health systems

31 01 2024

Publication Mentorship Program for First-Time Women Authors in the Field of HPSR: An interview with Linet Okoth and Sally Theobald

We sat down to speak with Linet Okoth and Sally Theobald who are both members of the ARISE consortium, about their experience taking part in the Publication Mentorship Program for First-Time Women Authors in the Field of HPSR. The program is collaboration between Health Systems Global (HSG), the Alliance for Health Policy and Systems Research (the Alliance) and Health Policy and Planning (HPP). They invite applications from early-career women based in low- and middle-income countries  (LMICs) working on HPSR issues, who are interested in publishing their HPSR research for the first time in a global peer-reviewed journal, but require guidance and support to submit a manuscript which has the potential to be published.

Linet Okoth works at LVCT Health in Kenya and was a mentee as part of the 2022/23 cohort of the Publication Mentorship Programme. She is a Senior Technical Advisor for Community Health, and is interested in health systems strengthening, specifically in community settings. Sally Theobald is a Professor in Social Science and International Health at the Liverpool School of Tropical Medicine in the UK, and was a mentor for the 2022/23 cohort of the Publication Mentorship Programme. Sally works on a number of different research projects, including ARISE.

What are the main points you think people should know about the mentorship process?

Linet: The programme is really rigorous. It requires a lot of commitment. You need to identify a policy issue to centre your manuscript around. It really helps if you have a mentor who understands your context, and who can guide you in coming up with a good topic and paper.

Sally: I’d really encourage people to apply. I think it’s a fantastic opportunity to go on a journey together with your mentor. How the scheme works is that mentors and mentees are matched based on interests and expertise and focus of the abstract in the early stages, and then you go on a journey together. In the beginning we’re agreeing key messages, making sure there’s internal coherence, and that it all hangs together. We also work with co-authors, bringing them with us.

It’s about being part of a broader family or cohort. I enjoyed building my relationship with Linet, but also having the opportunity to meet the other mentees and mentors. I think it was really positive that many of us were able to come together face to face in Bogota [at the Health Systems Research 2022 conference], to build relationships with each other, share experiences and learn new things. We had sessions that really made me think – like how do you draw people in and express the message of your paper? I think it’s great that that the program is also inspiring and teaching mentors as well.

Linet: The in-person gathering was an opportunity to meet other mentors, and the rest of the cohort, and get an idea of what they’re doing. Just having that sharing in one physical meeting was a good thing.

How did the mentorship process in help you to prepare for and publish your research?

Linet: The mentorship process has prepared me to get going with writing. The ARISE consortium is in its final year. I am part of the implementation team and a lot has happened on the ground, so you can be sure there’s so much to write. I have gained so much confidence, working with my colleagues to come up with the abstract, looking at the policy documents. I’ve done program work for quite a time, but I needed the courage to write something. This process has given me that courage, and I’m looking forward to doing even more papers with the team. Either the first draft or as a co-author on other papers, especially for ARISE. It really helps to have someone to go on that journey with you the first time.

Tell us a little more about your paper, and what motivated you to write on this topic?

Linet: The title of my paper is ‘Delivery of health services to pregnant adolescents in informal urban settlements in Kenya’ and I’m looking at perspectives of policy versus practice. In the implementation of ARISE, we’ve interacted with vulnerable populations, and one of those populations was child headed households. In the context of child headed households, you realise that many more girls are in this position than boys.

Also, I have an interest in maternal and child health, and most of the people who fall in this group are young girls who are accessing services in the health facilities. We noticed that even though we believe there are free maternal and child health services, there are challenges with young girls accessing these services because they cannot afford to, or the services are of poor quality, or they have challenges with laws and policies in the country.

So, if this girl is an adolescent and is pregnant, number one they are vulnerable because they are a child, number two they are vulnerable because they are pregnant. This made me ask ‘can I do something?’ Because we have free maternal health services in Kenya. but we still have girls not accessing services. For me it was important to find out why there was this gap? What is the issue causing them to not access the services, despite having all these things put in place for us as a country? So that’s what motivated me, and that’s what I wanted to find out. There is so much that I have gathered which speaks to the reasons why the girls are not accessing services.

How did you work together to refine this idea?

Sally: We went through different stages and phases, in terms of the focus, the messaging, the narrowing down. And what was also good for me about the process was having the journal very much on board. You have to focus the paper against the requirements and the interests of the journal.

In all of our discussions, we also talked about how youth and gender friendly services that are there in policy can evaporate in practice, if there’s not enough investment in the services and the critical health workers be able to really build gender and youth friendly services, and to build trust with people that have multiple challenges in accessing care. They may feel alienated by formal health services. Through our discussions, we looked at how we fit this within the policy literature and within the broader academic literature? How do you build on the results to tell a story, situated in the literature, as well as within the context of urban informal settlements in Nairobi, and tells a coherent narrative that resonates within Nairobi and in settlements beyond Nairobi, as well.

Linet, can you tell us a little bit about the skills that you’ve learnt through the mentorship relationship and up to this stage of the publishing process?

