Engagement activity with stakeholders at the macro level of the health system in Lima- Peru

Summary: Engagement activity with stakeholders at the macro level of the health system in Lima- Peru

On May 3, the COHESION project in Peru held a meeting with stakeholders, where stakeholders related to the health sector and the diseases related to the project (diabetes, hypertension and neurocysticercosis) were invited. The purpose of the meeting was to present the project, create links with different institutions and receive inputs or recommendations for the project.

The meeting was attended by members of the COHESION project in Peru, part of the COHESION team from Switzerland, public officials from both the Ministry of Health and the Superintendence of Health, as well as some civil society organizations such as the Diabetes Association of Peru and the Peruvian Federation of rare diseases.

The meeting began with the words of welcome from Jaime Miranda, Director of “CRONICAS center of excellence in chronic diseases”. During his welcoming he remarked the intention of the meeting to carry out a co-creation process between the COHESION project and the assistants, to think together ways of improving the health system, especially in the attention given in the primary health care.

Following, David Beran principal investigator of the COHESION project made a presentation of the project COHESION (in Spanish). He explained the linkage between the project with the Millennium Development Goals and the Sustainable development objectives. He also pointed out important qualities of the project like being a multidisciplinary and multi-country team. Finally he explained the different stages that the project has carried out and the stages to come in the next years.

Subsequently, the words were given by María Kathia Cárdenas, coordinator and researcher of the COHESION project and at CRONICAS Center of Excellence in Chronic Diseases. During her presentation she explained the COHESION project in the Peruvian scenario. She specified the project is being carried out in the region of Piura, in the health posts of Sicacate and Pingola, located in the districts of Montero and Ayabaca respectively. During this presentation it was also specified two of the studies that the project is carrying on, the evaluation of policies and the health system assessment. She explained details of each study and the different levels of analysis. Furthermore, she also explained the methodology that is being implemented based on the manual “How to investigate access to care for chronic noncommunicable diseases in low and middle income countries” (2012) from the WHO, and she also explained the activities that were already performed at the community level such as interviews with patients, health workers, head of facilities, among others.

Next, María de los Ángeles Lazo, researcher of the COHESION project and at CRONICAS Center of Excellence in Chronic Diseases, detailed the steps that will follow the project in the next months to involve the stakeholders at the macro or national level. She explained to the participants the important need of their support and expressed the intention of the project to involve them actively in the process, as well as with other key stakeholders. It was also specified that in the short term the COHESION project will be contacting them to have personal interviews, to know their opinions on the health systems facilitators and barriers.

Finally the discussion was opened to the attendees so they could express their opinions, comment or question of the project. This final part was moderated by María Amalia Pesantes, coordinator and researcher of the COHESION project and at CRONICAS Center of Excellence in Chronic Diseases. Some of the most important arguments and recommendations are detailed below:

  • To include the perspective of caregivers. It is important the health system recognized their task, not only in a financial support, but also to be trained in the care of the patients and to consider the importance of psychological support for the caregivers, who were also called “acompañantes” (companions).
  • Developing engagement with key stakeholders such as public officials and political representatives is a long-term endeavor.
  • It is necessary to establish relations with the regional health directorate in Piura. This entity is the responsible of providing the health service, while the Ministry of Health is in charge of regulating and monitoring. It was also suggested to interview the head of the department of Planning and Budget and Human Resources, and to include the Regional Government, who has also responsibilities related to health, poverty, access to water and sanitation.
  • It was also highlighted the important role played by community agents in the health system.
  • It was acknowledged the low ability of the Ministry of Health to communicate strong messages. Furthermore, civil society lack of relevant information about diseases, especially the most neglected population.
  • Past experiences on training diabetes educators were shared and it was noticed that one of the main difficulties in the training of health workers was the high rotation to other health establishments, and this should be taken in to account for the project.


COHESION Team (Switzerland):

  • David Beran
  • Sarah Lachat
  • Suzanne Suggs
  • Nathaly Aya Pastrana

COHESION Team (Peru):

  • Jaime Miranda
  • Maria Kathia Cardenas
  • Maria Amalia Pesantes
  • Maria de los Angeles Lazo
  • Charlotte Darwis
  • Rosa Salirosa
  • Silvana Perez Leon


  • Jorge Calderón (President of the Diabetes Association in Peru)
  • Luciana Bellido Boza (Representative of Intendance of Research and Development – SUSALUD)
  • Jorge Ferrandiz (Executive Director of the Department of Prevention and Control of Noncommunicable, Rare and Orphaned Diseases)
  • Maria Lourdes Rodriguez (President of Hecho con Amor-asociation of multiple sclerosis in Peru and President of the Peruvian Federation of rare diseases)
  • Lilliam Lindley (Representative of Hecho con Amor-asociation of multiple sclerosis in Peru and President of the Peruvian Federation of rare diseases)


Swiss team goes to Mozambique

The COHESION team meets in Mozambique. Three members of the Swiss team (Dr. David Beran, Dr. Claire Somerville and Mrs. Sarah Lachat) join the Mozambique team this week at Eduardo Mondlane University.

