From “know-do” to “how-why”…

ITM colloquium, 2014

Dr Julie Balen Lecturer, Global Health School of Health & Related Research (ScHARR) The University of Sheffield, UK 25 November 2014

Social scientists in global health research

SOCIAL SCIENTISTS ANONYMOUS… Inter-disciplinary global health research: worthy goal; fuzzy concept?

Anthropology

Psychology Sociology

Health economics Ethics Statistics

Political sciences Management History sciences Law Geography

Epidemiology Medicine

A complex landscape

Inter-disciplinary global health research: worthy goal; fuzzy concept?

Anthropology

Psychology Sociology

Health economics Ethics Statistics

Political sciences Management History sciences Law Geography

Epidemiology Medicine

A complex landscape – (a bit) more navigable? Health systems strengthening

Leadership is foundational element, but ill defined, under researched & poorly understood especially in complex, resource-poor settings , West Study design & setting The study of leadership

Leadership – a person, a position or a process?

1. Person: skills, abilities, personality, styles of engagement and behaviours of individuals

2. Position: formal authority and responsibility in an organization

3. Process: a set of dynamic activities and interactions occurring among and between individuals, groups and organisations in a specific context The study of leadership

A summary of the six key leadership styles explored in this study

Coercive Authoritative Affiliative Democratic Pace-setting Coaching

Modus Demands Mobilises people Creates harmony; Forges consensus Sets high standards Develops operandi immediate toward a vision Builds emotional through participation for performance people for the

compliance bonds future

Underlying Drive to achieve; Self-confidence; Empathy; Collaborates; Conscientious; Develops emotional Initiative; Self- Empathy; Builds relationships Team leadership; Drive to achieve; others; intelligence control Change catalysts Consults Initiative Empathy; components Self-aware

The style in a “Do what I tell you” “Come with me” “People come first” “What do you think?” “Do as I do, now” “Try this” phrase

Adapted from Goleman (2000) Predominant leadership styles

Democratic: “Healthcare delivery entails dealing with life, and in dealing with life, certain issues that are coming up, you can’t predict them. So if they are unpredictable, then that means it’s no longer in your domain. If you do not reach out, reaching out doesn't mean you don’t know.”

“I also conduct meetings... frequently call the staff and have a discussion, basically they will show you ways how to manage a facility. So I capitalise on what they say because I may not know exactly what is happening or may not know all, but sometimes their ideas are very good, I take them.”

Pace-setting: “I use the religious aspect, whatever we do to help others no one can pay you, the payment will come after death. This is how I encourage people to strive.”

Authoritative: “So it is context specific, I should think that a leader must always have a particular vision and wants that vision to be embraced by those around them so that we get to that goal.”

“My leadership skills, I think I’m just born with it. I don't boast of it but I think I am privileged that God granted me certain things, which through my own innovations I am able to do them so I am a tough leader.” A few brief conclusions

• Study of health leadership aids in constructing a narrative of local agency

• Relocates focus from thinking primarily about ‘interventions’ & ‘innovations’… towards people- centered health systems comprised of local actors & their sense of ownership, authority & power

• Adding “human dimension” to dominant paradigms in global health discourses

A few brief conclusions (2)

This work brings a new perspective to the study of leadership as an inter- subjective phenomenon that exists within a social & political reality & is shaped by particular, culturally determined ways of framing problems & solutions

http://www.conferencemanager.dk/islc2014/about-the-conference.html

• Brings to light the “rigour-relevance gap” • Not same as “know-do gap” so well known in global health research/practice • Focuses on the “why” rather than the “do” or “how” Mind the gap(s), please…!

Focus shifted to local level; Trans-disciplinarity 3. Assimilation 4. Adaptation is important; Inclusive participatory action research as tool for

RELEVANCE collaboration & reflection

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1. Acquisition 2. Application RIGROR RIGROR

KNOWLEDGE ---- ACTION 4th quadrant: adaptation

• To close both gaps, research must adapt to ask the right questions

• Reminder of a famous quote (Pablo Picasso): “Computers are useless. They can only give you answers.”

• Refocus on people (rather than technology & innovation) by addressing locally relevant questions/issues & through better engagement of/with local communities Summary comments

Successful inter-disciplinary teams need disciplinary experts & cross-discipline “bridges”

HPSR focused on geographical & financial access to medical technologies, innovations & service rather than on people – who form the core of health system

Concept of leadership can add human dimension to dominant models of conceptualizing/researching health systems/policy

HPSR needs to draw more on inter-disciplinarity; to be co- created/adapted at & by local level, through community participation & reflection in action (4th quadrant) Future outlook - ScHARR

Building inter-disciplinary team for participatory action research on leadership & health systems strengthening in The Gambia & Ghana – at the norming (i.e. “searching for funding”) stage…

Team currently conducting research into (among other things): • Lived-experience of health systems in urban informal settings of Northern Nigeria (where the state is relatively absent) [Muhammad Saddiq] • Real-life functioning of global health partnerships & their embeddedness within national contexts, focusing on Ethiopia [Henock Taddese] • Biomedical dominance & professionalization of health workers in Nigeria through a case study of Global Fund HSS grant [Samuel Lassa] • Impact of biomedical knowledge on evidence-informed health policy making, focussing on malaria control in Senegal/Gambia [Maelle deSeze] • Using cross-media data mining & analytics in Ebola control – dispelling myths

Acknowledgments

Special thanks to all key informants who participated in this study

Imperial College MRC Gambia Dr Lesong Conteh Prof. Umberto d’Alessandro (co-I) Prof Peter Smith Prof. Tumani Corrah (co-I) Dr Momodou Jasseh (co-I) The Gambia Government Mr Serign Ceesay Dr Adama Demba (co-I) Mr Sulayman Janneh Ms Marie Rose Thorpe Mr Landing Bojeng Dr Simukai Chigudu (student) MRC Drivers & Assistants

I gratefully acknowledge funding from and the National Institute of Health Research, UK

Ethical clearance obtained from The Gambian Government/MRC Joint Ethics Committee and Imperial College London Ethics Committee References – further reading

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