Spotlight on community engagement and involvement (CEI): CEI and the difference it makes

We speak to members of an NIHR funded project researching Stillbirth Prevention and Management in Sub-Saharan Africa and Asia and discuss how CEI contributed to and enriched their project. This episode also showcases the impact of CEI on communities, those with lived experience of stillbirth and on both policy and practice.


If you’ve listened to any of our podcast series on community engagement and involvement (CEI), we'd love to hear what you think!

Share your thoughts with our survey: https://docs.google.com/forms/d/e/1FAIpQLSdzm5ZYyCjF7VhVQs4cidrQJR6ck1z5xdVB5_s_xgiLb1UdEg/viewform


Please note these podcasts were recorded in early 2022. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.

Transcript

Podcast series: Spotlight on community engagement and involvement: Improving global health research and outcomes through engaging with local communities

Episode 5: Community Engagement and Involvement and the difference it makes

SPEAKERS

Carol Bedwell, Saumu Lwembe, Milcah Mwamadi

Saumu Lwembe  00:06

Hello and welcome to another episode of our podcast series on spotlight on community engagement and involvement. My name is Saumu Lwembe, an Assistant Director for patient, public and community involvement and engagement at the National Institute for Health and Care Research. I am joined by Carol Bedwell and her colleague Milcah Mwamadi from Malawi in Africa. In today's episode, we'll be exploring a topic that is of great interest to researchers, funders and policymakers; and that is impact of community engagement and involvement. Our guests today will take us through the difference CEI has made to their work around stillbirth prevention and management. To start us off, let me welcome our guests introduce themselves. Starting with you, Carol, kindly tell our listeners about yourself and the expertise you bring to today's discussion topic?

Carol Bedwell  00:55

Thank you Saumu. My name is Carol Bedwell. I'm a senior lecturer at Liverpool School of Tropical Medicine in Liverpool. I am a midwife and nurse by background and have been working in research for quite a number of years and in global health research for the last 15 years. I'm a co-applicant on our current NIHR Research Unit. And I've worked with midwives in Africa predominantly for the last 15 years. And we've been working on projects around intrapartum care and newborn care, antenatal care, and capacity development where.we've helped midwives to develop their capacity in many of the countries that we work with. The key countries I've been working with are Kenya, Malawi, Tanzania, Uganda, Zambia, and Zimbabwe. And with our new collaboration, we're also working with countries in Asia, which is India and Pakistan. Our research unit, I am the lead for two work streams. I'm also the community engagement and involvement lead, along with Milcah.

Saumu Lwembe  02:03

Thank you Carol. Milcah, welcome you to introduce yourself and tell our listeners about yourself and the expertise you bring to today's discussion topic as well.

Milcah Mwamadi  02:14

Thank you. My name is Milcah Mwamadi, I am an event planner by profession. I have had two stillbirths. I am community engagement and involvement lead, based in Malawi. I have worked for the past three years as community engagement lead in stillbirth research. And now I am leading the research of nine workstreams.

Saumu Lwembe  02:33

Thank you very much Milcah. So, we shall now go into about your research project because I was watching the video earlier on and reading the reports about your project and I find it really interesting actually, and I would urge our listeners to go into the NIHR website and access that video. But could you please tell us more about your research? Any of you can take up that question.

Carol Bedwell  02:58

Thank you Saumu, I'll answer that. We are an NIHR Global Health Research Unit and our work focuses on the prevention and management of stillbirth and neonatal death in Sub Saharan Africa and Asia. We are a midwife led multidisciplinary team, and we work across eight countries in those two continents. To give a little history about how we developed and where we've come from. We've worked for a number of years with the Lugina Africa midwives Research Network, also known as LAMRN which comprises of six countries in Sub Saharan Africa and these are Kenya, Malawi, Tanzania, Uganda, Zambia, and Zimbabwe. And during the course of our work, midwives and clinicians had highlighted to us about the need for stillbirth particularly in their contextual settings in Sub Saharan Africa. So as a result of this, we developed our initial Global Health Research Group with the NIHR on prevention and management of stillbirth in Sub Saharan Africa. And we worked on that over the period from 2017 to 2021. And it was during this research group that we developed an embedded CEI groups into our research. We knew that stillbirth was a particularly sensitive area in these countries, and it was an area that was often hidden and women and families didn't speak about it and neither did communities. And we were aware from our colleagues and also literature in the area that women and families experiencing stillbirth often face stigma and blame within their local communities following the death of their baby. We knew therefore, then, this particularly sensitive area, it will be vital to have input from women who had experienced stillbirth in developing and running the programme over the period of time that we were doing so, and this was to ensure that the research was relevant and acceptable to the local population and reflected their needs and views too. So the CEI groups we developed were actually really invaluable to the success of our research and contributed at all levels, from reviewing protocols and information sheets, advising about approach, introducing us to communities working with us when we're reviewing findings and providing input into dissemination events, both face to face and also through publications. From this work, we then developed our NIHR Research Unit application, expanding our work to include neonatal death, and also countries in Asia, which are India and Pakistan. And this application was really heavily informed by our CEI groups. We consulted with them during the development process of the application and they'd already suggested some areas of research that we would move forward with and we actually have nine workstreams of research within this application. And some of the areas they suggested which we hadn't maybe previously thought about so much was an adolescence experiences of pregnancy. And they were also very keen for us to explore further bereavement care, and also respectful care for women and newborns. And also as part of our development process, and moving forward with CEI,  we wanted to include a CEI member as a co-applicant as well. And this is Milcah who's with us today, and she's joint CEI lead with me for the overall programme.

