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Medics as influencers: a historical analysis of British Army military medical exercises in Kenya over two decades
  1. Patricia Falconer Hall1,2,3,
  2. T Falconer Hall1,3,
  3. Z Bailey4,5 and
  4. S T Horne2,3
  1. 1AMS Support Unit, Army Medical Services, Camberley, UK
  2. 2Academic Department of Military Emergency Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3Defence Medical Services Centre for Defence Engagement, Birmingham, UK
  4. 4Conflict and Health Research Group, King's College London—Strand Campus, London, UK
  5. 5U.S. Military Graduate Education, Air Force Institute of Technology—Civilian Institute, Wright-Patterson Air Force Base, Dayton, Ohio, USA
  1. Correspondence to Dr T Falconer Hall, AMS Support Unit, Army Medical Services, Camberley GU15 4LR, UK; tomfalconerhall{at}


Introduction Annual British Army medical training exercises have run in Kenya since the early 1990s, initially with a dual purpose—to deliver the Kenyan Extended Programme of Immunisation (in remote locations) and to undertake austere training. This provided a specific response to a capability gap request from the partner nation, but as this gap closed, the exercise changed in various ways. This study aimed to qualitatively explore the impact of these exercises on the Kenyan healthcare system and the influence and relationships between the nations.

Methods Semistructured interviews were conducted for 10 former senior commanders and medical officers who had deployed in key command and clinical positions from 1993 to 2019. Three researchers conducted thematic content analysis on the key-informant interviews.

Results Five domains with 18 subdomains formed the study’s analysis framework. 16 recurring themes were identified and placed into four categories that denote if they were of benefit to the engagement, enabled success, had the potential to cause harm or were a barrier to successful engagement. Three distinct phases of the exercise were identified: supporting Kenyan vaccinations, direct clinical care, training and education.

Conclusions This is the first qualitative analysis of the impact of a British Defence Engagement (Health) on the partner nation and UK influence gained through it. It has identified factors which may improve outcomes, namely, ensuring sustainability and continuity between iterations; maintaining enduring stakeholder relationships; responding to a capability gap request; intelligence-led planning with incorporated assessment, monitoring and evaluation; adapting to changes in needs or contextual settings; while ensuring mutual benefit in objective setting. These may be used as the basis for a conceptual framework supporting the planning and execution of high-quality, mutually beneficial Defence Engagement (Health) activities in future. This framework and future research would also benefit from gaining perspectives from the partner nation.

  • Health policy
  • International health services

Data availability statement

No data are available. No data are available as the interview recordings and transcripts have been destroyed in line with the study’s approval by the Ministry of Defence Research Ethics Committee.

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Data availability statement

No data are available. No data are available as the interview recordings and transcripts have been destroyed in line with the study’s approval by the Ministry of Defence Research Ethics Committee.

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  • Contributors STH is the chief investigator and as such designed the study (including gaining ethical approval), contributed to writing of the paper and is the guarantor of the guarantor for this study. PFH analysed the data and led the writing of the paper. TFH and ZB collected (through semistructured interviews) and analysed the data and contributed to the writing of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. The research was conducted as part of SH’s PhD supported by Conflict and Health Research Group, King’s College London.

  • Disclaimer The opinions expressed here are those of the authors and do not necessarily represent the views of the UK Defence Medical Services or the US Air Force.

  • Competing interests PFH, TFH and STH are serving officers in the UK Defence Medical Services. ZB is a serving officer in the US Air Force.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.