 Ieithi. Llyfridog, Jai iddech chi rydych i'r ddweud y ddwyg mewn syni, o'r hyn o'r holl gwych silnig o'r group i'r systeilau ac yn ei siŵr. Mae'r gwaith o gwiornol ddefnydd yn gweithio fel sylfaenol ac mae'n gweithio i ffroedd y bydd ymddangos gyrfa siŵr yn Oxford, ac yn baitgadon ni, fel gennyddi o ymgyrchynod yn holl gwych i'r gydag yr oedd o'r cyfreithoedd cyrrydannych clywbwynt arddangos o'r LMI. i'r hiad, os yw mwynwys i wych, ydych chi'n dod yn eich hynny creu gwahau i eich sylwed gyda'r systym ni, ac yn ei wneud gyfawr, gyda'i'r pom i yw yn gallu rhyngwyl. Felly yma mae'r gwertheg freedomiaeth o bears i'w gestion i'w rhann Modern's i'w'r cyfrifoedd o'r cyfrifoedd o'r profiad o dda, ac rydyn ni'n ddweud, chi'n gwertheg, ystod o'r cyfrifoedd, cerdd ychydig i'r pywyddoedd, ac yn y tuall hwn yn gyflawn. Rydyn ni'n gweithio'r rhaglennu yn hollu'r unigol, yn dweudu'r adrwysu, yn gweithio'r ddeudau, yn economiaeth, yn sylfaenol, yn gyflawni'r dŵr, ac yn gyflawni'r hollu'r dŵr. A'r ysgrifennu ymdilych yn ymddill, yn ymddill ac yn amlwyr o Hollu ac Francis, gyda'r fanfasig amser o'r dŵr. A'r ddu, yn ystod, byddwn ni'n gyflawni'r dŵr, ydy'r cwmwysigau syddiad yn cael ei gwirio fany o fynd yn cyhoeddiad Cymru, ond er mwyn ambniad lle mae'r cwmwysigai ar gyfer y cyfosedigau, ond ond bysyn gyda'r cyffredin yn coor o bwysigiaeth rhan o'r cyffredin, ond y byddw i ymddangos unig, yr ysbyrydd yn cyfrifol ymwysig, ond ti'n gydag ymddangos ym mwyn cyfrifio'r cyffredin ac'r cydymeth sydd i'r cyffredin i fynd yn cael ei gyrdd. Ond mae gennych, ac mae gennym, oherwydd o mynd i ddiagnostics a gweithio, maen nhw i'Mtall unrhyw expreziad, sy'n meddwl iawn, sy'n ei fawr ifanc a'r fawr cymaint oherwydd rydw i'n amser i'n gweld rwylo boedol nhw i'r unrhyw sydd. Rydw i'n fawr o'r number hwn yn ddiwedd, chi'n rhaid o'r ymddangos i wneud a'r lywodraeth i'r cyframe ysgolfaeth a phatio. Felly, mae bod yr hyffordd meddwl ysgolfa phawr wedi cyffredig hyffordd yn fawr fawr eich gweithio, i fod i siaradw'r gwaith yn gyllidebolencingи i gweithio, ond mawr yma, a'r rhai trafodau yn gorfa, a'r rhai adroddau, chonodau, hyd yn ei ddefnyddio'r gwaith—y'r rhai gywir i gyflawni'n i gweithio, a'r llunio i gweithio i gweithio, ac nid o gweithio i gweithio, ac swyddi sydd i gwybod i'ch wych o'r cyfrŵel, i gweithio i'r cyfrannu, i gweithio i gweithio i gweithio, a'r cyfrannu a chyfrannu i gweithio i gweithio i gweithio i'r cyfrannu. yr hyn yn ddigonol, yn ei wneud i gael gweithio, rydym ei gweithio i sgwm ysgwm iawn. Roeddwn yn ei wneud o gweithio i nad oed gennu eu syr wythyr yn eistedd i ei wneud i gyrfa leol, a'i gyrwodau ac yn ei fyw ymrithio yn rhan o hynny'n gweithio, ac yn gweithio i ysgwm iawn yn ymddangos ar Fraernau, a'r hynny'n cael ei gyrwodau sgwm iawn yr hynny, ac mae'n gweithio am bobl yw holl gyrion iawn yr hollol sydd wedi chi'w gael'r hollol sydd ar Mennynog, a'r hollol sefydliadau ar gyfer Onig a Mhwyl Hesgedig. Bennyn Giesig yn y dda'r ffondio'n gweithio'n ffordd am hyn, mae'n gweithio'n gweithio. Ac dweud i ddweud arweithio'n gweithio'n gweithio dechrau Gigiol unrhyw ac sy'n golygu cofnirio'n ddweudio i'r gweithio'n gweithio'n gweithio. a'r bydd y dyfodol yn chi'n meddwl i'n meddwl i'r ffordd o'r ffordd o'r dweud, ac o'n meddwl i'n meddal fel ymddangos yw'r fforddol. Oherwydd, nid ydynt yn bwysig fel ydych chi'n mynd yw'r ysgolion ac yn yw'r ysgolion i'r ffordd o'r gweithi'r ysgolion, ond rwy'n meddwl i'w meddwl i'r gwbl ysgolion. Mae'n meddwl i'r meddwl i'r gweithio i'r ffordd o'r gweithi'r ffordd o'r gweithio oedd ydych chi'n mynd i gael gweithio'r ffondi yn ddysgu sydd wedi'i cynnig oedd o'r gweld rhai. Felly, rwy'n gwybod i'n ddweud flwyddyn o'r ddweud y ddiagnostig a technolig. Felly, sebastiaeth yw Fuller yn ei ddweud ddweud rhai ddweud yng Nghymru Cymru wornig i gyflawni gwazio ymddangol, ychydig i'r parwyr o'r ddweud am y dygnostig. In this particular application, his aim is to introduce an implementation point of care test for STI's in Zambia. And he's introducing an approach as an exemplar of a transferable approach that could be used for the implementation of different types of diagnostics in different contexts. And the approach, which will be introduced by the research team in collaboration with the WHO and with colleagues in Zambia yw ymwneud ymwneud ymwneud ymwneud y platdyn nhw, oedd yw'r cyffredinol gyda y cyfnodau sydd wedi cael ei ddweud fawr ddyfodol ychydig o ddifwng, gyda'r cyffredinol i ddefnyddio y ffasig ei ddwylo'r diagnostig. Felly, dyna'r cyfrwyng ymwneud ymwneud yw'r cyffredinol ymwyneud a'r cyfrwyng ymwyneud. Mae'r amser ychydig yw'r cyfrwyng hwn yn ymwyneud ymwneud, gyda'r cyfan crowding hwn yw'r cyfan i gynnig o gondol am y trawyddoedd a hynny o'r cilwyddiadol yn rhan i'r gynhytrdeol ni. Beth yw Lennard Bartyma, ac mae hwn ydw i gofio ychydig o'r Cyfan Roedd Plen o'r pthelymeddiadol yn Gwana. A hyn, mae'r gyfan o rhan i gondol ymwyslo yn ymchwilio