Q and A

Research for Impact is one of the core strategic themes in SU`s Vision 2020. How does your research relate to that?

My research is related to strengthening the health workforce and service delivery in family medicine, primary health care and district health services. Almost all my studies provide evidence that can be used by decision and policy makers in improving health and health care – and therefore have an impact. For example, recent studies have focused on group empowerment for people with diabetes, evaluation of home delivery of medication by community health workers, the treatment of COVID-19 in district hospitals and factors affecting the retention of medical officers in district health services.

Please give us your impression of the role that research and innovation can play in the betterment of society?

The World Health Organisation says that “health systems, policies, strategies and operational plans should be informed by the best available evidence of what works and how. Health systems research and implementation research on interventions that support all three components of primary health care is key to providing this information.” In order for society to flourish, we need to build a solid social foundation and not exceed the environmental limits of the planet. Health and health care are an essential part of building that social foundation and research can provide the evidence needed for us to provide health services that improve health, equity, resilience, efficiency and responsiveness of the services to people’s needs.

What would you regard as the most important aspects to consider to effectively support researchers?

In the field of family medicine and primary health care in sub-Saharan Africa there is much work to do in building research capacity and established researchers. Some of the things that we have been trying to support from SU are:

• The Stellenbosch University Family Physician Research Network – this is a network of family physicians working clinically in health centres and district hospitals across the province. Busy clinicians identify key research questions and then work together with academic support from the university to conduct research that is feasible and which also builds their research capacity.

• The AfriWon Research Collaboration – this is an online training programme and mentorship scheme for novice and early career researchers in the region., led by family physicians within the first 5-years of qualifying. Mentees link up with peer mentors and peer mentors with more established researcher mentors to build both research skills and supervisory skills.

• The Primafamed network – a network of departments of family medicine and primary care in the region hold monthly e-workshops to build capability in performing and supervising research.

• Ensuring that every department of family medicine in the country have family physicians or other staff members who have been trained as researchers through doctoral research programmes.

Of course all these initiatives need funding and support, which is not easy to obtain. We particularly need funding to enable clinicians to take time out to complete doctoral research and develop their research capacity. Trying to work clinically and do research is hugely challenging without this.

What do you enjoy most about your job and what are the aspects that you find challenging?

I enjoy mentoring and supporting colleagues as they grow and develop in terms of research and teaching students. I am also motivated by creating and innovating with new ideas to improve health care – our latest initiative has been education for people with diabetes via a WhatsApp Chatbot. I also enjoy the connectivity in the region and the opportunities to support the growth of family medicine in different countries. Working with the Metro Health Services and supporting them through research and policy development has also been meaningful. Most international research grants are focused on specific diseases and there are few opportunities to obtain funds that support the development of primary health care as a whole system. Working with the global Primary Health Care Research Consortium we are trying to find funding to keep the consortium going. A recent 30by2030 campaign is challenging funders to ensure that 30% of their funding goes to projects that focus more broadly on systems and service delivery and not just specific diseases and vertical programmes by 2030.

What is the biggest piece of advice that you would give early-career researchers?

In my field, all family physicians are obligated to perform a small research project as part of their training, but very few go on to do more research or become researchers. I think that in our setting, completing a doctoral degree is a great way of developing the research toolkit and also developing expertise for a long term focus on a relevant topic that requires further inquiry, development and research. Integrating research, reflection and scholarly writing into your work as a clinician early on will enable you to keep developing in this area, keep a broader mental horizon and keep the work interesting.

The COVID-19 pandemic has had an impact on the way we work. What, from your point of view, is the most pertinent change and how will this affect your work in the future?

COVID-19 has disrupted many research projects in the health services. We have had to continue employing researchers, using up funds, while not progressing with the work. Finding additional funds to complete the work is hugely challenging as funders only seem to grant no-cost extensions to the timeframe. At the same time we have been forced to innovate technologically both in terms of data collection and in terms of interventions to improve health care. Family physicians in training have been delayed from completing due to delays with their research and final examinations. My staff are all working from home and we have discovered how much of the work can be done without physical presence or face-to-face contact. The holding of meetings and workshops via Zoom or Teams has become the norm and as my staff are spread out across the whole province this new culture will be of huge value as we go forward. One of our goals in terms of environmental sustainability has been a reduction in travel and more use of video conferencing – COVID-19 has helped us achieve this goal!

What do you do for fun (apart from research!)

For fun I enjoy painting and as my home has no wall space left I have been taking over the long grey walls at the Faculty to display my artwork. Clinical pharmacology, my next door neighbours, have been asking for more! https://rm85656.wixsite.com/bobmash

I am also a keen mountain biker, cyclist and hiker and enjoy doing this with family and colleagues in family medicine.