Saumu Lwembe  06:23

Thank you, Carol, that is really interesting to hear, especially in the elements you've just said around having the community voice if you like, from the first iteration of of the work, being influential in terms of prioritisation on the research areas for your second and current piece of work. That in itself is strong isn't it is quite powerful, because you can already see the impact of the community voices in this. But if I can just take you back a bit in terms of your first iteration of the work, how did you find these community groups and individuals that you got eventually got involved in your research? How did you go about finding them? Increasingly, those are the questions that researchers that are new to this field ask but where do I go to find these communities? How do I go to find these individuals? Can you shed a bit light on that?

Carol Bedwell  07:14

Yes, certainly, to start with, we actually conducted some scoping work with our partners in each of the countries. Because we were although, we'd worked with stakeholders before, we hadn't really worked with CEI groups as such. So what we wanted to do was find out what people's knowledge was, what was already out there, were there any groups that we could tap into, or an expertise that we could use and locally to help develop our CEI groups. And what we found is and for our, for our topic, area, and for our partners, there was very little understanding around CEI itself. And the idea of women having a voice to speak out in the community was very difficult for some people to really understand. Within that area of healthcare, women really didn't have a voice in terms of themselves being sort of patients within that system, or women within that system. So we started out by doing some training with the researchers to start with, so that they understood the role and the position that we were in. And we asked them to identify initially facilitators, and to see if there were any local groups around stillbirth that we could maybe tap into. Unfortunately there really weren't, so our key point was to identify facilitators who had the skills to facilitate a group, essentially, so that they could bring a group together, they could listen to everybody, they could organise group meetings and report back to us, and we could report to them  our findings and our feedback as well. So the first stage is actually identifying the facilitators. And the second stage really was identifying the group members. And we really did this by snowballing, by word of mouth around women who had experienced stillbirth and will be willing to take part in a group. And we did think long and hard about how to go about this, I actually did speak to Involve in the UK about the best way to approach this. Because at the time there was actually not very much guidance around in terms of global health, but there is much more now coming from the NIHR and moving forward. So we gained our participants really by word of mouth and people who wanted to take part. And the good thing really about all the groups across all the countries is these participants, group members stayed with us throughout the whole project, which I think was really good. So our initial meetings were very much around sort of getting to know each other, and gaining trust and Milcah can probably talk more to how those meetings developed. 

Saumu Lwembe  10:00

Yeah, I really will be interested in hearing Milcah’s view as well in terms of even how she found her voice. And you mentioned about her being a co-applicant in your current award. But before before going to Milcah and actually Milcah I also wanted to hear your voice in this. There is obviously cultural nuances. And getting it right from the outset is very important is really key in whether CEI will actually be impactful in your project. And I know you, you say to us that you work in Asia, you work in Africa, and in this, it might be similar geographical region, but actually, the nuances, the cultural differences in subjects that are otherwise taboo, can be really different. So I think as to around how did you navigate those cultural challenges or nuances, did you, for example, find yourself having to go through the men or the husbands in the households, for you to be able to have a conversation with the women or the wives? How did you navigate that? And then Milcah on your end I think I'll really be keen to, to know, how did you get interested to work with Carol in this work? You know, how is that because this is something that people don't talk about. And here you are actually actively involved in that.