Policy Analysis and gender are at the top of the agenda, but the team will not miss the opportunity to advance the community and health system assessments and reporting.

The team is grateful to be able to profit from face to face time in the country.

National Policy Analysis in Peru

One of the main research outputs of COHESION consists of an analysis of global and national policies related to non-communicable (NCDs) and neglected tropical diseases (NTDs). The partners in Switzerland conducted the global policy analysis, whereas national policy analyses are in progress in Mozambique, Nepal, and Peru.

The COHESION team in Peru met on January 23rd to review the preliminary findings of their national policy analysis. Interesting perspectives were raised in relation to the Peruvian policy agenda, methodological considerations were shared and lessons learned were expressed that will be shared with the partner countries. In addition, participants spoke about potential activities that will follow once the analysis is finalized, including publications and dissemination of findings to national stakeholders.



The COHESION Project’s first Global Advisory Board Meeting

On the 21st of November 2016 at the Geneva University Hospitals (HUG) in a conference room overlooking the old town of Geneva, a significant event was held for the COHESION Project. This was the first Global Advisory Board Meeting. So why was this important?

First and foremost, it was the first time that the Global Advisory Board of the COHESION Project met. This meeting brought together 11 of the 12 Board members, providing a unique and diverse group of people from UNAIDS, WHO, London School of Hygiene and Tropical Medicine, the Permanent Missions of Mozambique and Peru, the State of Geneva and the HUG. This group of policy makers, clinicians and researchers all shared a common passion for global health.

COHESION presented its work and got feedback. Dr. Claire Somerville, COHESION Co-Investigator and lead on the Policy Analysis, presented the preliminary results of the Global Policy Analysis.

This meeting was a great opportunity to exchange and learn from the experience of our Advisors. Most importantly, this meeting was a chance for the COHESION Team to be challenged, in what we are doing and how we are doing it.

Our Advisors challenged COHESION with regards to the interventions and how to evaluate them. They argued that the development and evaluation should use both qualitative and quantitative methods and also use an iterative process. They all saw the value of what COHESION was trying to achieve and stressed that we have the potential to make a difference. P. Perel insisted that this impact needed to be measured and reported.

Discussions also focused on the wider determinants of Noncommunicable (NCD) and Neglected Tropical Diseases (NTD). P. Godfrey-Fausett recommended that COHESION look beyond health systems and look at “systems for health”. F. Romao and Y. Jackson added that the issue of vulnerability and gender needed to be examined in different ways, for example making services sensitive to men and women. S. Aebischer insisted on the necessity to adopt a non-vertical approach and to develop interventions at the community level as behaviour change is needed to reduce the risk of obtaining an NCD as well as for managing them.

So what are the lessons from our first meeting? COHESION needs to continue to think about the impact of our project and how to continuously measure this. As noted by A. Costello: “NCDs are the great big dark matter of health. They are invisible to most people, but are massive.” Through COHESION, we hope to ensure that NCDs and NTDs and the people who are faced with these health challenges become more visible and empowered to tackle these dark matter. We will strive to do this with the communities and systems we are working with. Together, we believe we can make a difference.

*From left to right

  • Dr. Anthony Costello, Head of the Department of Maternal, Newborn, Child and Adolescent Health at the WHO
  • Dr. Claire Somerville, CO-PI COHESION, Graduate Institute, Geneva
  • Dr. Sigiriya Aebischer, Senior Resident, Tropical and Humanitarian Medicine Division, Geneva University Hospitals (HUG)
  • Dr. Francelina Romao, Health Counselor, Embassy of Mozambique in Geneva
  • Prof. François Chappuis, Head of the Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG)
  • Dr. David Beran, Principal Investigator COHESION Project, Geneva University
  • Dr. Peter Godfrey-Faussett, Senior Science Adviser, Office of the UNAIDS Science Panel, UNAIDS
  • Ms. Maria Jesus Alonso Lormand, Director of the International Solidarity Service, State of Geneva
  • Dr. Yves Jackson, Senior Consultant, Division of Primary Care, Geneva University Hospitals (HUG)
  • Dr. Pablo Perel, Director of the Centre for Global NCDs at the London School of Hygiene & Tropical Medicine, Senior Science Advisor at the World Heart Federation
  • Dr. Gilles Eperon, Senior Resident, Tropical and Humanitarian Medicine Unit, Geneva University Hospitals (HUG)
  • Mr. Carlos Briceño, Ministro Consejero, Permanent Mission of Peru to the UN

 Not present: Ms. Lauranne Botti, Research Fairness Initiative (RFI) Manager at the Council on Research for Development (COHRED)


r4d Mixed Methods Research Workshop

The Swiss Programme for Research on Global Issues for Development organized an r4d Skills Mixed Methods Research Workshop with Alicia O’Cathain, on integration and quality assessment. The full-day workshop took place in Bern on 28 October 2016 and congregated project leaders, project coordinators and Ph.D. students of r4d projects funded by the Programme, including COHESION.