Linet: I think one of the skills is patience! Also, working with different co-authors, having people with different perspectives on how you want to present this information, how people think differently around your topic, and what they want to focus on. It takes patience to collate all these thoughts and opinions, bring them together into something that makes sense, and as the lead author translate this into something that is coherent.

Secondly, I really improved my literature reading skills – you need to do a lot of reading, summarising, referencing. There are lots of suggestions around papers to be read, and you need to read them all, understand them, summarise them, and be able to refer back to them. Reading for me used to be a setback, but I think now it’s a skill that I have embraced, and I’m looking forward to using in the future.

There’s a lot of information, and condensing all that information is a skill. I can write and write and write, but this was a time to think about exactly what I wanted to say, to summarise, and be succinct.

Those are key skills that I learned through the program. And I think it’s something that I am taking forward as I continue with my career in research.

Beyond the skills learned through the mentorship and publishing process, what are some of the other advantages of being part of this cohort?

Linet: Through the programme I have had exposure to people who I wouldn’t have otherwise. For me it’s about the people – technical people, who can guide me in my writing. That’s another thing that that I needed to embrace research. My background has meant working on a lot of programs and with program managers. Through this project I’ve got to know and interact with some editors, researchers and academics. That exposure for me was a very good thing. It was great to have the physical session in Bogota that brought us all together, sharing, and getting quick, in person feedback on our work.

Also, the financial support offered to allow me to travel to HSR 2022 was really important, because without it I would have had to join the session virtually which wouldn’t have been as useful. It was so good that the program facilitated our travel to Bogota, and allowed us to interact with mentors and mentees on the program in person.

Any final thoughts on the programme and the experience?

Sally: It’s really wonderful to hear Linet reflect on the courage to write, on the power of reading, on the learning, on the journey, and also feeling inspired to be able to write further papers as first author or co-author. Obviously in ARISE we’ve got less than a year left, and I would love to see all of us really pushing on the outputs of all forms, including papers!

I really want to encourage others to apply for the program. It is really hard to write those first papers, and to go though it with a mentor, but also a wider cohort and a network to support each other is a really positive process. And I learnt a lot through it as well, so this a learning and network building opportunity for mentors as well as mentees! And I think it’s a great strategic partnership between the Alliance, Health Systems Global and the journal, really coming together in that way to support authors, and helps them with that early experience.

Linet: For me the experience has been so good. It’s exposes early career researchers to writing. Once they put the call out for the next cohort, I will encourage everyone to apply. It’s just a good experience for people who want to do research, people who want to write but are struggling. Because working alongside your mentor makes the burden lighter. There were times when I struggled and panicked in the process, but someone who helps you walk this journey is so helpful.

It’s been a good experience, and good exposure. I would encourage anyone who is eligible to apply for it to go for it!

If you want to learn more about the Publication Mentorship Program you can read more on the Health Systems Global website, listen to this podcast about the experiences of some previous participants, and check out the 2020 supplement on the Alliance for Health Policy and Systems Research website.

A woman sits cross legged on the floor. She is wearing white bottoms and an orange top. Her hair is tied back in a short scarf. She holds her arms out in front of her in a graceful dance move. She looks down to her fingertips. Her eyes are lowered. The carpet underneath her is an orange colour and behind her is dark wood paneling.

10 12 2019

The right to health: Supporting marginalised people living and working in urban informal spaces

By Rachel Tolhurst, Shrutika Murthy, Lana Whittaker, Prasanna Saligram and Surekha Garimella

‘Our rights, your accountability’ was a slogan used by social accountability practitioners from around the world at the COPASAH Global Symposium. Human rights are a fundamental underpinning of many people’s movements to demand accountability for health equity. But how do we understand rights to health? Who can we hold accountable to ensure that the right to health of marginalised people living and working in urban informal spaces in the Global South is realised? These are questions we have been grappling with in ARISE.

READ THE NEW COPASAH CHARTER ON SOCIAL ACCOUNTABILITY FOR HEALTH.

Rights to health

The UN Charter for Human Rights and Covenant on Economic and Social and Cultural Rights enshrine the right to health in international law. This extends beyond healthcare to the ‘underlying determinants of health’ and is therefore indivisible from other human rights such as the rights to food, water and shelter. Many of the struggles discussed at the Symposium focused on claiming the right to healthcare, which was a priority for community-based activists. However, we also heard powerful testimonies of how biomedical models of health that have been imposed as part of imperial, neo-colonial, patriarchal and neo-liberal regimes may be experienced as a form of violence. For example, how they have damaged and undermined indigenous and traditional models of health such as Latin American models which are grounded in the natural, social and spiritual world or care for women in childbirth provided by dais in India.