Carol Bedwell  11:15

Okay, so the countries were very different, as as you know, that, you know, although they're on the same continent, they are very different in terms of approach in terms of understanding and different contexts and cultures around stillbirth particularly. We, as we say, we did by word of mouth and we didn't really, for this project have any issues around having to go through families as such. And it was we were very much guided by the local partners and the facilitators. And it was they in this iteration that identified people and approached people. And then maybe the discussions took place with families as well for them to take part in the research. So it was very much locally led, because they knew the best people to approach and how to go about it and that was how it was done.

Saumu Lwembe  12:08

Thank you Milcah, I mean Carol. So that's an element of delegating authority, if you like, to our local partners to be able to, you know, make inroads to some of these very important pieces of work. So Milcah we’re keen to hear your voice. How did you get invited to this?

Milcah Mwamadi  12:24

The story is quite interesting. Well, how I got involved is one of my colleagues that I was staying with approached me to tell me that one of the facilities is actually running a research around stillbirth and because she knows my history that I've had stillbirths in the past, and I had a group on Facebook, it was a support group whereby I was leading, helping other women that had stillbirths in coping, after after the ordeal. So she knew of me and approached me and said, Would you be interested to work in this research? I said, Yeah, obviously, I've already been doing something like this. So that's how I got to get involved.

Saumu Lwembe  13:05

Oh, thank you Milcah. And again, that obviously, for our listeners, that's that's an important point to know, if you if you adopt if you like an asset based approach to know that the area of your research you're venturing into is something that there could be some self organisation already happening in the local area and so tapping into those resources is important, and I think become even more significant in terms of bringing efficiencies to your research. So in terms of you getting involved as a co-applicant, how do you find your voice in there? How, how impactful is that in terms of, you know, taking the project forward?

Milcah Mwamadi  13:42

I'm glad that I'm co-applicant. I'm glad that my thoughts are actually taken into context and actually I have a voice that is heard. And a lot of some of the things well, they cannot take everything because of ethics and everything else, but most of the things that I'm able to contribute, are taken on so it's it's really empowering for me to be actually a co-applicant.

Saumu Lwembe  14:06

Great. So obviously that influence element in there is coming through. So back to both of you what were the main challenges you faced in embedding CEI in your project because you obviously have done this really well. But not everything was as glorious as we would want to imagine was it?

Milcah Mwamadi  14:26

Actually it wasn't because CEI was a new concepts to many of the researchers, many of the even our country, Malawi, it was it was new. And it wasn't easy to understand the role of CEI also to understand that CEI are not research participants. So it took a lot of training in this subject to fully grasp it. And another thing is that African women, we are not used to speaking out because of cultural beliefs with some research, especially stillbirth, it's a taboo in our country, you can’t just talk about it openly. So, for actually the initial meetings, we needed space for the group to get to know each other first. I remember the first, the first meeting that we had with the researchers, they had to bring in an icebreaker first where the CEI we talked about a stillbirth experience. And then when we saw the empathy from the research team, it made the CEI to open up more, and build that trust afterwards. That's where we were open enough and we felt that we were able to discuss some sensitive issues around the stillbirth. 

Saumu Lwembe  15:31

Thank you Milcah,that's really good to hear. And in terms of the work, Carol, in the other continents as well, what are the challenges that you faced in embedding CEI for example, in in the projects in Asia, compared to those in Africa, or vice versa? 

Carol Bedwell  15:50

We've actually only just started working in Asia with this new project that started last year. So again, and talking to the country leads, there's probably quite a bit of work to do, again, like we did with our previous project around people understanding what CEI is, understanding the differences in roles,and understanding the benefits it can bring to the programme as well. So at the moment, we're in that stage of developing and training researchers. And, and, and going through the process now of doing identifying CEI leads and groups. So we're still in the early stages in that in those countries. However, we have learnt an awful lot over our previous four years worth of work. We've developed some resources and a handbook and things like that, that are helpful in moving forward. And we develop those resources, also with the CEI leads from each country. So they were co-produced at the end of our research group. So that we would have this going forward to develop new groups, because although we've still got the groups and within our countries in Sub Saharan Africa, because we're running different work streams with different focus, we're needing to develop new new groups, and it's really good to have the expertise we have in the countries and in the local settings to be able to support new CEI facilitators moving forward.

