Interview: Statistician Professor Osman Sankoh

Professor Osman Sankoh

By Kemo Cham

[First published on www.politicosl.com] Professor Osman Sonkoh is a Sierra Leonean born scientist and Executive Director of the International Network for the Demographic Evaluation of Populations and their Health [INDEPTH Network].

INDEPTH, which is headquartered in Ghana, is a network of health and demographic surveillance systems (HDSSs) and it seeks to provide a more complete picture of the health status of communities.
The network currently has presence in 20 countries across Africa, Asia and the pacific.

In this interview with Politico, the Njala University and German trained renowned statistician talks about his origin, academic journey and his effort to have Sierra Leone join the INDEPTH network.

Sankoh, fondly called Mallam O by his friends and colleagues, also talked about the importance of research to not just academic development but also to influence policy changes for national development.

The interview was conducted in Freetown during his last visit to the country towards the end of November.

Please read on.

Politico: By way of introduction just give us a brief background of yourself.

Professor Sankoh: I was born in Warima. It’s a village about 11 miles from Masiaka, which is 47 miles from Freetown. I went to primary school there and then I went to Tomlinson High School in Songo where I sat to my O’ Level. I didn’t do A’level. Then I attempted to go to Njala University. It was a college in those days.

Politico: Was that unusual in those days? Going to college directly from O’ Level?

Professor Sankoh: Well, from a village school, from where I didn’t do science, it was. When other people would have gone through their A’ Level and all of that, I went to university. It was tough because I went to do mathematics and English.

Politico: That’s another unusual combination

Professor Sankoh: In my first year, the guys who came from A’Level, it was just like waw! They would stand and not even copy any note. Then I started asking myself, am I in the right place. But then I worked very hard and eventually I graduated with a distinction in mathematics at Njala and I was retained as a research and teaching assistant.

After two years I got a scholarship and went to Germany to do my studies. I did another bachelors degree honors in statistics, did a masters degree in statistics and then did a doctorate in Applied Statistics. And then I was retained and started teaching at a university there. And a few years later, I got this (INDEPTH job). I was very much interested in applications in medicine, and epidemiology.

INDEPTH is trying to generate credible information, data about people based at the community level and individual household level.

We do have census which everyone knows in this country. But that happens once every ten years. Then there are in between surveys, like the demographic household surveys. They hold that once every five years. But what we do is different. We go to a village, or consider it a whole district. Then we take our census. We don’t try to disprove what happened about the figures statistics Sierra Leone gives. The intention here is that because Statistics Sierra Leone would have done their figure five or more years ago, we start now, if we want to know, for example, the number of people living in a particular community or particular household.

The idea is that we want to be able to follow this individual from a particular point in time when we met them up to ten to 20 years down the line. So it’s like you build a cohort and you build a relationship with the individual.

Politico: So will you get to a point where you want to cover the whole country?

Professor Sankoh: No. We wouldn’t want to cover the whole country because in research you can have samples of particular areas then you extrapolate. There are methods in statistics that can help you look at various factors and then you can say, all things being equal, this is a very similar situation. Then you can inference about a population that you have not really investigated as you have done elsewhere.

Politico: What determines which community you target? I thought this was about having statistics of the whole country, a data bank of some sort.

Professor Sankoh: What we are trying to do with this DHSS is not to replace the national health information system. In fact I was talking with Dr SAS Kargbo, who is the director of Health Policy and Planning at the Ministry of Health and Sanitation [MoHS], and they have shared with me the strategic plan for their directorate. So the research sites that we are talking about will contribute to their efforts. And there is no competition.

So what we now try to do is to strengthen those efforts, to work with the local health officials to bring a little bit of organized structure and do analysis. Then we can now help generate high quality data.

Politico: You did a presentation recently. Give us a brief idea what that was about

Professor Sankoh: I am the CEO for a global organization that does health research. We are now in 20 countries, in Africa, Asia and in the Pacific. And it’s growing. And I am Sierra Leonean. So I cannot see something go somewhere which I lead and my country is not part of it. So the reason why I have been coming is to say you have got to start; it has to be a home grown initiative, then you apply to be a member of my organization.

As the head of this and then Sierra Leone is not benefitting people would not understand. I wouldn’t have the opportunity every time I come across someone then I explain to you how we do our things.

I was so pleased to have Fourah Bay College, College of medicine and Allied Health Sciences [COMAHS] Njala University, people from the Ministry of Health, and there were some reporters... So it was really just trilling for me and I saw some of my students.

