Your recent work has focused on health systems research in sub-Saharan Africa. How has your career brought you to this point?
MK: I have a somewhat nonlinear path to academia. I’m a physician originally by training and practiced family and emergency medicine in northern Canada, which really informed my perspective on health systems, informed my research questions, and actually has really contributed to the reality testing of some of the research and policy recommendations that we’re really prone to giving inside academia.
Also, I have had policy experience at the UN and have a bit of a sense for how countries struggle to implement health systems that work. I think the combination of these perspectives—both from very practical, on the ground delivery of health care to discussions with policy makers who are often very stretched by multiple agendas and donor demands and requests—has really given rise to what is for me a very rich research agenda around the functioning and quality of health systems.
What a wealth of experience you have. Can you tell us a little more about your work and the important intersection of health systems research and maternal health?
MK: Maternal health offers really important insight into the functioning of health systems. To provide quality maternal health care it doesn’t suffice to have simple interventions—a little bit of Vitamin A, or bed nets, or one-off technologies—what it really requires is a system: a system of individuals, facilities, of community links to facilities, and for all of that to be working all of the time in order to really avert maternal deaths.
I think mothers with labor complications are only one group [who needs functioning systems]. Other folks in communities [need them] as well; people with accidents, injuries and emergent conditions get good care [and] benefit from [systems] working.
That makes so much sense. If a health system can’t respond well to an obstetric emergency, it likely also can’t respond well in other emergencies. Can you share with us one of your more surprising recent findings?
MK: There are a lot of global efforts to get pregnant women on antiretroviral treatment, [and we] assume that women once on treatment will stay in it; that’s how we protect future babies, protect family, and optimize the woman’s health outcomes. The difficulty is that women don’t necessarily stay in treatment and [in recent research] we wanted to understand how we could organize health services to better match what women hope and expect from a health system in Ethiopia and Mozambique.
What we found from interviewing women is that respectful treatment is incredibly important to women as a part of their routine care provision for HIV as well as the opportunity to access non-HIV services in the same clinic. Women don’t see HIV as an isolated thing that they’re tackling in their lives, they have multiple health needs. When they come to clinic they want to make sure they can attend to those health needs and be efficient. That was a novel insight, we didn’t realize it would be one of the top attributes to maintaining women in treatment!
You have a Twitter account. That’s great! Tell me a little bit more the value you see in using social media in global health:
MK: As researchers involved in health systems, part of our social obligation is to highlight strong evidence and to disseminate findings of our research and colleagues’ research that is relevant to politicians and policy makers today. I think in particular, Twitter has been very useful in promulgating research findings and stirring up discussion and debate within the field.
We agree! Now that you’re with us at the Harvard Chan School, what are you looking forward to?
MK: There are massive and wonderful opportunities. I’m excited to be at Harvard, it is a cauldron of wonderful ideas and brilliant thinkers and also just a real history of engagement with policy makers and with health system leaders, which I think really enriches the research, enriches the questions and brings opportunities to engage at a really meaningful level for health system change.
I hope to take the next year to stand back a little bit and ask myself which directions are the most meaningful in terms of provoking change for women, populations, and communities. I think of importance is, fundamentally, how can we push forward beyond fragmented health programs and siloed health initiatives of the past to create a flexible, responsive health system for users.