  • Medicine
  • Family medicine
  • Nursing

  INTRODUCTION: In 2014, the South African government adopted a differentiated service delivery (DSD) model in its "National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)" (AGL) to strengthen the HIV care cascade. We describe the barriers and facilitators of the AGL implementation as experienced by various stakeholders in eight intervention and control sites across four districts. METHODS: Embedded within a cluster-randomized evaluation of the AGL, we conducted 48 in-depth interviews (IDIs) with healthcare providers, 16 IDIs with Department of Health and implementing partners and 24 focus group discussions (FGDs) with three HIV patient groups: new, stable and those not stable on treatment or not adhering to care. IDIs were conducted from August 2016 to August 2017; FGDs were conducted in January to February 2017. Content analysis was guided by the Consolidated Framework for Implementation Research. Findings were triangulated among respondent types to elicit barriers and facilitators to implementation. RESULTS: New HIV patients found counselling helpful but intervention respondents reported sub-optimal counselling and privacy concerns as barriers to initiation. Providers felt insufficiently trained for this intervention and were confused by the simultaneous rollout of the Universal Test and Treat strategy. For stable patients, repeat prescription collection strategies (RPCS) were generally well received. Patients and providers concurred that RPCS reduced congestion and waiting times at clinics. There was confusion though, among providers and implementers, around implementation of RPCS interventions. For patients not stable on treatment, enhanced counselling and tracing patients lost-to-follow-up were perceived as beneficial to adherence behaviours but faced logistical challenges. All providers faced difficulties accessing data and identifying patients in need of tracing. Congestion at clinics and staff attitude were perceived as barriers preventing patients returning to care. CONCLUSIONS: Implementation of DSD models at scale is complex but this evaluation identified several positive aspects of AGL implementation. The positive perception of RPCS interventions and challenges managing patients not stable on treatment aligned with results from the larger evaluation. While some implementation challenges may resolve with experience, ensuring providers and implementers have the necessary training, tools and resources to operationalize AGL effectively is critical to the overall success of South Africa's HIV control strategy.

  DOI

• A Qualitative Exploration of Community Ownership of a Maternity Waiting Home Model in Rural Zambia

  Global Health Science and Practice · 2020 · 20 citations

  Senior authorCorresponding
  • Political Science
  • Business
  • Public relations

  CONTEXT: Ownership is an important construct of sustainability for community-based health programming, though it is often not clearly defined or measured. We implemented and evaluated a community-driven maternity waiting home (MWH) model in rural Zambia. We engaged stakeholders at all levels and provided intensive mentorship to an MWH governance committee comprised of community-selected members. We then examined how different stakeholders perceive community ownership of the MWH. METHODS: We conducted 42 focus group discussions with community stakeholders (pregnant women, fathers, elders, and community health volunteers) and 161 in-depth interviews with MWH stakeholders (health facility staff, district health officials, and MWH governance committee and management unit members) at multiple time-points over 24 months. We conducted a content analysis and triangulated findings to understand community ownership of the MWH and observe changes in perceptions of ownership over time. RESULTS: Community members' perceptions of ownership were related to their ability to use the MWH and a responsibility toward its success. Community and MWH stakeholders described increasingly more specific responsibilities over time. Governance committee and management unit members perceived their ability to represent the community as a crucial component of their role. Multiple respondent types saw collaboration between the governance committee and the health facility staff as key to allowing the MWH to meet its goal of serving the community. CONCLUSION: The perceptions of community ownership evolved as the intervention became more established. Use of the MWH, and clear understanding of roles and responsibilities in management of the MWH, seemed to foster feelings of community ownership. To improve the sustainability of community-based maternal and child health programs, interventions should be accessible to target communities and clear roles should be established among stakeholders.

  DOI

Frequent coauthors

• Jeanette L. Kaiser

  Boston University

  44 shared

• Davidson H. Hamer

  Boston University

  34 shared

• Thandiwe Ngoma

  Right to Care

  32 shared

• Taryn Vian

  University of San Francisco

  27 shared

• Jody R. Lori

  Dodowa Health Research Centre

  26 shared

• Godfrey Biemba

  Lusaka Apex Medical University

  26 shared

• Sydney Rosen

  Boston University

  25 shared

• Peter C. Rockers

  Boston University

  18 shared

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