Defining the future role of the African District Hospital in provision of Paediatric and Adolescent Health Services

Project Overview

There is no universally agreed definition of a hospital. For the purposes of this DPhil we are most concerned with facilities that should provide inpatient and ambulatory care to populations at district or regional levels (hereafter referred to just as district hospitals). In larger district hospitals (likely to have a total of 80 inpatient beds across specialities and often many more) norms and standards in low and middle-income countries (LMIC) often aspire to have services led by at least one obstetrician, paediatrician, physician and surgeon with post-graduate training supported by basic laboratory and imaging diagnostic resources. Such facilities are often also centres providing experiential training to multiple health worker cadres (nurse students, medical interns). The Alma Ata Declaration clearly states that these facilities are a critical part of the primary health care system. Yet their role within primary care and how they may provide complementary services to other parts of the primary health care system, beyond the management of acute infectious diseases of childhood, has largely been ignored. As the Sustainable Development Goals are helping re-focus attention on primary health care systems we need to define the roles African district hospitals should play in the provision of paediatric and adolescent health services as part of efforts to deliver quality services to populations at scale.

Work on this DPhil will likely benefit from the candidate becoming familiar with how paediatric services have changed in high income countries (HIC) in recent decades. As care for congenital and other chronic illnesses, mental and reproductive health needs, and increasing recognition of children’s rights have risen to the fore during a period of rapid technological change entirely new models for service delivery have been created, especially in the field of adolescent health. These have major implications for training and workforce demand. In many African countries health systems are still focused on care for those with acute illness episodes with hospitals expected to manage the severest forms of these illnesses. As a result LMIC health systems are typically poorly prepared to offer integrated care for chronic conditions in general (outside HIV care) and in adolescents and children specifically. While there are efforts to begin to address these challenges (eg. new research could contribute to long term strategies and policies aimed at improving paediatric and adolescent health service delivery. Areas that would likely form part of a DPhil include:

Initially the DPhil student will work with supervisors and collaborators to review global and national policies aimed at guiding the longer term development of paediatric and adolescent health services in LMIC. At the same time global examples of high quality and innovative service provision strategies in this area might be identified and reviewed. Specific research questions will be refined with the supervisory team, research methods identified and a proposal for empiric studies developed. These studies are likely to be carried out using Kenyan hospital settings as sites for data collection in partnership with researchers at the KEMRI-Wellcome Trust in Nairobi ( and the Ministry of Health in Kenya. Opportunities also exist to develop linkages with the WHO EURO office which is involved in thinking on child health redesign for this region.

Background references:

Training Opportunities

The purpose of this DPhil is to introduce the student to health policy and systems research with a focus on the linkages between primary and secondary care systems in the provision of paediatric and adolescent health care. The student would conduct epidemiological and health services research and could develop a specific interest in how patients navigate the health care system or health workforce development. Time will be spent learning and conducting literature reviews and identifying and exploring different theoretical perspectives that then inform study designs. Skills in proposal writing to satisfy the requirements of scientific and ethical review will be developed. Where necessary appropriate training in research methods will be provided (eg. in qualitative or quantitative data collection and analysis) and there will be opportunities for engaging with a wider body of researchers in Oxford and Kenya conducting health systems research.  It is anticipated that during the course of the DPhil and linked to the collection of primary data approximately 6 months may be spent in Kenya based at the Nairobi offices of the KEMRI-Wellcome Trust Research Programme ( This work will also potentially involve experts at WHO-EURO headquarters in Copenhagen conducting work aimed at predominantly eastern european health systems.


Tropical Medicine & Global Health


Project reference number: 993

Funding and admissions information


Name Department Institution Country Email
Professor Mike English Tropical Medicine Oxford University, Nairobi KEN
Dr Chris Paton Tropical Medicine Oxford University, NDM Research Building GBR
Dr Jacob McKnight Tropical Medicine Oxford University, Nairobi KEN

There are no publications listed for this DPhil project.