ddechrau'r cyfan. ymwyiaid yn y ffocau ddaw i gael hyn o ffordd gyda enthau'r cyfnodau cwelir yma yw'r gwerthfyniad. Y rhan oedd y maen nhw wedi eu cyfnodau ar hwnnw o'r cyfrydiau yn y ddigonol â'r cyfnodau cyfnodau yn y gyrdd yma yn gweithio'r cyffredinol. mae'n rhoi bod y cyfrifolwyrfod yn y ddiddordeb gyda llwyddoedd dyw'r ddwy yma o fy mhwympiad o dod o gwni fy ddim yn rydyllol o gwyrddion ar gyfer hyn gyffredinol i gawr. I'm going to give a few examples of research falling under these three groups of these boxes here now. One of these, Show B, a clinical researcher has submitted and will be interviewed in the next couple of weeks for a Welcome Trust's Early Career award. This is aimed at solving the wicked problem, a problem of many interrelated complex influences on the problem of high mortality among small, vulnerable new-borns Indonesia. Shobi is interested in better understanding the problem and then introducing with collaborators in Indonesia innovative interventions with a focus on shared decision making and family centred care. So this is an example of introducing, implementing, designing and evaluating complex interventions in health systems. So so far I've given some examples of research that's under review and that will hopefully be funded for the rest of the presentation Jake and I are going to just give you some illustrations of research that's recently received funding. One of these I'm delighted to say is an NIHR professorship and this is work that I've been funded to lead looking at moral distress amongst frontline research staff. Moral distress is our situations where people know what they ought to do in a situation but the circumstances don't allow them to to do what they ought to do and moral distress can have a whole range of symptoms and implications for the people who are experiencing it and it's something that's gained a lot more attention since COVID-19 in the NHS in UK but the kind of situations that lead to it are everyday experiences in many LMICs and the idea with this grant is to work out how this might be minimized, how it might be managed and this is important because it has implications for individuals, it's bad for science and it's bad for health system delivery as well. So this is work in collaboration with Kenya but also with the WHO and many other collaborators from different contexts at the heart of it is an international set of case studies which expose frontline staff to different types potentially of moral distress. So I'll be under I'll be keen to characterize this and then to look at through these case studies how transferable that learning is across many other LMICs with the overall goal of developing practical guidance for funders, for institution leads and for team managers and research leads. So I hope that gives a flavour of some of the work so far and I'm going to hand over to Jake who's going to talk about the rest of our work. Cheers Sassi, more on everyone. I'm going to talk to you about climate change and healthcare infrastructure first which is an area that I've been really keen to develop for quite a long time but recently got the opportunity to do it. Yeah this is already mentioned you might have otherwise heard about it too because I've been telling everyone about it but yeah this is a novel extreme weather risk insurance system for Kenya or new risk as we call it I don't know if we do prizes for acronyms but I want one if that's the case and it's led by myself and my colleague Ben Soffa in who's based in Kenya. Our focus is on preparing Kenya's health system, its counties, its communities and its patients for extreme weather. You've probably seen on any given week extreme weather events happening around the world but of course when they interact with poorer communities more vulnerable communities we get very very large disasters North Africa so on recently but Kenya gets them quite regularly droughts floods mudslides and this work is targeting that area. The funder is the NIHR and it's a collaboration with Kenry Welcome and four county governments who really do a lot of the decision making in Kenya and also St Andrews. They are yeah it's also worth saying this is three million pounds over four years beginning in January. Just to tell you a little bit about how we're approaching this because I think it does in some way speak to some of the work that we do in the health systems collaborative. The first layer of this, the first layers of this in fact are kind of GIS layers so we have a climate analysis which we can see spatially and they've got very accurate lately they can get down to one kilometer resolution and that's highly relevant if you want to look at the extreme weather effects that you'll see in each given health facility in Kenya. Now luckily previous work of Kenry Welcome shows very accurately where different health facilities are in Kenya and so we can see the climate, the extreme weather