Saumu Lwembe  17:17

No, thank you Carol. So from the both of you a few themes are emerging around this. And it's really around one having that asset based thinking in recognising that there is actually local expertise in the geographical areas you're going into. And tapping into that. Another element is around the delegated authority element, that actually all you need to do just empower your local partners to be able to do the work to have that power and authority to be able to, you know, recruit your community groups for you recruit some of the members and to actually deliver on some of the operational aspects for your community engagement elements in there. And another thing is, we definitely one of those things that are propagating is around the whole element of co-production, because it's important to bring people along with you. And it's essentially when you have those ingredients that you're almost on the pathway, isn't it to actually having something that really make a difference to everyone involved in that. Now talking about the difference, tell us more about what CEI brings to your research award, how is it catalysing your research and I know in your previous conversations you probably have mentioned some of this, but just to reflect it in more detail.

Carol Bedwell  18:37

It’s bought an awful lot to the project. And more than we ever expected at the outset, to be honest with you in terms of both the input into the project, and also how the women have been in the CEI group, CEI members have become empowered over the course of the project as it as it's run itself. And so in terms of things that had happened during the research group, we found that the CEI groups contributed to all levels as I was talking about before. But they also contributed much at a much greater level as well, as I said before than what we were expecting. So they've worked at community level and so at local level, we have got CEI members who now sit on stakeholder groups in each country, so they provide a CEI perspective into those. The CEI groups across all the countries have built relationships with facilities and are now very much an important resource. And Milcah can probably tell you a little bit more about how those groups have worked in country. Because for example, the Malawi group, that Milcah’s involved in held an awareness workshop at their local facility, which is really, you know, really important, really empowering. I want Milcah to talk to some of these really because some of these things are sort of, you know, things that she's really been involved in and can discuss well.

Milcah Mwamadi  20:08

Yeah, so as Carol mentioned that we at local level we the CEI’s we sit in our stakeholder groups in each of our countries, so that that allows us to be part of decision making. And then CEI groups across all countries have built relationships with facilities. In Malawi, we're able to hold a stillbirth awareness workshop for facility staff, where we talked about our needs, and where we can fit in a CEI in their system. Tanzania group were involved in staff training, around understanding care for stillbirth. And then in Zimbabwe, there was actually a new clinic that was built for pregnant women that once experienced stillbirth. Now this one, I look at it as something that is great, because once you have a stillbirth, and then afterwards, when you get pregnant, there's just a lot that actually comes up. I mean, there's so many emotions, and you're not even sure about what the next pregnancy is going to hold. So for you to actually get some special treatment in the pregnancy afterwards is really great. And Kenya, Malawi, Uganda, we've worked with facilities that allowed us to redecorate and transform the wards into private rooms that just women that have just experienced a stillbirth can actually stay in, you know how it is when you once have a stillbirth and you lose a baby, and afterwards, they put you in a room whereby someone else has just had a baby. And then you see the woman carrying the baby or holding the baby, it just brings so many emotions. So having a ward separate from that ward, separate from the birth ward was actually a great thought for us to say women can have their pregnancy they can they can actually grieve in privacy. And well, we've been raising awareness in communities. Zambia group attended church meetings to raise awareness and also developed community play. And in Malawi, we have a Facebook group that we help other women, too, who have just experienced stillbirth to cope. So those are just some of the things that we have actually done as CEI, there's actually a lot, do I have some more time? 

Saumu Lwembe  22:34

I can imagine. And, you know, I was I was quite taken with your example of the experiences in the hospital in the maternity wards where you've got, you know, mothers that have lost their children and others. And it's interesting isn't in the work that you've done, it's almost those small changes that make a big difference and the immediate impact in terms of the health service configuration in there, because just having that achievement, if you like in terms of getting the service providers to consider a separate unit, for mothers that have unfortunately lost their babies, making such a massive difference to the outcome, the health outcomes of those women. I think that is a strong achievement, if you like, a real thing for you to celebrate. I'm also interested I think, in previous conversations, Milcah you talked about being involved in delivering training across different countries in Africa. And that in itself brings me to the thought around the knowledge mobilisation for CEI, because I would imagine as you're going through those countries, some of the examples that you are giving, in terms of the training, you're either bringing a lot of intelligence from your work in Malawi, into Tanzania, and then you're probably taking that into Kenya, bringing, you know, so there's a lot of cross fertilisation and cross learning in that, do you want to say a little bit more around your experiences on that and  probably Carol how you actually taking the learnings from your work in Africa into Asia. 

Milcah Mwamadi  24:02

Because when we first started the project, there was not much to actually learn about CEI so we came up with a guidebook about CEI and the work and that is what we've actually been running around with helping other CEIs to understand the whole thing because as we talked about in the in the first conversation that we needed training to understand that CEI was different from research. Because there were times when the CEI we felt okay, why is it that we're not too much involved in the in the research and we found out that we are not the researchers, we are contributing to the research we are CEI contributing to the research. So this this is the type of training that we were running across all the countries for the CEIs is to know their role to understand their role and what is it that is expected of them. 

