Lucinda Manda Taylor: an ethicist and social science research leader from Malawi, stresses on genuinely engaging with local stakeholders in the co-creation of knowledge
The Spotlight series is an interview-based profile series by McGill Global Health Perspectives. The series focuses on researchers and practitioners in global health outside of high-income country settings (and) or representing marginalized groups. For our fourth spotlight profile, we are featuring Dr Lucinda Manda Taylor, Senior Lecturer, program director for the Master of Science in Global Health implementation program at the University of Malawi, College of Medicine, now known as the Kamuzu University of Health Sciences and Research Fellow in the Centre for Bioethics in Eastern and Southern Africa (CEBESA) and the Training Research Unit of Excellence (TRUE).
Dr. Lucinda Manda Taylor, who grew up in Malawi, completed her doctoral studies in applied ethics at the University of Kwa-Zulu Natal, South Africa. As an educator, she is currently a senior lecturer in bioethics and social science research methods at the Kamuzu University of Health Sciences, Malawi. She was the deputy head of the Health Systems and Policy department and is the current program director for the Master of Science in Global Health Implementation program. She was also the editor-in-chief for the Malawi Medical Journal. Her research focuses on exploring the perceptions of community members and research stakeholders on the ethical conduct of research and clinical practice. She also focuses on community barriers that impede access to health care and factors that determine access and uptake to health services.
Can you tell us about your journey in global health research?
In terms of education, I completed my post-secondary education in one go. I completed my undergraduate degree in psychology and political science, followed by a master’s degree in political science at the University of Kwa-Zulu Natal, formerly known as the University of Natal. I completed my PhD in applied ethics at the same university. My path was not the traditional linear path to a global health career. Having completed my tertiary education outside of Malawi, I returned home and was employed by the medical school at the University of Malawi. In the corridors of public health or what was then known as community health, I nurtured and grew in this intellectual space that allowed me to bring my ethics qualifications and social science and humanities background into global health.
We are fortunate to have you with your expertise as we try to make global health a more equitable field. Can you speak about your current position and the roles you have?
My current work is divided into three spheres. I’m a senior lecturer in the School of Global and Public Health at the Kamuzu University of Health Sciences in Malawi. I teach ethics and social sciences research methods to undergraduate and post-graduate students. I’ve also been appointed as the program director for the Master of Science in Global Health implementation program. I was the deputy head of the Health Systems and Policy department in the School of Global and Public Health. I provided and continue to provide academic and administrative leadership and support in these roles. This is one-third of my tasks. The other two-thirds are divided into research and outreach activities. My research and outreach work focuses on improving the health and wellbeing of Malawians. I have spoken on the radio about women’s mental health during COVID-19 when most professional women worked from home while juggling family responsibilities. I have also spoken on radio and television about promoting women’s health through exercise. I have talked about the ancillary benefits of daily activities on the brain and the body because I’m also a certified fitness instructor, so I love spreading the message of health and wellness taking the time to take care of ourselves. All these outreach activities are part and parcel of community engagement which I firmly believe is required for every researcher.
Focusing on the ‘other two-thirds’ outside of your educator and administrator duties, can you tell us more about your research and outreach work?
Dr. Lucinda Manda Taylor
So, to preface my answer, I want to provide context for who I am and why that matters in my research.
First and foremost, I am a Malawian, and I am also a mother of two. As a mother of two, I am personally invested in optimizing and improving health outcomes for Africans in general and Malawian mothers and their children. So, much of my applied research focus is on improving maternal health, and with that also comes child health. I am also very interested in understanding the community’s opinions about the role of research in their lives, mainly how research should be conducted ethically and appropriately in response to community values and needs. I am also interested in how public and community engagement in science, medicine, and research can be improved to help optimize the community and individual health outcomes. I think that is where my ethics background connects strongly and fits in quite nicely.
So, my research work, I would say, straddles the disciplines of ethics and social science to create a complementary body of work that aims to empirically assess the role and potential of grassroots or local stakeholders in shaping health interventions because, I think the traditional approach of health policy has been top-down in its orientation, with exterior experts, technocrats bringing with them their preconceived notions of problems in Malawi that need correcting. Knowing this, in the space of my research work, I try to demonstrate that individuals who are targeted by health interventions can also make valuable contributions to health policy and implementation. I try to argue that we need to put weight on the agency of these communities rather than considering them as objects in a system that needs policy optimization.
Within this process, you appreciate how ethics is also crucial – particularly ethics in research practice. I always highlight that when we are looking at community involvement, engagement, uptake in interventions, implementing policy, or conducting research in the African or Malawian context, we should not be focused on importing wholesale “what-works- in-the-west.” Instead, our solutions to our health problems should be shaped by local needs, local understandings, and local values. So, for me, this marriage of two traditions – ethics and community engagement and involvement – helps give insight into how to engage with communities needing care and have them appreciate the health interventions we bring in.
You rightfully stressed the importance of ethical research and cultivating that culture. What key pointers do you have for researchers to promote ethical research and build skills?
First, you must learn what the fundamental ethical principles of research are, and once you know them, you must be purposeful in applying those principles. For example, I explain to students that ethics is a crucial discipline to understand and practice regardless of the global health pathway they choose.
To expand a bit, there are fundamental ways to treat human beings. These fundamentals are born from the idea that every human being is worthy of respect and dignity. If you have that foundation, you know and understand why it is so important for researchers to apply the principles of autonomy, beneficence, and justice. So, I always emphasize laying the following foundation: we have inalienable rights and inherent worth as human beings. And if you recognize and appreciate your value as an individual, you can ask, “would I want this done to me?”