I have seen in Ghana, for example, there are three field sites which are owned by the ministry of Health. The ministry does not have money to give them like that, say ‘go and do research.’ But the ministry of health says, ‘these medical doctors are part of the ministry, we pay them salaries, they are small, whatever, but if you take them, you can do what you want to do, they can contribute. If you have a project, please work with them and encourage them by topping up their salaries.’

They are now celebrating their 28 anniversary. 28 years ago they saw a vision fo establishing a research center, and a lot of these centers have contributed to the decision making process of the ministry.

Politico: So you work in collaboration with that research center?

Professor Sankoh: Definitely, they are all part of my research organisation.

Politico: So you do not go and build the structures there. They have to go and build them and you work with them?

Professor Sankoh: Exactly. Then we coordinate them. What we want to focus more on is the potential to compare what is happening across countries, across continents, because if you talk about West Africa, if you level up your aggregate data, you will find out that many of the things really are not different. The people are the same.

What happens here is that those are field sites where we train students; students do their masters from there; they do there PhDs from there. And there is very little here from Sierra Leone in terms of doing research. There are people who go through lots and lots of these programmes without having the field experience. Why don’t we clear it!

You asked earlier on how we select these sites.

Politico: Yes

Professor Sankoh: Let’s assume that there is a health centre in Warima. You would want to think that that’s the place I would start from. And that’s pragmatic; that’s where I come from and it’s easy for me to talk to the people. I would want to start from there.

But that’s not the way to do it. We’ve got to look for scientific criteria. And that would guide us on how to select. We have to start from a research question, something that the ministry of health and any other relevant ministry is interested in.

Let’s say for example maternal mortality. We want to look at a chiefdom or a district where we see a higher level of maternal mortality and the district that we see a lower level of maternal mortality. Then we want to say what are the causes of this. Then we look at the figures from statistics Sierra Leone. We look at the figures from DHS. We look at probably Unicef’s. We look at other programmes.

We then have everyone present their data. Most of them maybe presenting different sets of data, but that’s not the problem. It’s good to have some data. What we are now trying to do is to harmonize these data.

If 50 mothers are dying out of 1000 live births in Kambia, and then probably somewhere else there are 200 mothers dying out of 1000 live births….then we say it’s low there and its higher there. So let’s start setting up our research center there to look specifically at this issue. What is it that people from Kambia are doing right that the maternal mortality rate is slow? What is it that these guys are doing not completely right? So now we start our project, focusing on maternal mortality. So since we are already there, we can now start looking at other diseases…that’s now how you expand.

Politico: I understand that this is not your first visit to Sierra Leone under this project, but that this is your first presentation. In between, have you been seeing any changes?

Professor Sankoh: Well…it is not easy to start anything because you need money to do this, although to start something you don’t need too much money. To start with you need people who are committed. You need to get to institutions that get to know what the essence or the utility that you are proposing is. And that’s why I never gave up, because I knew that along the line I would find people who would listen to me, who would get to understand what we are doing. So there is always the right time.

When I came the last time Ebola came. Ebola is not the thing that you would want to do the kind of research that we are doing. It surprised everyone here. There were mistakes here and there but we are grateful it ended.

Let’s imagine you had a research center, where you go to people’s homes and you are playing with children. You couldn’t have done that with Ebola. But if we were set up, with our surveillance center, we would be able to catch that up and report it quickly.

But all that happened here was just hearsay.

Politico: You think you have now got the attention of the relevant people?

Professor Sankoh: I think you so.

Politico: So now if you were asked to advice, what’s the first action that you would want to see them take?

Professor Sankoh: Well, for now we are setting the core group. Things fail when you come from outside, even if you are a Sierra Leonean, and you want to push people like that. That’s not the point. Let people take their time, but still not too long; stay behind them, discuss with them, let them see the relevance of what you are doing, and then it would work.

Before I leave, I would ensure that we have young people, who get convinced and who would be pushing the strings.

But also there is something that’s working on our favour now. There is Kings Partnership Sierra Leone. They are at Connaught Hospital. I visited them. It is a group of committed, young and senior people who are good partners for this country. And so that’s also my link.

Politico: So earlier you said money is relevant for research but that it’s not all about money. But money is good…

Professor Sankoh: They are trying. I studied in the University of Dortmund in Germany. I was working at another university there. I am from Sierra Leone. I can understand the issues here. That’s why I am not going to begrudge anyone. I am not going to blame people but I am going to just say what I have seen I know it’s good, and I am going to try and assess. And I just want to tell the people also [that] research programmes can bring a lot more of money to the university.

