Social and behavioural research

Over the years a large social science research programme has evolved within the KEMRI-Wellcome Trust Collaborative Research Progamme. The focus of social and behavioural research (SBR) has been around three key inter-related areas:Students of Shariani Secondary School discuss the meaning of the KEMRI Logo.

• Application of ethical research principles for biomedical research in low income countries. Initiated with studies around community understanding and views of the research centres' activities in Kilifi, a large scale communication strategy for the center has evolved. The communication strategy, research around implementation and impact, and consideration of the generalisability of findings, are supported by an advisory board with experts from the region in policy, communication, community engagement, and ethics.
• Access to health care at household and district levels. Initial research exploring household vulnerability to health costs in Kilifi is now being carried out in four districts across Kenya. Future research will include documenting the impact of Kenyan health financing mechanisms on equity in access.
• Assessing malaria medicine retailer programmes in Kenya (Wellcome Trust and WHO/TDR funded). Following initial and highly promising pilot programmes in Kilifi, the Ministry of Health incorporated private retailer programmes into the national malaria control strategy in 2001. A study is currently comparing the implementation and impact of retailer programmes in four districts.

SBR researchers in Kilifi are increasingly linked with researchers in the Consortium for Research on Equitable Health Systems (CREHS) group in Nairobi. CREHS work on strengthening health system policies and interventions to preferentially benefit the poor. Current studies are examining the implementation of IMCI in Kenya to promote health and health system equity, and evaluating the introduction of health facility funds in Kenya. Future research will be around mechanisms to motivate and retain health workers, particularly in "hardship areas", and documenting approaches to expand access to ACT through retailers.

The above research programme has been funded primarily by The Wellcome Trust, MIM/TDR and DFID. External scientific support and mentorship to this programme has been primarily through collaborators based at The Centre for Health Policy at Wits University, the Health Economics Unit in University of Cape Town, the Health Policy Unit at the London School of Hygiene and Tropical Medicine, SARETI at the University of Kwa Zulu Natal, and the Ethox centre in Oxford University. In addition to the SBR/CREHS groups, there are also social scientists working in primarily epidemiological or clinical studies, either as research assistants or as PhD students. For example there are social scientists involved in HIV vaccine trials, and in epilepsy and genetics studies in Kilifi. In Nairobi social science research beyond the CREHS group includes exploring the research-policy-practice interface, and health worker motivation around quality of health care provided in hospitals.

• Capacity building in social science is built into all of the above research, with additional activities including:
• Formal training opportunities at collaborating institutions
• In-house workshops for social scientists working in KEMRI and in other Kenyan institutions.
• The formation of two networks of social scientists within the KEMRI-Wellcome Trust Programme.