Secondly, I would advise patience to students who are contemplating going into global health research, scholarship, and academia. Research work and research outputs can bring recognition and prestige, and often, there is this increasing need to rush to the accolades, to funding, credit, and promotion. But it is important to practice patience and recognize that all researchers started at the bottom. Students need to appreciate taking on tough data transcription, analysis, and writing jobs. With those laborious tasks, you position yourself better to become that good global health researcher and the principal investigator you want to be.
As you mentioned, there can be challenges and strengths in the status quo of how research is conducted. So, in the context of Malawi, can you elaborate on some strengths and challenges of global/public health research?
The strength of doing global and public health research in Malawi is that we have an excellent opportunity to define new ways of improving health. This is a great opportunity, particularly for resource-constrained countries like Malawi, where health systems are weak, infrastructure is inadequate and financial and human resources are scarce. So, my present involvement in implementation research that looks at the acceptability and feasibility of introducing and implementing efficacious treatments that are cost-effective and relatively easy to scale up is an exciting research space to work in because I think that is where the magic happens in public health research. More specifically, when you have a feasible and acceptable intervention and determine that it is cost-effective to scale up, you are, therefore, at the cusp of addressing a significant health need. So, I think that is where the strength lies in global health research within Malawi.
So, if we were to consider the structures that fund and govern research, such as the government of Malawi, can you describe their role and understanding of public health research?
In Malawi, there generally is a close collaboration between researchers and the government bodies such as the Ministry of Health. Technical Working Groups (TWGs) have been established, such as the Reproductive Health Directorate or the National Malaria Control Program. The establishment of these TWGs is where researchers find opportunities to engage with government officials and representatives to present current evidence to support the change in treatment guidelines. So, we have a conducive environment that considers our research work and roles.
However, one of the challenges we have as a low-income country is that we don’t have enough resources to drive our research agenda. We rely a lot on donor funding to implement health programs and for research that generates evidence for policy.
In your opinion and based on your experience, how can global health research do better in Malawi?
There is a current buzzword or phrase that research proposals require us to talk about: “co-creation of knowledge.” It is an important concept, but to be impactful with our research work and agenda to improve people’s lives, we need to be authentic in our approach to the idea of co-creating knowledge. I do not want to sound too cynical; however, when we write grants or design research, I feel that we don’t genuinely engage and collaborate with grassroots and local stakeholders to develop our research proposals. We tend to skip this part. I think the co-creation of knowledge needs to be deliberate and needs to start before generating a research proposal to gain funding for a project. I say this because the co-creation of knowledge would improve the uptake of our interventions and facilitate the knowledge translation pathway, where the aim is to move the best evidence into policy and practice. It would then result in better health processes and outcomes. Essentially, we need to work deliberately and thoughtfully to engage with local communities to help shape research ideas and engage with health policymakers at the beginning to understand Malawi’s health research needs. Explicitly focusing on policymakers, I know that most global health research wants to have an impact - to improve policies, processes, and practice. We also know that engagement with policymakers can be laborious and is a continuous process, but if you don’t co-opt them early, it will be hard for them to accept the results. If policymakers are aware of the research idea and agenda early in proposal development and why this research is essential, it is easier to engage policymakers when you reach a stage where you have evidence strong enough to push for policy change.
In essence, if we can purposefully conduct our research engagement and research practices, it will demonstrate meaningful collaboration – and help ensure that our research is not just archived in journal articles and stored in the ivory towers of academia.
As you said, co-creation of knowledge is essential to bring in voices that matter, to build equity and reach. Now, as global health looks to improve through movements such as decolonizing global health, what specific improvements should researchers, funders, and institutes make?
I want to say these are my reflections on how to improve research and collaborations in global health.
There is a need to make more room for women to break barriers. This year’s (2022) International Women’s Day theme is “break the bias,” or as they say “#breakthebias.” As I situate this concept in the health space, I observe that many women continue to play second fiddle to men in global health research collaborations. As a mid-career level woman, I have had to contend with this challenge in the workplace. I have seen men get to be the principal investigators on huge international collaborative grants. Women are often placed as co-investigators, where women often do most of the heavy lifting. So, that is number one; help women break barriers to break the bias and create an equitable playing field.
Secondly, I also think we need to make room for more people of color. It is perhaps as essential as decolonizing your workplace, specifically in my local (Malawian) context of global health research. I am fortunate enough to work in a Malawian public institution, but I am also an observer. In my observations, I have noted that there are research institutions in Malawi - established from funding from the West. These institutions tend to place people from the West to occupy leadership positions and define and drive the research agenda.
When I reflect on this situation, it is almost as if the “native” – the Malawian – is incapable of leading research institutions – which is untrue. Don’t get me wrong. I am not trying to advance an agenda where women or people of color should get opportunities based on tokenism or to tick a box. I believe in merit – and I know that there are a lot of women and people of color who are passionate about improving lives. They are just as productive and hardworking. So, if I were to make any recommendations, I think there is space to genuinely recognize women and people of color and reward these efforts. It would be a significant step towards decolonizing the workplace and establishing an equitable global health research space and field, particularly as a desire to strengthen the capacity of research institutions and researchers from the so-called “Global South” to conduct locally but globally relevant research.
Lucinda Manda Taylor Tweets at @TaylorsTrinket
About the Author(s):
This is a collective effort of the McGill Global Health Perspectives Team. Mariane Saroufim and Shashika Bandara led the interviewing and the writing for this conversation with Lucinda Manda Taylor.