Saumu Lwembe 24:59

And you know, sometimes I have those twitter moments and you made a statement there that is tweetable “CEI we are not the researchers we are contributing to the research”, very important message that sometimes gets lost. So in terms of thinking about the long term benefits, then or impact in policy and practice, what are some of those long term benefits in policy and practice do you anticipate in your projects that can be attributed to CEI?

Carol Bedwell  25:25

Okay, and so I'll say, I'll say our CEI groups have helped focus our research around areas that are important to the populations that they serve. And hence, the finding should be important to local policies and practice. You asked before about how CEI was impacting on our work moving into Asia now. So our CEI groups helped to co-develop an intervention called advancing bereavement care. And it was a communication training intervention for health workers. And we completed that in Malawi, Uganda, Zambia, and Zimbabwe. And that work there has helped to form part of a larger bereavement care intervention, which we will be moving forward into India and Pakistan, where they will be feasibility testing that whereas we'll actually be moving into a main trial in the countries where we've already feasibility tested it. But we understand that there may be differences within those countries. So although our CEI groups have been involved in the development of it, the CEI groups in Asia will also be involved in developing that further and moving it forward so that is appropriate to their context. And I think there are already some changes in practice, as Milcah alluded to, in terms of things like changing rooms, and using curtains and that is actually something that health workers have said to us, actually, we hadn't really thought about prior to this. So it's actually changing behaviour change, really, and people thinking differently about how they work. And, you know, keeping the CEI embedded within the projects moving forward is really, really helpful in terms of making sure that they're relevant to the local population. And our current CEI groups are very, very supportive of helping others develop groups in maybe different topic areas, or different countries or different areas, but they're happy to lend their overall expertise as to how to develop these groups and how to run the groups, because they are all slightly different and dependent on the topic area where they were based, etc so they all did run slightly differently. So hopefully, there will be some sort of sustainability moving forward from those groups as well. And I also think one of the key things, and Milcah alluded to it before is about the empowerment of women and their ability to speak out within their communities. So that will be one thing that would be a, you know a residual benefit of the programme in that if women feel more empowered to speak out, if the topic of stillbirth is less stigmatised and people can talk about it, then that can only help to develop and improve care for women and how they're treated in communities moving forward as well.

Saumu Lwembe  28:17

Thank you Carol, and Milcah on, you know, from your perspective, what are some of the benefits, you can think of impact long term even for you as an individual that you can attribute to CEI that if I hadn't been involved into this in this project, I probably wouldn't have been able to do ABC and D?

Milcah Mwamadi  28:35

One of the things that I can say is just the mere fact of sitting at a stakeholder board meeting in facilities and making decisions and those decisions actually being impactful for the facilities to change some of the things in the in the hospitals. I mean, for me, that's actually great. And just the thought of women speaking, talking out loud about stillbirth experiences, expectations and everything else. For me, that's huge. Because we were never able to do this. We just do it probably in groups in secret and everything else, but speaking out about this issue that there's a programme that was run on BBC, whereby they were talking about stillbirth, and I was featured in it. We talked a lot about the impacts of stillbirth and it actually affects you mentally, too. So being able to talk about is a relief, because it no longer affects you mentally because you're talking about it and seeing something actually done about what you're talking about, for me that's great empowerment.

Saumu Lwembe  29:45

Thank you Milcah. Definitely strong voices there in terms of even just the health and well being of the individual as well. Carol, did you want to add something? 

Carol Bedwell  29:54

Yeah, just really around the sustainability and long term impact of the project. One of our groups, our Zambia group, our CEI representatives were invited to present to the Ministry of Health in Zambia, which is really important and helped to raise the profile of stillbirth within the country and help raise the priority level of it within the country as well. So I think that's a really good potential long term impact of the project. 

Saumu Lwembe  30:22

Certainly, having that direct engagement with policymakers, I couldn't agree more. Thank you. So obviously, you've done CEI really well. And I should say congratulations, but is there anything you would have done differently? With the benefit of hindsight.

