Podcasts on Health systems research

Sassy Molyneux

Professor Sassy Molyneux's main interests reside in Social science and Ethics in Public Health. Over the years, social scientists have developed a programme of empirical work on research ethics. This work is based on an understanding that while the ethics of human subjects research may be universal, there can be big differences across contexts and circumstances in key ethical issues or principles.

The KEMRI-Wellcome Trust research programme

The KEMRI-Wellcome Trust Research Programme is a major Wellcome Programme. Its work has had a major influence on national and international health policy. Research spans a wide variety of topics and disciplines including research on malaria and bacterial and viral infectious diseases, work to map disease risk and intervention coverage and work on research ethics and health systems strengthening.

Sassy Molyneux: Governance in practice

I was brought up in Malawi; I lived there as a kid from 3-13 then moved backed to the UK. I did a human geography degree ultimately which I took up because it had lots of really exciting sounding courses. I didn’t really have a career idea but the courses were race and racism, international politics, local cultures, global processes, feminism. So I just went along to enjoy the courses and indirectly I guess that has been the basis of some of my further career choices, both living in Malawi and that course.

My main focus at the moment in my research is governance of both health and research systems. I think this is a really important area because it doesn’t matter how good your policies are, how excellent your drugs are, what interventions you design if they don’t actually get implemented and have an impact at the frontline where it really matters (with patients, with participants, with users, with communities), all those interventions won’t have the kind of outcomes, they won’t meet their potential. So the governance of health systems and of research systems is about the oversight of them and their organisation, so a lot of work that I am doing now focuses on that overall topic.

I think it is really important to understand and to explore governance of both health systems and research systems because if there is proper oversight, if there is proper organisation of these systems then you have an opportunity to make a difference and to make sure that all of those interventions and ideas that people have like drugs, like vaccines, like policies, meet their potential – that’s why I think it is important. There are two main areas that I am focusing on within healthcare and research governance; I am interested in how communities are involved and responded to in health delivery, so the interactions with communities. So this has become a hugely sexy topic – there’s loads of money, loads of other types of resources put in to engaging communities. But there is very little understanding of how this can actually happen in practice on the ground so it is a really important area to research and make sure these good intentions are achieved. So that is one area that I am interested in within that overall area of governance. The other area is another area that has gotten a lot of attention; it is the audits SOPs, rules and regulations within health systems and research systems that are trying to achieve better performance and more efficient services. Again this is an area that has become so fashionable that people took about it being a cultural movement, it is happening in so many different areas. But there is also a bit of a backlash now saying that these things can also remove people’s focus, that  attention can all become about form-filling and making sure that you are doing what your bosses and funders want you to do and that can be damaging for what happens at the frontline and what happens with patients and communities. So that is the other area of accountability and governance that I am really interested in, that I think is really important to understand what’s happening in reality on the ground in order to make sure that the intentions are achieved.

I think it is very important to use methods that are appropriate to the question and often with the kind of research that I do it is important to have a mixture of methods, both quantitative and qualitative, a combinations of interviews but also observations because people don’t always say what they think and they might not be able to articulate what their real priorities and concerns are.  Often mixed methodologies and often action research, actually doing something to change a situation and watching and carefully documenting how that implementation unfolds and learning through doing rather than just learning by observing.

What was interesting recently was just looking at the newspaper headlines and seeing that in January this year there was big attention given to nurses, for example in the NHS, and asking whether they are actually focusing on patient care or are they focusing now on paperwork? That is not a figure but that kind of media attention is now being drawn to the topics that I am very interested in, is obviously interesting to me.

The research that I am involved in has an impact immediately for the institution that I work in. I work in an institution with 800 staff with multiple different types of studies happening and when we learn how we should do our research more ethically we immediately try to implement that in our research institution. In the country I am involved in a technical advisory group for health systems in research in the country. So you can feed in ideas from our research in that way and at an international level I am involved in various networks and how similar and different, different issues are in different countries and different places, for different situations, and we can also draw on the different connections that we have with decision makers at many different levels and try to make sure that our research is heard in the places where it needs to be heard.

I think for somebody thinking about research, if I draw on my own experience what I have done all the time is focus on what I think is the most interesting and important and I have gone out there and tried to make the right collaborations and meet the right people who can support me to do some good quality work around it. There is no denying that it is a very challenging area and highly competitive but that is more than compensated for I think by a hugely diverse job in many ways.  You are never doing the same things twice, you are always moving forwards, you are often independent in your life, in your thinking, you are not being given institutional ways of talking or ways of thinking .I guess my advice would be go with where your heart is and stick at it, and build up the right collaborations to support you to where you want to go.