Sassy Molyneux
Biographic Data
| ID | 1259298 |
|---|---|
| NAME | Sassy Molyneux |
| GIVEN NAMES | Sassy |
| FAMILY NAME | Molyneux |
| SIGNATURE | MOLYNEUX S |
| AFFILIATIONS | Kenya Medical Research Institute |
| ORCID | 0000-0001-9522-416X |
| VERIFIED | Yes |
| TOTAL WORKS | 90 |
| TOTAL CITATIONS | 225 |
| AUTHOR COUNT | 90 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1999 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 8 |
The ‘Public’ in Public Involvement
Public involvement, or patient and public involvement and engagement (PPIE), is widely embedded in health and care research and is valued for its moral, ethical, and methodological contributions. However, its application in workforce research raises important questions about the voices that might be missing from the 'public' when research's primary object of inquiry is healthcare staff, organisations, and systems, rather than patients and service…
Advancing health policy and systems research and analysis
Health systems are at a crossroads. Globally, health systems are straining under the weight of responding to persistent and emergent challenges. Uncertainties in health financing, service delivery, new technologies and disease burdens are hindering health systems abilities to maximize collective and scaled action to achieve health equity and social justice. In March 2025, a group of health policy and systems experts were convened by an organizati…
‘We cannot just keep it in our palm’
This study investigates the development and implementation of Liberia’s policy to integrate the case management of neglected tropical diseases (NTDs) into the broader health system. The policy responded to persistent challenges of inequitable access and fragmented services, as outlined in Liberia’s 2016 national strategic plan for integrated NTD case management. Using a qualitative case study approach, the research draws on stakeholder perspectiv…
Beyond survival
Evidence is lacking on how birth complications affect postpartum wellbeing in low-resource settings, and how to support post-complication recovery in these settings. To address this gap, we conducted a mixed methods study at three county referral hospitals in Kenya to explore the impact of birth complications on mothers’ and families’ postpartum experiences and wellbeing. We used a convergent parallel study design, including a quantitative cross-…
Applying a multi-layered, mixed methods approach to evaluate technology and workforce interventions in Kenyan neonatal units
Understanding how to best implement healthcare innovations in resource-poor settings requires complex interventions and evaluations, often straining existing healthcare systems. We aimed to address this challenge in our Kenyan neonatal intervention research by deeply integrating stakeholder engagement, applying layered methodologies, and leveraging our research team's diverse expertise. This paper reports on the design and implementation of a res…
After neonatal care, what next? A qualitative study of mothers’ post-discharge experiences after premature birth in Kenya
To support transitions home, strengthening the timing and adequacy of information provided to mothers at discharge from the neonatal unit in low-income settings in SSA and Asia - such as Kenya-is essential. Introducing strategies to build and assess mothers' competencies with skills such as breastfeeding and identifying signs of deterioration before discharge could support their smooth transition home. Targeted engagement interventions at the com…
Emotional dimensions of nurses’ daily work in newborn units in Kenya
We draw on our data, the wider literature, and nurses' recommendations to reflect on the interplay between emotional well-being and ethical nursing practice, and to make suggestions for ongoing health system strengthening efforts
Newborn technology use in low-resource settings
Neonatal deaths remain a critical public health challenge in many low- and middle-income countries (LMICs), including Kenya. Affordable technologies such as Comprehensive Positive Airway Pressure (CPAP) and phototherapy machines can reduce neonatal mortality and are used in these settings. However, their introduction and implementation in resource-constrained health system contexts are poorly understood. This study investigates how communication …
Community engagement and the centrality of ‘working relationships’ in health research
Community engagement (CE) is widely accepted as a critical aspect of health research because of its potential to make research more ethical, relevant and well implemented. Although CE activities linked to international health research involving Low and Middle Income Countries (LMICs; see author note) have proliferated and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood …
Understanding health system responsiveness to public feedback at the sub-national level
Responsiveness is one of four health system goals alongside health outcomes, equity in financing and efficiency. Many studies examining responsiveness report a composite satisfaction index or proportions of patients describing satisfaction with dimensions of responsiveness. Consequently, responsiveness is predominantly based on collation of service users’ feedback and could be termed service responsiveness . We conceptualise system responsiveness…