Carol Bedwell  30:34

I think at the outset, we were starting from scratch, and l although we've done sort of PPI within the UK setting, we will we really finding in our feet with our first project,and sounding out and seeing how the group's developed really. And I think, as we've done with this, this later project for the research unit, we've made CEI one of our first priorities. So I think the earlier we can embed CEI within the project, the better, because as Milcah was saying, it does take time to do, it takes time to find your facilitators and participants. But you also need that space for people to be able to feel comfortable to talk and to trust each other. And I think one of the things we understand probably a little bit more now is how long a time we need to help the groups to develop. And they provided input at all levels, and certainly towards the end of the project, they provided in, you know, incredible amount of input and support for the programme. And, and really, really influential, you know, we got so much more out of it than we expected at the outset, to be honest.

Saumu Lwembe  31:40

Thank you, Carol. So it really building enough time for relationship building there. And capacity enhancement at the outset is important. So if you had to give advice to someone looking to embed CEI in their research, what three tips would you give them?

Carol Bedwell  31:53

I think the first one, the key one really is to choose a good facilitator, somebody who can, who has the skills to bring out the discussions and encourage members to give their views. Because as Milcah was saying earlier, it can be quite difficult for people to speak out in a public, you know, in a group setting where they are not used to having their voices heard, or they're not used to being asked for their opinions, because we found that was quite, quite common. So the second point, I would say, is to ensure the group members understand the roles and what is expected of them. And again, that's something we did quite a lot of work around and are still doing work around as we move forward to developing more groups. So that's just the group members, and also the researchers as well, because it's a new concept to them in a lot of cases. So everybody to know their roles and understand what's expected of them. And I would say the last tip is to, again, around expectations, but also to ensure you give feedback to the group. So what you've taken on board within your project, and why. If there are things that you haven't been able to take on board, that the CEI group have suggested, to provide them with the rationale for that. So they understand why and they're not thinking they're being ignored, it might be that you can't embed something because you know, you've already gone through ethics or or, or you know, it's just something that can't be done in that project but could potentially be done in another project moving forward. So it helps to make them important to make them feel part of the research, even though not necessarily involved in every step. And let the groups know that there may be periods of time where we don't need their input, for example, around data collection maybe, we might not need input for a period of time, but so they don't feel that they're neglected or forgotten about but still feel part of the research.

Saumu Lwembe  33:44

I would argue Carol and Milcah that the project you're running is almost given naturally to CEI by virtue, that you are speaking to people you're almost within that, that you actually you need to speak to the mothers, you need to speak to the community groups for you to succeed in your research. But what advice would you give someone undertaking a research that is more desk based and is less into human interactions, health economics, you know, kind of research, for example, or data, evidence gathering, research that is not it's less, there is less human interaction within it.

Carol Bedwell  34:26

I think it's important always to not lose sight of the person is the research aims to help ultimately. So although it's desk space, the person's views, the ultimate users views are still important as how the research will affect them. And so, to give an example from our current project, one of our work streams is around developing a core outcome set related to stillbirth and also related to bereavement care. So although this report relates to the reporting of findings and research and may seem very researcher focused, it's still important that the findings we report resonates with women, their families and communities are important to them as well. So we're including CEI in that, because ultimately what we report will affect women moving forward.

Saumu Lwembe  35:15

So in a way, the message I'm getting from your Carol is that there is not research that really cannot embed CEI. Every research can and should have a component of CEI within it?

Carol Bedwell  35:26

Yes

Saumu Lwembe  35:27

Thank you and any last minute comments, we’ve come to the end of our podcast but I just wanted to give you a second if there’s any last minute reflections you might have?

Carol Bedwell  35:39

I think just to say that the success of the CEI within our groups definitely down to the CEI members themselves and the facilitators within the countries because they showed such enthusiasm and commitment to the work that was out with anything we did, we just set the group's up and they ran with them. And they provided this input and support which has been brilliant.

Saumu Lwembe  36:03

Thank you, Carol. Milcah,do you have any last minute reflections? Anything you want to add? There'll be benefit. 

Milcah Mwamadi  36:10

Yeah, I just want to say that I think it also comes down to having a great research team. I mean, when you have a great research team, the researchers and the CEI working together, then it brings out the best output, because when all of them are open with each other, and then they bring feedback to you because sometimes as Carol said that sometimes there's just an era of silence and you're like, are we still involved in the research, but when feedback is actually great, then you know, you're still in the loop. So having a great research team is always good.

Saumu Lwembe  36:48

Thank you very much. So thank you Carol and Milcah for what has been a really great discussion. And a huge thank you to all our listeners. Please do share, tweet and tune in to the other podcasts that we have in our series. And please do let us know what you think by sending an email to social.media@nihr.ac.uk, that’s social.media@nihr.ac.uk .That's all from us. Enjoy the rest of your day.