Health systems research

Mike English

Oxford Health Systems Research Collaboration (OHSCAR)

Professor Mike English leads the Health Services Unit at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya. This unit aims to strengthen equality in access to affordable quality health care in Africa. Studies are based on health systems clustered around five main topics: malaria, service delivery & access, information for decision making, governance and financing.

Professor English leads efforts to develop multidisciplinary links with Oxford through the Oxford Health Systems Research Collaboration (OHSCAR).

The KEMRI-Wellcome Trust research programme

The KEMRI-Wellcome Trust Research Programme is a major Wellcome Trust’s overseas programmes. 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.

Working for NDM

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Mike English: Better hospitals for children

I started off training in medicine, then after some years in medicine I trained in paediatrics, which is a speciality dealing with children. Then I ended up working overseas in Kenya and I have been there over 20 years.

My current research is basically trying to change the ways that hospitals work for children. So we tend to focus more on what the doctors should have around them, what medicines they should have or maybe a new vaccine. But we have tended to ignore maybe the way that people should work so that maybe they provide the best care.  Most of our work now is trying to see how we can reshape Kenya hospital and the way people work inside it so that children get the best treatment.

Children’s health is a big deal for our part of the world and until recently it was more than 1 in 10 children who were born and then died before they reached the age of five. In some parts of Africa it is still like that. In Kenya it has gotten slightly better but there is a big problem and the things that we can do to alleviate that problem seem to be a good idea. I think it is an important area as well as children don’t really have a chance to speak up for themselves so they need some of us to do it for them.

We use a variety of methods and that is one of the things that is interesting. We do things like statistics so that people who have a mathematical background feel very comfortable with dealing with numbers and algebra. And then we use people from very diverse backgrounds, people who have come to us having done humanities for instance and subjects like politics or economics and they tend to focus more on the way people behave and the way the environment around people shapes the way they behave, so we try and work with all sides of the research to get a big answer.

So I think one of the areas that we work on at the moment and are particularly focusing on is that there is almost an absence of statistics so often in the African context we really don’t know what is happening with healthcare. We don’t know how many people are getting treatment, we don’t know how well those treatments work so are actually at the moment trying to develop some of those statistics. I can’t give you any specific numbers at the present but there are hundreds of thousands of children admitted to Kenyan hospitals every year and we have not had a good way of knowing how well they are treated before. Those are the issues that we are dealing with.

I think the impact of research and perhaps the impact of my research is reflected in the impact of the broader team of the people that I work with than anything else and it is partly that we have been working for a long time on some of the same issues. We have got a team of people; we have good links with different parts of the Kenyan health establishment and the universities. I think that we have made an impact in a variety of areas including the way that some of the hospitals do work in the government sector in Kenya. We have made an impact by changing the way that people think about research and the types of research that can be interesting. I think we have begun in our engagement with some of the younger health workers and health workers in training and begun to impact on the way that they think about both research and the way they think about practice.

I think if you are thinking about a career in research then you need to like arguing. A lot of it is about challenging yourself, challenging other people to justify what they are doing. You need to be able to take a contrary opinion every now and again and put your money where your mouth is. It is also a lot of work but interesting, stimulating. It is the kind of job that you will carry home with you in the evening which may not please your family too much but that is the reality. If you want to leave your job at 5 o’clock in the evening and forget about it until 9 o'clock in the morning then research is probably not the job for you.