effects that we'll see in each given facility and then we also have some data on population and which populations are served by which one of these facilities and we also know how vulnerable they are so that's pre-existing indexes of their vulnerability, their economic ability, their access to education, clean water all of these things, the social determinants of health as well as access to healthcare and then finally we'll probably adjust a new WHO survey which is attempting to look at how prepared facilities are but it's the one that they've developed is this kind of internal checklist but we want to make something up with a bit more rigor in it so we can see how how affected these facilities will be and then finally a lot of the work that we do is oriented towards the users of health systems towards patients in the communities that hospitals serve and that's very much the case here as well. We want to take all of these different layers and present them back to communities and say what do you want to do about this because the truth is there's been a long and very failed history of people who look like me coming to bits of Africa and telling them what they ought to do in certain certain kinds of emergency situations so instead we want to go there and say you know how you had that flood in 2018 and it lasted like 10 days and it was terrible well what if it lasted 20 days what would you do how would you prepare and help them to build local plans? This is really important because yeah the communities have already told us some things that really changed the shape of this whole project so I can't emphasize our work with communities enough and then finally the bit that's in the the fancy acronym is the risk insurance sites we want to package this up and see whether or not we can ensure the health system to stay open during periods of extreme weather. This is a bit of a reach it's almost like a stretch goal in kind of you know entrepreneurship terms or something but the the the the truth is that well the fallback is that each one of these components speaks you know develops its own useful outputs and so this they stack together to allow us to address this larger question about whether or not insurance would work. So that's that's yeah that's climate but also just more broadly in health systems resilience and responsiveness are related and very complementary project is led by Mike but also with collaborators in Macarell and Vitz and yeah that's a large welcome trust discovery award that's five million I think over four years four years and this this work is broad but looking at that first uh layer of hospital treatment which traditionally has been a little bit underrated a little bit underloved by a lot of global health emphasis we put a lot of emphasis on primary healthcare because that's cheaper and it's closer and you know the health economists like it but we've perhaps looked past the important role of first line hospitals in both in providing services themselves which are not available in the primary healthcare setting but also in supporting that network of of lower facilities too. We had a meeting recently in Oxford this isn't all the health systems collaborative there there's some other people in it but there are a lot that is a lot of the faces that are in our group and a lot of the people that are involved in this it's really big international collaboration it's a very large project and should keep Mike and lots of others busy for for the foreseeable future. Again just thinking about the way that this has been dealt with so far again this is the map that I mentioned before that came up and put together where you can really see facilities around Africa and it's super useful to be able to to see them spatially that way but I suppose this this project is more often looking at those ones that are a little bit farther away a bit less dense those little dots that are kind of on their own and in in that way we start to see a whole different set of issues that affect those those hospitals and most often in the way that they've been dealt with so far it's been in terms of the certain levels of de jure services they should be able to offer so some people get together in in Geneva or somewhere similar and they say you know a hospital like this ought to have this this and this but of course on the ground that's not necessarily what they have and they perhaps look past their their the the role that they have in providing other services and maintaining health in the region more more more broadly strategic investment is needed in this and that will be an element of the work that's looked at but importantly for Mike and a lot of the team members we're really focused on HRH human resources for health a lot of this work that we would like to do a lot of the the the remaining goals and global health that the stuff that we want to focus on it's always dependent on people doing it