Plugging the gaps in global health data
Gates Cambridge really inspired me and showed me what is possible to do in the world. I also gained some very close friends. It is wonderful to have that global network and to feel part of something bigger.
Neonatal mortality accounts for 45% of child mortality in Kenya. A set of key health system challenges undermine newborn survival in more deprived areas.These include, limited access to quality care for sick newborns and inadequate availability of appropriately skilled human resources.
A project co-led by Gates Cambridge Scholar Georgina Murphy  is investigating the gaps in provision and quality of inpatient neonatal care in Kenya and the role of nurses in providing that care in the high-burden resource-limited setting of Nairobi, Kenya.
One potential solution being explored is task-shifting - training assistants to take on some nursing tasks. This can be politically controversial, but alternatives such as hiring extra nurses are expensive. The project argues that success is more likely if task-shifting approaches are based on the values, preferences, knowledge and skills of stakeholders and frontline health workers.
As Senior Postdoctoral Researcher at the Nuffield Department of Medicine at the University of Oxford, Georgina was co-principal investigator of the ‘Health Systems Research Initiative: Providing evidence to strengthen health systems and improve health outcomes’ project from May 2014 to December 2017. Her role involved coordinating international collaborators, co-investigators and advisers in Kenya, UK and USA. Being an epidemiologist by training, she directly led the quantitative studies that form part of the multi-disciplinary research project. A third of her time on the project, which is supported by a £1 million Health Systems Research Initiative grant, was spent at the KEMRI Wellcome Trust Research Programme, Nairobi, where she directly managed a team of junior researchers and students.
“Neonatal mortality is a very large problem in Kenya. One of the key ways to reduce it is to make sure that babies who are sick when they are born get adequate hospital-based care,” says Georgina. One major problem that the project aims to address is the lack of information available to the government on the adequacy of current neonatal inpatient services. “There is a lack of data on a general population level about how many babies might require hospital care,” says Georgina, “and on the gaps in the quality of what is being provided in terms of inpatient neonatal services as well as about what kinds of improvements could be made. Without data it is difficult to make good evidence-based decisions. Efficient and effective healthcare is important everywhere, but is particularly crucial when resources are limited in poorer settings.”
Results from the five-year project have started to be published in the last few months. It is now moving into a phase that will focus on potential solutions in collaboration with policymakers, nursing unions and healthcare workers. “All of our research is done in close partnership with local government and those with the power to design and implement change. We spend a lot of time on engagement and communicating research findings. Ownership of the problems and the solutions identified through our research by these key stakeholders is crucial for sustainable change,” says Georgina.
Alongside co-leading the project, Georgina has also done some consultancy work for Oxford Policy Management, an international development consulting firm which aims to help low- and middle-income countries achieve growth and reduce poverty and disadvantage through public policy reform. She also runs the Naji Foundation, which provides grants for the promotion of evidence-based medicine in Ireland and the UK and focuses on how the public makes informed choices around health. She helped found the organisation while doing her PhD at Cambridge after she was contacted by entrepreneur Samir Naji through a family friend because of her work on global health.
Gates Foundation Fellowship
In February, Georgina will take up a prestigious two-year position as a Gates Foundation Fellow in Global Health, based in Seattle. She is aware it will be different working for a large funding organisation compared to working in academia. “My academic work was very hands on, working in East Africa and directly with local stakeholders. I’m looking forward to continuing to approach global health from a ‘real-world’ lens but side-stepping out of academia for a while,” she says. “At the Gates Foundation, I’ll be working on projects, problem solving and strategy in a dynamic environment, with people from a variety of professional backgrounds. It’s a wonderful opportunity for me to better understand the breadth of actors in global health and the role of the Gates Foundation, while strengthening my leadership skills. I’m excited by the prospect of working in such a diverse and inspiring environment, with the opportunity for mentorship and sharing experiences with peers.”
She adds that being a Gates Cambridge Scholar meant she has a good grasp of what the Foundation is trying to achieve.
Georgina, who has published extensively and presented at many international academic conferences, grew up in Ireland and developed a strong interest in international politics and science from a fairly early age. At school she was involved in the model UN. When it came to university, though, she opted for a degree in science, while continuing to be engaged in international politics and development in her spare time. Indeed, while she was at university she combined politics and health as Chairperson of the Executive Committee of the THIMUN Youth Network, which had consultative status at the UN. Among other activities, she was HIV/AIDS Committee Coordinator of the Network and President of the Assembly, which involved directing a conference for over 100 participants from 22 countries.
Georgina did her undergraduate degree in Molecular Medicine at Trinity College Dublin. It was the first year of the course and it aimed to bridge the gap between lab-based science and clinical medicine. That desire to bridge the gap between expertise from different areas was to become a feature of Georgina's career.
Having done her degree, she was clear that she wanted to work in health and development so did her MPhil in Development Studies at the University of Cambridge. During her master’s she met Dr Manj Sandhu at the Department of Public Health and Primary Care, who took her on as a PhD student to lead a research project on non-communicable diseases in rural Uganda. Georgina received a Gates Cambridge Scholarship for both her MPhil and PhD.
In Uganda, where she lived for a year during her PhD, she led a project that involved going door to door to more than 8,000 villagers evaluating non-communicable health problems, such as obesity, diabetes and heart disease. Similar to the Kenyan project, the research focused on filling a data gap. It whetted Georgina’s appetite for working on health systems in developing countries.
She says that the experience she gained in Uganda, combined with that of being a Gates Cambridge Scholar, gave her the confidence to take on the Oxford/Kenya project. During her time at Cambridge, she was internal officer on the Gates Cambridge Scholars Council and an active member of the Gates Cambridge community. “What I learned at Cambridge was really invaluable. There was no way I could have taken on that responsibility if I had not had that experience,” she says. “Gates Cambridge really inspired me and showed me what is possible to do in the world. I also gained some very close friends. It is wonderful to have that global network and to feel part of something bigger.”