Power and positionality in the practice of health system responsiveness at sub-national level
Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to…
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems
We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in pr…
Respecting relational agency in the context of vulnerability
Despite advances in theory, often driven by feminist ethicists, research ethics struggles in practice to adequately account for and respond to the agency and autonomy of people considered vulnerable in the research context. We argue that shifts within feminist research ethics scholarship to better characterise and respond to autonomy and agency can be bolstered by further grounding in discourses from the social sciences, in work that confirms the…
How do foundation year and internship experience shape doctors’ career intentions and decisions? A meta-ethnography
PURPOSE: Foundation years or internships are an important period for junior doctors to apply their knowledge and gain clinical competency. Experiences gained during the foundation years or internships are likely to inform newly qualified doctors' opinions about how they want to continue their career. We aimed to understand how medical doctors' internship experiences influence their career intention/decision. METHODS: We conducted qualitative evid…
Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya
Public Finance Management (PFM) practices influence the attainment of health system goals. PFM processes are implemented within the budget cycle which entails the formulation, execution, and monitoring of government budgets. Budget monitoring and accountability actors, structures, and processes are important in improving the efficiency of health systems. This study examined how the budget monitoring and accountability processes influence the effi…
The hidden emotional labour behind ensuring the social value of research
Health policy and systems research (HPSR) is a multi-disciplinary, largely applied field of research aimed at understanding and strengthening the performance of health systems, often with an emphasis on power, policy and equity. The value of embedded and participatory HPSR specifically in facilitating the collection of rich data that is relevant to addressing real-world challenges is increasingly recognised. However, the potential contributions a…
The influence of internship training experience on Kenyan and Ugandan doctors’ career intentions and decisions
BACKGROUND: Medical internship is a key period for doctors' individual career planning and also a transition period for the broader labour market. OBJECTIVES: We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda. METHODS: We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors' internship exp…
How does power shape district health management team responsiveness to public feedback in low- and middle-income countries
Responsiveness is a core element of World Health Organization’s health system framework, considered important for ensuring inclusive and accountable health systems. System-wide responsiveness requires system-wide action, and district health management teams (DHMTs) play critical governance roles in many health systems. However, there is little evidence on how DHMTs enhance health system responsiveness. We conducted this interpretive literature re…
A framework for managing health research capacity strengthening consortia
There has been a steady increase in health research capacity strengthening (HRCS) consortia and programmes. However, their structures and management practices and the effect on the capacity strengthening outcomes have been underexamined. We conducted a case study involving three HRCS consortia where we critically examined the consortia’s decision-making processes, strategies for resolving management tensions and the potential implications for con…
Model for developing context-sensitive responses to vulnerability in research
Health research in low-resource settings often involves individuals and populations defined as ‘vulnerable’. There is growing attention in the literature to the ethical dilemmas that frontline research staff face while conducting such research. However, there is little documented as to how research staff might support one another in identifying and handling these dilemmas in different contexts. Over the course of conducting empirical ethics resea…
Towards an appropriate ethics framework for Health and Demographic Surveillance Systems (HDSS)
INTRODUCTION: Health and Demographic Surveillance Systems (HDSS) collect data on births, deaths and migration from relatively small, geographically defined populations primarily in Africa and Asia. HDSS occupy a grey area between research, healthcare and public health practice and it is unclear how ethics guidance that rely on a research-practice distinction apply to HDSS. This topic has received little attention in the literature. In this paper,…
Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya
Efficiency gains is a potential strategy to expand Kenya’s fiscal space for health. We explored health sector stakeholders’ understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stake…
Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh
A complex web of gender related influences at health systems/services and household/community levels have important implications for young children's recovery post-discharge. Immediate interventions with potential for positive impact include awareness-raising among all stakeholders - including male family members - on how gender influences child health and recovery, and how to reduce adverse consequences of gender-based discrimination. Specific i…
Applying a gender lens to understand pathways through care for acutely ill young children in Kenyan urban informal settlements
Women in urban low-income settings are disproportionately impacted by acute child illness and the related treatment-seeking and recovery process. The range of interventions needed to support mothers as they navigate their way through children's illnesses and recovery include: deliberate engagement of men in child health to counteract the dominant perception of child health and care as a 'female-domain'; targeted economic strategies such as cash t…
An innovative leadership development initiative to support building everyday resilience in health systems
Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya…
Trust and informed consent
Ethics and the ethnography of medical research in Africa
The ethics of medical research have grown as an area of expertise and debate in recent years, with two broad approaches emerging in relation to transnational research: (1) the refinement of guidelines and strengthening of review, processes primarily to protect the right of individual research participants and strengthen interpersonal relations at the micro-level; and (2) considering more centrally, as crucial ethical concerns, the wider interests…
Taking social relationships seriously
Individual informed consent is a key ethical obligation for clinical studies, but empirical studies show that key requirements are often not met. Common recommendations to strengthen consent in low income settings include seeking permission from community members through existing structures before approaching individuals, considering informed consent as a process rather than a single event, and assessing participant understanding using questionna…
Understanding of informed consent in a low-income setting
Beginning community engagement at a busy biomedical research programme
Recent debates have described theoretical approaches to identifying situations where this is most critical and potential mechanisms to achieve it. However, there is relatively little published experience of community engagement in practice. A major component of the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme is centred on Kilifi District General Hospital and surrounding community of 240,000 local residents. Document…
All her children are born that way’
Mothers of children with SCD were particularly vulnerable to stigmatisation within families, with underlying structural influences that suggest these findings may apply to other similar settings in Africa, and have relevance for other genetic conditions. The potential, nature and form of stigmatisation point to the role of effective communication and SCD management in addressing for blame and discriminative effects of having a child with SCD. The…
Promoting the social value of research in Kenya
What role can health policy and systems research play in supporting responses to Covid-19 that strengthen socially just health systems
To say that we live in turbulent times is a massive understatement. COVID-19 ruthlessly exposes the fault lines of health services and systems, and the responses put in place to prevent its spread or mitigate its effects may affect people more than the actual infection. The outbreak in Wuhan quickly grew to a pandemic that has affected countries and regions all over the world in many, and as of yet, little understood ways. This is a global infect…
Priority setting for health in the context of devolution in Kenya
Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need …
Hospitals as complex adaptive systems
There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of…
Involving Research Stakeholders in Developing Policy on Sharing Public Health Research Data in Kenya
Increased global sharing of public health research data has potential to advance scientific progress but may present challenges to the interests of research stakeholders, particularly in low-to-middle income countries. Policies for data sharing should be responsive to public views, but there is little evidence of the systematic study of these from low-income countries. This qualitative study explored views on fair data-sharing processes among 60 …
The role of community-based organizations in household ability to pay for health care in Kilifi District, Kenya
There is growing concern that health policies and programmes may be contributing to disparities in health and wealth between and within households in low-income settings. However, there is disagreement concerning which combination of health and non-health sector interventions might best protect the poor. Potentially promising interventions include those that build on the social resources that have been found to be particularly critical for the po…
Shocks, stress and everyday health system resilience
Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses…