A more holistic understanding of health and well-being, in line with the WHO definition of health, is rarely pursued within ‘basic packages of care’, which focus on preventing mortality. A wonderful performance-based discussion on well-being facilitated by Anita Santhanam, reminded us of the need to find a common language to express our wider well-being (or ill-being) and to embrace and promote the care dimensions of healthcare and the multiple processes that are needed to promote well-being. ‘Colonised’ hierarchies of knowledge in global health, such as the dominance of the ‘gold standard’ of randomised control trials, may detract from efforts to find consensus about health between marginalised people and the people who are accountable to them.

The right to health also relates to freedoms such as the right to control one’s own body, including sexual and reproductive freedom, and the right to be free from interference, such as being free from torture. At the Symposium the sexual and reproductive rights of women and girls, women’s control over their bodies and freedom from gender and sexual violence were prominent topics. These rights should be protected by the state, but also involve the development of stronger accountability processes within communities. We need to find ways of ensuring that we are accountable to each other as human beings to treat each other non-violently, with respect for bodily autonomy and dignity, within families and communities, without this detracting from the struggle against more remote institutions and states.

Who is accountable?

The UN Committee on Economic, Social and Cultural Rights stated in 2000 that nation states have a three-fold obligation to respect, protect and fulfill the right to health, but also that actors beyond the state have obligations in this regard. These include health professionals, local communities, civil society organisations, and the private business sector. Most of the movements celebrated at the Symposium focus on increasing the accountability of the state for their obligations towards citizens.

Marginalised people in urban informal spaces often face challenges in making rights claims to the state. For many, ‘informality’ means that they lack state recognition of their right to live and work in the city and thus their rights to housing, clean water or sanitation. This lack of formal citizenship often undermines their eligibility for entitlements such as food rations or access to health services. Institutions of the state may nonetheless be present in their lives to some extent, sometimes in malign forms, including in police harassment and caste-related stigma and discrimination in health services.

State capacity to fulfill its obligations may also be weak due to neoliberal reforms leading to a skewed understanding of what it means to be a responsive state. Whilst states have an obligation to continuously move towards realising the right to health, many lack both the will and capacity to do so. In many contexts the democratic space and legal basis for rights claims is also shrinking. Lines of accountability are also being re-drawn due to neo-liberal globalization, with accountability flowing towards global capital.

In urban informal spaces, many non-state actors (people and institutions) create a complex web of governance and service provision, supplying water, toilets, electricity, dispute resolution and health services, usually outside of the regulatory reach of the state. How do marginalized people hold these actors to account for their obligations to respect, protect and fulfill their rights to health, in the absence of a legal framework of entitlements? Are there more direct social or political bases of accountability that can be leveraged?

In ARISE we aim to learn more about what people already do in practice and how to strengthen this. One of the exciting things about the COPASAH Symposium was the large number of accountability practitioners sharing their experiences. One such strategy was moving beyond an adversarial approach to working with healthcare providers. To see them as allies with whom social accountability can be built, on a foundation of community solidarity.

Women and providers working together

In one of the ‘practitioner huddles’ at the Symposium, conversations revolved around the barriers in accessing quality health services and the methods that were adopted in order to overcome them. Historical and cultural process were held responsible for deep-rooted biases within health systems and how these perpetuate the exclusion and marginalisation of certain communities. The lack of a tradition of ‘accountability’ within the government further complicates matters – as very often government officials are themselves unaware of the law and their associated obligations. It was argued that it is not the mere existence of a law that is important but its implementation.

Women, along with some of the community health practitioners, explained how indigenous women are discriminated against and mistreated at health facilities because of their cultural beliefs. Indigenous women are penalised for not giving birth to their children at health facilities and threatened with the prospect of their children not being ‘registered’ as citizens.

Women and practitioners also emphasised the importance of taking a people-centred approach and building the capacities of vulnerable communities, to effectively monitor health policies and services. Communities have been trained in accessing information, understanding government structures, collecting evidence from the field and advocating their demands to different stakeholders as part of this process.

Whose rights?

The UN declaration of Human Rights states that “All human beings are born free and equal in dignity and rights”, yet intersecting inequalities and power relations from the global to the local level undermine this. Many people living and working in informal urban spaces experience extreme marginalization and discrimination because of multiple intersecting identities such as caste, class, ethnicity, disability, religion, sexual orientation and gender.

The ‘social suffering’ related to being ‘othered’ and not afforded the dignity of being fully human is an important dimension of ill-health and ill-being. A critical aspect of strengthening social accountability is the realization of the rights of people ‘marginalised by design’ to freedom from discrimination, violence and to full societal participation. Many inspiring examples of feminist, anti-caste and egalitarian approaches to building social accountability movements were presented at the Symposium.

Lessons from intersectional politics also stress the importance of identity-based movements through which oppressed people create new, ‘de-colonised’ identities, realising their ‘power with’ and ‘power within’. In ARISE we are grappling with questions of how to support such identity-based movements as well as promoting the inclusion of the most marginalized within broader social movements that may be required to hold the powerful to account. We are standing on the shoulders of the many giants of accountability practice we had the privilege to learn from at the Symposium.

Photo credit: The image was taken by Rachel Tolhurst and shows Anita Santhanam’s performance on well-being at COPASAH