on the ground and so there's always been a big focus in our group on HRH in developing that for that really came across in in in our project recently and again this is speaks to the how related these two projects are we went to tell them about this this you know this amazing climate science project that we were going to do we pulled together some community members to talk about it we said we're going to fix your local hospital we're going to put solar panels on it we're going to provide you know help help provide water for it would that be useful to you and they said no we don't want you to do that they're useless they don't show up for work and if you look a little further staff aren't paid you know that they're regularly paid it's really difficult to get to that facility and so imagine we did all that work to make that facility resilient but then it doesn't open because staff don't want to work there and that's something that Mike's going to really look at and this group's going to look at how do you support care even in these hardship areas how do you convince young doctors to go to really distant places and work under a tin roof in 45 degree temperatures not easy i'm sure and then next you're not reading this wrong we are now doing some work in the NHS thanks to Atacrit so this is a exciting new work something else that you know it's been a recurrent theme in in our group is around task shifting and i don't know if you all know about the role of physician associates in the UK but they're like the other roles that have preceded them in task shifting they've been introduced somewhat quietly and then grown rapidly and that looks to be happening to physician associates so a thousand new physician associates graduating every year and they're working in NHS hospitals sometimes much more in some areas than in others as far as i understand but little is known about their roles and the scope of their work so this exciting new work will be led by Atacrit in both in in Kenya and in the UK this is quite practical work there's some outputs for this that should really help you know people on the ground and it should lead to better data systems and tools which will you know allocate and plan for these PAs much more effectively it should help with recruitment retention and role satisfaction this is a real problem like do they become junior doctors at some stage once they're really experienced what's the top end of a PA look like what does their future career look like so just stepping into that problem but then also trying to develop some short videos to explain this and share it and sharing learning across across the different trust that we work within this project a final one from our group is Shobie i don't know if she's online Shobie are you here somewhere no good i can be really kind to her then she's saving her plushes but Shobie's amazing the Shobie did you know pediatric surgery and worked in various places around the world she's really passionate about child health and i think from her perspective so many of the things that she was dealing with were were avoidable or by the time that she saw them in the clinic that they were problems that were manifested much earlier in in kids lives and so she became interested in diet and general health and welfare of children and this led her to do some work which was quite you know it wasn't like there was a big call for loads of money in this she just did it so she's got my eternal respect for that and yeah she's been looking at food poverty in Oxford which is a shameful phrase there's even a worse one there's malnutrition in Oxford which we can talk about too but yeah she does this amazing work in pulling together a whole network of front line food bank workers and support people who work around schools people who volunteer their time and weren't you know had put themselves down to part-time work so that they could run food banks and do other things in the communities they work from she invited them all to Green Templeton and kind of united them and has since then been to the you know houses of parliament and pushed this at very very senior levels and has had all kinds of impressive um effects as a result of this so yeah a little uh cropster Shobie um that's it for now uh where we're a broad group this isn't really covering a lot of the areas that we we have been working in for example doing a um a work in Vietnam around intensive care that's closing now but um has been super interesting a lot of work and supporting different technologies different ideas for for hospitals and health systems and that implementation science method is um something which is pretty common across our group and so if you've got new technologies or new systems or new kind of clinical ideas that you'd want to bring into practice it might be worth um giving us uh giving us an email and connecting as we'd happily talk through your project and your ideas