Consent and Community Engagement in Diverse Research Contexts
Consent and community engagement (CE) in health research are two aspects of a single concern-that research is carried out in a respectful manner where social value is maximized. There are important overlaps and interdependencies between consent and CE; for example, CE can provide insights into how best to tailor consent to context and can be an important component of consent processes. Engaging communities can also have intrinsic and instrumental…
Managing misaligned paternity findings in research including sickle cell disease screening in Kenya
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems
We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in pr…
Maternal mobility across the rural-urban divide
This paper describes the mobility patterns, rural-urban linkages and household structures for a low-income neighbourhood on the outskirts of Mombasa, Kenya's main port, and a rural settlement 60 kilometres away. Drawing on interviews with a sample of mothers resident in each location, it documents their perceptions of the advantages and disadvantages of rural and urban life, and shows the continuous interchange between the two areas. It also high…
Implementation of patient charges at primary care facilities in Kenya
With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect. In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups. We present data on user fee implementation, revenue and expenditure from a nationally representative survey of Keny…
Estimating inequalities in ownership of insecticide treated nets
Research on the impact of socio-economic status (SES) on access to health care services and on health status is important for allocating resources and designing pro-poor policies. Socio-economic differences are increasingly assessed using asset indices as proxy measures for SES. For example, several studies use asset indices to estimate inequities in ownership and use of insecticide treated nets as a way of monitoring progress towards meeting the…
The Effect of Delivery Mechanisms on the Uptake of Bed Net Re-Impregnation in Kilifi District, Kenya
The results of recently completed trials in Africa of insecticide-treated bed nets (ITBN) offer new possibilities for malaria control. These experimental trials aimed for high ITBN coverage combined with high re-treatment rates. Whilst necessary to understand protective efficacy, the approaches used to deliver the intervention provide few indications of what coverage of net re-treatment would be under operational conditions. Varied delivery and f…
The importance of gender analysis in research for health systems strengthening
The Effect of Delivery Mechanisms on the Uptake of Bed Net Re-Impregnation in Kilifi District, Kenya
The results of recently completed trials in Africa of insecticide-treated bed nets (ITBN) offer new possibilities for malaria control. These experimental trials aimed for high ITBN coverage combined with high re-treatment rates. Whilst necessary to understand protective efficacy, the approaches used to deliver the intervention provide few indications of what coverage of net re-treatment would be under operational conditions. Varied delivery and f…
Taxation in Britain since 1660 Roy Douglas
Journal Article Taxation in Britain since 1660 Roy Douglas Get access Catherine Molyneux Catherine Molyneux St Hilda's College, Oxford Search for other works by this author on: Oxford Academic Google Scholar The English Historical Review, Volume 115, Issue 464, November 2000, Page 1313, https://doi.org/10.1093/ehr/115.464.1313 Published: 01 November 2000
Urban health in developing countries
Intra-Household Relations and Treatment Decision-Making for Childhood Illness
This study, conducted on the Kenyan coast, assesses the effect of intra-household relations on maternal treatment-seeking. Rural and urban Mijikenda mothers’ responses to childhood fevers in the last 2 weeks ( n =317), and to childhood convulsions in the previous year ( n =43), were documented through survey work. The intra-household relations and decision-making dynamics surrounding maternal responses were explored through in-depth individual an…
Maternal mobility across the rural-urban divide
This paper describes the mobility patterns, rural-urban linkages and household structures for a low-income neighbourhood on the outskirts of Mombasa, Kenya’s main port, and a rural settlement 60 kilometres away. Drawing on interviews with a sample of mothers resident in each location, it documents their perceptions of the advantages and disadvantages of rural and urban life, and shows the continuous interchange between the two areas. It also high…
Maternal mobility across the rural-urban divide
This paper describes the mobility patterns, rural-urban linkages and household structures for a low-income neighbourhood on the outskirts of Mombasa, Kenya's main port, and a rural settlement 60 kilometres away. Drawing on interviews with a sample of mothers resident in each location, it documents their perceptions of the advantages and disadvantages of rural and urban life, and shows the continuous interchange between the two areas. It also high…
Understanding of informed consent in a low-income setting
‘Even if they ask you to stand by a tree all day, you will have to do it (laughter)…!’