The difficulty is that you will need to find time to apply and you will need to do good proposals and that’s also failing in many of our countries. So where I come in…I will come, not just to talk, and organize proposal development sessions. I have written a number of them that are successful. I have raised more than a $100m proposal for this organization that I head. I am the principal investigator in many of them. So I can come with those proposals that are successful.

Politico: So all the authorities here need to do is to have their facilities available for you and their human resources? These are the people you need to train?

Professor Sankoh: If you are going to set up a field site, you should be able to get people to work there. You need to train your field workers, you need to train your field supervisors, you need to train even the site managers to manage it. Then you need to train the investigators, and the scientists who go there.

You can have your degree, but you would not have had your whatever guidance toward field research. We would train you.

Politico: You are going to be working with students, academics…?

Professor Sankoh: Yea. All of them.

Politico: They don’t have to be ministry workers.

Professor Sankoh: No, they don’t have to be ministry workers. That’s why we call it health and demographic surveillance system. You of course would have people who are interested in health research, but also people who are even interested in education research. If you go to an area, let’s say we have gone to this house and you have five kids who go to school. Three dropped because of other reasons. Then you go to another household, and you have that info, you go to 1000 households – kids who go to school dropout rate and reasons; so you can do an education research. So it’s general.

It’s research for health but then you can come up with lots and lots of everything. We can also tell about the social and economic status.

If I came to you last year and found you riding a bicycle, and after sometime you are successful and got a good job, and then I visited you a year later and you are riding a motor bike, and another year later you have a car; so we can even track the progression with time.

And that information we generate, is not just about publishing in international journal, it’s about feeding back to the community, to see what’s happening and that the community is also making progress.

Politico: As far as this initiative is concerned, from here where does it head?

Professor Sankoh: We are developing a partnership with King’s College, London. We are now developing a proposal for funding. And this is what I hope and pray that we are successful with; because if we have that proposal funded, then we will take off from the ministry or the universities here the burden of looking for money. We would have brought the money and we would involve them. So once we have started, my brother it’s going to continue.

With the first project, we can now develop new research proposals. And then it would just go on and on and on. And then we would be training Sierra Leoneans…

Politico: Is everything set if you have the funding?

It’s not just having the funding. They have given me their national strategy for the next five years; I am going to study that. I have given them my word. You can have a strategy, but if you don’t have a way of implementing it then it’s nowhere.

I am an expert in this area. You don’t need to pay me. I am going do this. I will read this and I will be working with the directorate to support.

Politico: With your experience, Sierra Leone is just emerging from Ebola, and we know research is not happening here. Do you think without research programmes like those can attain their goals?

Professor Sankoh: It’s going to be difficult. Let me qualify that. At COMASH and the military hospital, we have my colleagues there, my former class mates. They are doing good work. And at COMAHS, Dr Samai and colleagues are now looking into a vaccine for Ebola. So that’s some research that’s going on. So some bits and pieces of research is happening. So we cannot say that research is not happening, but just that it’s not to the level that it’s supposed to be.

Politico: There have been expressions of anger over western researchers not involving locals. Do you get such complaints when you go around the world?

Professor Sankoh: If you don’t have or develop capacities for even to dialogue with our western partners, then you miss it.

Politico: You think its dialogue that’s missing?

Professor Sankoh: The thing is that these people don’t come here for nothing. If you think it is philanthropy wherein a scientist comes from outside and spends his money and energy, do research and they just say you take it, no way. But it’s the leadership.

Dr Samai and others, like Col. Sahr Foday [head of 34 Military Hospital] are capable people. But it’s that dialogue that is needed. When these people come from overseas, even if they bring their money, they should respect the locals, the nationals who contribute to these researches. And there are principles even when you are publishing, they should not just be the first author. The person who you call first, is usually the person they say is the lead researcher.

I will give an example where they would be doing this Ebola vaccine trial here. When the BBC wants to interview who has led this research they would call someone abroad.

When for example CNN or VOA or BBC wants to interview who leads the study, they would call an American, they would call a British or what have you … But then we would to change that.

We shouldn’t be too angry these days. We find a way of saying hey guys, that’s not the way we want to do it here.

So right at the start when you want to collaborate, we say these are the rules. If there are going to be ten papers, yes you can be a lead author in one, Dr Samai can be a lead author in the second paper, Malam O a lead author in another paper, etc. So a win win situation … really most prevail.