Examining the ability of early career medical staff to support the provision of high quality care in Kenya.

Project Overview

Inpatient care in Kenyan county hospitals is largely provided by recently qualified physicians in a period immediately following or within 2 to 3 years of their graduation (medical officer interns and medical officers respectively). These junior physicians provide ‘frontline care’ in hospitals. When providing paediatric or neonatal care they are under the supervision of typically a single paediatrician who is rarely available to support them in their real-time assessment and medical management decision making, especially when doing duties at night or at weekends. The hospitals these junior medical staff work in are high stress environments. On paediatric wards mortality rates can be high (typically about 5%) and on neonatal wards even higher (up to 20%). There are few nurses, material and diagnostic resources are often missing and the working context may appear chaotic and overwhelming. While such challenges are widely acknowledged and recognised by those working in these systems there is surprisingly little detailed examination of what the effects of such work has on the junior medical staff themselves or their ability to provide high quality care.

The proposed DPhil will explore the following issues using Kenya as a country case study:

To address the questions outlined above the student will initially spend time identifying useful literature and develop a solid theoretical basis for subsequent empiric work. Literature on burnout / resilience and human resources management may be illuminating together with literature on the shaping of professions and practical norms. Drawing on this literature the student will likely undertake a detailed literature review in one area and proceed to develop a proposal for empiric work to be conducted in Kenya where considerable work already engages with county (district) hospitals. Empiric work might employ document review, in-depth interviews and group discussions. The work would likely also be usefully informed by some periods of observing work in hospitals (in the form of ethnographic observation). Overall the aim would be to identify critical areas / strategies for improvement in the preparation of the medical workforce or the support provided once to individuals once they are in practice anticipating that this might be beneficial for patient care.

Background references

Health worker resilience https://gh.bmj.com/content/2/2/e000224

Motivation https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-43

Human Resources for Health https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-018-0301-0

And https://academic.oup.com/heapol/article/33/suppl_2/ii27/5050014

And http://www.who.int/alliance-hpsr/resources/publications/9789241513357/en/

Training Opportunities

The purpose of this DPhil is to launch a new area of enquiry on the preparation for work and the coping strategies of junior medical staff in Kenya and how existing practices may impact paediatric and neonatal inpatient care. The work is intended to help an individual gain an understanding of health systems in the specific arena of human resources for health with a focus on understanding the organisational and social factors that directly affect health workers themselves and indirectly affect patients. Time will be spent learning and conducting literature reviews and identifying and exploring different theories and methods that then inform study designs. The student will be expected to lead the design of studies based on their skills and interests developing a detailed proposal to satisfy the requirements of scientific and ethical review. 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 primarily linked to the collection of primary data up to 6 months may be spent in Kenya based at the Nairobi offices of the KEMRI-Wellcome Trust Research Programme (www.kemri-wellcome.org) and the DPhil will be co-supervised by Dr. Edwine Barasa http://kemri-wellcome.org/author/ebarasa/

Theme

Tropical Medicine & Global Health

Admissions

Project reference number: 995

Funding and admissions information

Supervisors

Name Department Institution Country Email
Professor Mike English Tropical Medicine Oxford University, Nairobi KEN menglish@kemri-wellcome.org
Dr Edwine Barasa Kemri Wellcome Trust KEN ebarasa@kemri-wellcome.org

There are no publications listed for this DPhil project.