Trust and informed consent
The role of community-based organizations in household ability to pay for health care in Kilifi District, Kenya
There is growing concern that health policies and programmes may be contributing to disparities in health and wealth between and within households in low-income settings. However, there is disagreement concerning which combination of health and non-health sector interventions might best protect the poor. Potentially promising interventions include those that build on the social resources that have been found to be particularly critical for the po…
Engendering health sector responses to sexual violence and HIV in Kenya
In Kenya many people who have been affected by sexual violence turn to the health sector for clinical treatment and preventive therapies. This interface provides a vital opportunity to impact on the dual epidemics of HIV and sexual violence. Despite this, the uptake of post-rape care services in health facilities is low and health care providers felt ill-prepared to deal with the consequences of sexual violence. A qualitative study was conducted …
Promoting the social value of research in Kenya
Beginning community engagement at a busy biomedical research programme
Recent debates have described theoretical approaches to identifying situations where this is most critical and potential mechanisms to achieve it. However, there is relatively little published experience of community engagement in practice. A major component of the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme is centred on Kilifi District General Hospital and surrounding community of 240,000 local residents. Document…
Ethics and the ethnography of medical research in Africa
The ethics of medical research have grown as an area of expertise and debate in recent years, with two broad approaches emerging in relation to transnational research: (1) the refinement of guidelines and strengthening of review, processes primarily to protect the right of individual research participants and strengthen interpersonal relations at the micro-level; and (2) considering more centrally, as crucial ethical concerns, the wider interests…
Taking social relationships seriously
Individual informed consent is a key ethical obligation for clinical studies, but empirical studies show that key requirements are often not met. Common recommendations to strengthen consent in low income settings include seeking permission from community members through existing structures before approaching individuals, considering informed consent as a process rather than a single event, and assessing participant understanding using questionna…
Reducing user fees for primary health care in Kenya
We conclude that reducing user fees in primary health care in Kenya is a policy on paper that is yet to be implemented fully. We recommend that caution be taken when deciding on how to reduce or abolish user fees and that all potential consequences are carefully considered
Estimating inequalities in ownership of insecticide treated nets
Research on the impact of socio-economic status (SES) on access to health care services and on health status is important for allocating resources and designing pro-poor policies. Socio-economic differences are increasingly assessed using asset indices as proxy measures for SES. For example, several studies use asset indices to estimate inequities in ownership and use of insecticide treated nets as a way of monitoring progress towards meeting the…
Estimating inequalities in ownership of insecticide treated nets
Towards achieving Abuja targets
Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained
Factors influencing implementation of the Ministry of Health-led private medicine retailer programmes on malaria in Kenya
Understanding the context and implementation processes of PMR programmes and the perspectives of key actors are critical to identifying measures to support their effective implementation. Financial barriers underlie many described challenges, with important implications for policies on subsidies in this sector. In spite of barriers to implementation, increased exposure to programme activities promoted trust and improved relationships between PMRs…
Direct facility funding as a response to user fee reduction
There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with health facility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries in…
Dynamics and Constraints of Early Infant Diagnosis of HIV Infection in Rural Kenya
A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolm…
All her children are born that way’
Mothers of children with SCD were particularly vulnerable to stigmatisation within families, with underlying structural influences that suggest these findings may apply to other similar settings in Africa, and have relevance for other genetic conditions. The potential, nature and form of stigmatisation point to the role of effective communication and SCD management in addressing for blame and discriminative effects of having a child with SCD. The…
Analyzing the equity of public primary care provision in Kenya
The paper shows how local area poverty data can be combined with national health facility surveys, providing a tool for policy makers to assess the equity of input and service availability. There was little evidence of inequalities for most inputs and services, with the clear exceptions of electricity and laboratory services. However, efforts are required to improve the availability of key inputs and services across public facilities in all areas…
Community accountability at peripheral health facilities
Public accountability has re-emerged as a top priority for health systems all over the world, and particularly in developing countries where governments have often failed to provide adequate public sector services for their citizens. One approach to strengthening public accountability is through direct involvement of clients, users or the general public in health delivery, here termed 'community accountability'. The potential benefits of communit…
Medicine (64 works) · Political science (61 works) · Public relations (46 works) · Sociology (43 works) · Global Maternal and Child Health (41 works) · Nursing (36 works) · Business (34 works) · Economics (29 works) · Public health (29 works) · Psychology (28 works)