Meet the 2014-15 Pillars of PRIM&R Award Winner: Francis Kombe

We are pleased to introduce you to the 2014-15 Pillars of PRIM&R Award recipient, Francis Kazungu Kombe. Francis currently serves as a senior community facilitator in charge of training at the Kenya Medical Research Institute/Wellcome Trust Research Programme (KWTRP). Over the next year, he will be using his award for a project that explores strengthening fieldworkers’ capacity to address practical and ethical challenges in international research settings. Read on to learn more about Francis’ background and his project.
At the heart of my Pillars of PRIM&R project are fieldworkers—the front line staff who engage with prospective or actual study participants to collect data or seek consent. Fieldworkers play a vital role in maintaining a strong link between research institutions and the communities they serve.
A growing number of publications highlight the ethical dilemmas associated with fieldworkers’ involvement in studies, including the potential for them to exploit community trust in order to meet recruitment quotas, the challenges they face in maintaining privacy and confidentiality in the community, and the possibility of being exploited through unfair employment practices.1 Fieldworkers are often residents within the community in which they are employed, and their insider knowledge about the community’s socio-cultural, geographic, and leadership structures can help inform sensitivities around research implementation. However, fieldworkers can experience tension between professional expectations to adhere to ethical guidelines in the conduct of research, and the need to remain responsive and sensitive to ethical issues raised by members of their community. At worst, this tension can undermine data quality and, ultimately, the ethical standards of the research.
Support and training of fieldworkers to address complex ethical questions is so crucial to their work, but it varies between institutions. As well, standard curriculum for training fieldworkers is not available, making it difficult to compare the quality of training that fieldworkers receive.
As a former fieldworker, I have experienced firsthand the struggle to get already willing community members to understand the most basic concepts of research before getting them to consent to community-based and clinical research studies. In these communities, therapeutic misconception is common, while the concept of research remains alien. It is through this unique experience that I developed a passion for research ethics and capacity building, a skill-mix that I use to empower the community and staff, and enhance their understanding about research. This is what is at the core of my current work, which seeks to understand the impact of different pedagogies, support structures, and trainings in strengthening the capacity of field workers to address the moral and ethical dilemmas they face in their daily activities.
Throughout the next year, and with the help of my Pillars of PRIM&R award, I plan to explore ways in which fieldworkers at international health research institutions in Sub-Saharan Africa can be effectively supported to handle practical and ethical challenges. Specifically, I plan to:

  • Map out current practices in relation to training, support, and performance management of fieldworkers in the region
  • Conduct telephone surveys of fieldworkers and fieldworker managers in an effort to compare experiences and lessons learned in supporting fieldworkers
  • Convene a group of fieldworkers’ managers and supervisors for a consultative workshop where participants will discuss standard approaches that could be developed to strengthen support of fieldworkers in research activities

Long-term, I hope that the outcomes of this project will feed into ongoing work at research institutions across the region, informing appropriate and consistent support systems for fieldworkers. I also hope to develop a generic approach and broad curriculum for fieldworker capacity building. I look forward to sharing my experiences and outcomes with you, and thank PRIM&R for their support through their Pillars of PRIM&R award.
The Pillars of PRIM&R Award recognizes professionals whose scholarship in the field of human subject protections and/or animal care and use reflects PRIM&R’s mission and core values, and who demonstrate exceptional potential for leadership in the field of research ethics. To learn more about the Pillars of PRIM&R, please visit our website.
1. S. Molyneux, D. Kamuya, P.A. Madiega, T. Chantler, V. Angwenyi & P.W. Geissler. Field workers at the interface. Dev World Bioeth 2013; 13: ii-iv, D.M. Kamuya, S.J. Theobald, P.K. Munywoki, D. Koech, W.P. Geissler & S.C. Molyneux. Evolving friendships and shifting ethical dilemmas: fieldworkers’ experiences in a short term community based study in Kenya. Dev World Bioeth 2013; 13: 1-9.