Sassy Molyneux: Strengthening health and research systems

I'm Sassy Molyneux and I'm a Professor in Global Health.

My two main areas so far have been in health systems, and there I've been interested in how we can better understand and assist health systems in coping with and building resilience to both everyday stresses, which can come from, for example, not having enough resources like staff and medicines and equipment, but also changes to policy and practice that happen very regularly. Coping with those stresses as well as more periodic shocks that can be, for example, health worker strikes or epidemics or problems that arise as a result of climate change. That’s one area, and the other area is around research ethics, so how can we make sure that we conduct high quality, important research in ways that are responsive to the local communities and populations involved.

One area that crosscuts all of my interests is frontline staff. Frontline staff play a really critical role in the everyday business of doing research and of providing health care. A project I have is to look at how we can minimise and manage moral distress amongst frontline staff who are involved in international research projects. I'm excited about this project because I think it's really important. Moral distress is a situation where people know what they think they should do in a given situation, but institutional constraints mean it's not possible to do it. This can be really bad for the staff that are involved. They can feel stressed, their well-being can be affected, and it can lead to them leaving work and not being able to perform their work properly.

Moral distress - we all heard a lot more about it during COVID-19 in high-income countries, but the kind of situations that lead to moral distress are everyday realities in the context in which we conduct global health research. Actually, that's one of the reasons we want to do research in those settings, because in those communities there is a lot of exposure to difficult situations. As researchers in international networks, we're basically putting our staff into situations where they're exposed to moral distress without enough support. My project is looking into how we can better support that.

If we're able to minimise moral distress and to manage it better, we should be in a situation where we're helping to protect staff who are really critical to getting research done and to delivering health systems as a first. As a second, if we're not protecting and looking after the well-being of those critical staff, then we're not going to have as good quality research, we're not going to have as good quality health care. It's really important to focus on this area that's been pretty neglected so far, not only for those people but also for science and for the public.

I think at the moment we have lots of guidance out there on, for example, how we might better protect participants in research. There's also better guidance on how we might have fair collaborations between high- and low-income countries for example. But there's very little on how we might look after the staff who are often not the most powerful in research programmes and in health systems but do really important work. I'm really keen to be working with lots of people from different contexts, from different types of studies to think together and work together to change policy and guidance around how we can better minimise and manage distress in these groups.

This interview was recorded in July 2024.