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The COHESION project addresses health challenges related to non-communicable (NCDs) and neglected tropical diseases (NTDs) in low and middle-income countries (LMICs). The project partners in Mozambique, Nepal, Peru and Switzerland have been conducting baseline studies and co-creation sessions with stakeholders to inform the development of interventions at policy, health system and community levels.
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ICRD
In September, team members from Peru and Switzerland met in Bern to participate in the 4th edition of the International Conference on Research for Development (ICRD). Project partners together with the Council on Health Research for Development (COHRED) and the Swiss Commission for Research Partnerships with Developing Countries (KFPE), held a session on increasing equality in partnerships. Silvana Pérez León, research assistant from Peru, was awarded a scholarship to participate in a session on partnerships between health services and communities.
Policy Analysis
The findings of the global policy analysis on NCDs are currently being written up and interviews for the NTDs global policy analysis are in progress. We thank the representatives of different sectors for participating in our interviews. Their time and contributions helped tremendously.
Systematic and Scoping Reviews
One systematic review is examining social marketing interventions for NTDs (see protocol), and two scoping reviews on health education for NTD and NCD interventions at PHC level are underway. Stay tuned for results soon.
Collaborations
Cross-country collaboration has been essential to facilitate data analysis and to prepare for the forthcoming COHESION joint site meeting taking place in Nepal this November. During the meeting, project team members, the SNF program coordinator and SNF advisors will discuss the results of the baseline research and of the co-creation processes carried out in each country. We will also determine how to move from research to interventions.
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The Lancet Diabetes & Endocrinology published a commentary from the COHESION investigators on “The need to focus on primary health care for chronic diseases“.
Aya Pastrana N, Miranda JJ, Somerville C, Beran D, Suggs LS. (2017) Social marketing interventions for neglected tropical diseases (NTDs): A systematic review protocol. PeerJ Preprints 5:e3350v1 https://doi.org/10.7287/peerj.preprints.3350v1
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A three-day workshop on data coding and analysis to train team members in the use of NVivo was conducted in July. Qualitative data analyses for the community health perceptions study and for the health system assessment are in progress, and a preliminary report will be finalized soon.
Moreover, Tavares Madede from Mozambique is now formally registered as a PhD student at the University of Cape Town (UCT) and had a first meeting in Cape Town with the supervisor from UCT and COHESION PI, Dr. David Beran. Upon return to Maputo, Dr. Madede, MD, MPH continues working under the supervision of Professor Albertino Damaceno, COHESION project co-PI.
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A first round of co-creation sessions were conducted in August in Moamba and Xipamane districts, to share preliminary results with and receive suggestions for interventions from stakeholders at the community, health facilities, district and province health directorates, and at the Ministry of Health.
During these meetings, stakeholders confirmed a lack of awareness on NCDs and suggested health education campaigns might be a possible solution. They also reported a major problem of access to quality care and medicines; for example, PHC staff shared their need for training on NCDs, diagnostic tools and a regular supply of basic medicines.
In relation to NTDs, case detection at PHC level is difficult due to lack of laboratory facilities and lack of attention to these diseases by health workers. For schistosomiasis, the selected NTD for Mozambique, people reported regular mass drug administration (MDA) at school level but no / low capacity to reach isolated populations.
Policy stakeholders insisted on the importance of advocating for NCD and NTD in Mozambique, both still overlooked compared to infectious diseases.
At the moment, a second round of co-creation sessions with stakeholders at all levels are in progress in order to prioritize interventions to be developed in the next phase of the COHESION project.
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Co-creating in Sábie, Moamba District, August 2017
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Co-creating at Moamba Health Centre, August 2017
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Analysis of data collected for the community health perceptions study, the health system assessment and the national policy analysis are in progress.
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In Nepal the co-creation process was launched in August and aimed at involving stakeholders at different levels in the selection of potential interventions. Two workshops were held in Itahari and Banyani districts, participants included PHC staff, local health authorities and community members.
In relation to NCDs, suggestions were numerous but mainly focused on Behavior Change Communication (BCC) interventions to promote healthy lifestyle and prevent these diseases, and on the need to improve access to diagnostic and treatment at PHC level. “Monthly lab camps” were also suggested as a way to improve diagnosis for NCDs. As for leprosy, the selected NTD for Nepal, active case finding door to door and health education targeting remote vulnerable populations were mentioned. For both NCDs and NTDs, stakeholders asked for better follow up and regular supply of drugs.
At the policy level, similar co-creation workshops were held in Kathmandu during the “National Conference of Nepalese Society of Community Medicine (CONCOM)” and at the “Nepal Health Research Council (NHRC)”, participants from different sectors contributed in identifying potential interventions. Some of the discussion topics included the need to improve the health insurance coverage and the global budget for health.
The suggestions provided by stakeholders from community, health system and policy levels are being studied by the Nepalese COHESION team, to prepare for a next round of consultation where the aim will be to prioritize interventions that could be developed during the next phase of the project.
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Co-creating at NHRC, August 2017
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Co-creating in Baniyani, August 2017
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Coding and analysis of the data collected for the community health perceptions study and for the health system assessment are in progress, and a paper with the findings of the national policy analysis is being prepared. Furthermore, the Peruvian team has exchanged lessons learned in relation to data collection and analysis with the Mozambican and Nepalese teams.
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The suggestions from the local Advisory Board have been essential for the project. In the second meeting that took place in June, advisors provided ideas for potential interventions and suggested the co-creation process should be framed carefully to avoid generating community members’ expectations about interventions that are not feasible for the COHESION project.
Following their suggestions, the first round of co-creation workshops with the communities of Sicacate and Pingola started in July. The Peruvian team held meetings with community members and together brainstormed potential COHESION interventions. The experience from previous visits to the sites allowed team members to use effective communication strategies to invite community members and secure participation. The community suggestions revolved around getting more information about the disease, making diagnostic tests available at the PHC, and providing examples of well-balanced meals and sanitation improvement.
Stakeholders at the health system and policy levels, who were interviewed as part of the health system assessment, also provided ideas of possible interventions. Both these ideas and those provided by communities were reviewed and discussed by the COHESION team in Peru, to select a smaller set of interventions that were presented to the advisory board to receive feedback.
A second meeting with the communities is planned for October 28-29, to discuss a subset of potential interventions from which community members will then make a final selection and present the reasons behind their selection.
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Co-creating in Sicacate - July 2017
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Co-creating in Pingola - July 2017
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