Alicia O’Cathain is a Professor of Health Service Research, University of Sheffield, UK; and has published widely on mixed methods, mixed teams and randomized control trials. During the workshop, Dr. O’Cathain engaged participants in sessions covering definitions, rationales, designs, reporting, integration of qualitative and quantitative data, and assessing quality.

Four members of the COHESION team (Jorge Correia, Nathaly Aya Pastrana, Olivia Heller, Sarah Lachat) and one member of the project Advisory Board (Dr. Sigiriya Aebischer-Perone) participated in the workshop. Team members discussed and reflected on how to integrate and disseminate the findings of   data to be collected by the Project, balancing the insights obtained from qualitative methods with those from quantitative methods. Dr. Aebischer-Perone will share the reflections during the first Swiss COHESION Advisory Board meeting in Geneva on 21 November 2016.

To find more information about the workshop click here


Swiss based Advisory Board meets in Geneva

The members of the Swiss-based Advisory Board meet in Geneva today (21 November 2016) to discuss the project. Many thanks to the following for agreeing to this important position:

  • Dr. Sigiriya Aebischer-Perone, HUG
  • Carlos Briceno, Permanent Mission of Peru
  • Lauranne Botti, CORHED
  • Anthony Costello, WHO
  • Dr. Gilles Eperon, HUG
  • Peter Godfrey-Faussett, UNAIDS
  • Dr. Yves Jackson, HUG
  • Maria Jesus Alonso Lormand, International Solidarity Office of Canton of Geneva
  • Pablo Perel, LSHTM/WHF
  • Francelina Romao, Mozambique Permanent Mission
  • Surendra Yadav, Permanent Mission of Nepal

COHESION meets to analyze NTD & NCD policies

On 14 November 2016, five members of the larger Global Policy Analysis team met in Geneva. Led by Dr. Claire Somerville (The Graduate Institute), and following Shiffman’s Political Priority framework, the team identified preliminary themes across NTD and NCD documents and resolutions in the actors and actor power, ideas, political contexts, and issue characteristics. Very interesting findings so far.

More to come from both the global and national policy analysis teams soon.





Views from the World Cardiology Congress

COHESION at the heart of the matter: Views from the World Cardiology Congress
by COHESION Principal Investigator, Dr. David Beran

I was invited to give a talk at the World Cardiology Congress on lessons from diabetes and health systems that might be of use for cardiology. An interesting opportunity and when I found out that my co-Investigators Albertino Damasceno and Jaime Miranda would also be there I saw it as an added advantage to be able to see them and catch up on COHESION.

On my flight to Mexico, the Congress was in Mexico City, the person sitting next to me on the flight asked if I was going to Mexico on holiday and I said no that I was going to a Congress. They asked which Congress and I said a cardiology congress. “Ah so you are a cardiologist?”, my neighbour asked. “No” was my answer. “Then what kind of doctor are you?”, was his retort. “Actually, I am not a doctor, I work in public health and health systems”, I replied and started describing what I actually do. Luckily the bewilderment of my fellow rowmate was interrupted by the all too important question by the flight attendant͞, “Chicken or pasta?” At which point we wished each other a pleasant meal and that was the end of our interaction.

That brief contact with my fellow traveller highlighted many things. One, the view of health as that of a doctor’s domain. Secondly, that public health is a misunderstood concept and people outside the health arena do not really understand what it means. Another issue is that for many people when they hear a disease, e.g. cardiology, they see this as something that doctors and medicine can fix, versus a large societal health issue that requires multiple actors to address within and outside the health system. Finally, that I need to find a better way of explaining what I do…

These issues are essential to highlight based on this somewhat trivial interaction in that at the World Cardiology Congress many of the sessions were geared towards issues that could not have been further away from what my travel companion imagined what cardiology and a cardiology congress entailed. I attended interesting discussions on tobacco, alcohol, health systems and specificities of heart disease in different parts of the world, e.g. Africa versus Latin America. All of the presentations had one thing in common, that the COHESION project is well and truly at the heart of the matter.

To give you an example why I say that. The sessions discussing tobacco, alcohol or obesity or those discussing hypertension management highlighted that these phenomena once thought of as being only found in high-income countries have now become global issues impacting all strata of populations within and between countries. In parallel certain countries face this burden as well as the burden of cardiovascular disease linked to infectious agents such as Rheumatic Heart Disease. For an excellent review of the challenges of cardiovascular disease in poor populations see http://www.ncbi.nlm.nih.gov/pubmed/27297348 which Jaime Miranda contributed to. These examples highlight the double burden of disease as a challenge, but very few of the presentations or discussion highlighted what could be done. Many described possible avenue for improvement: strengthening health systems, better health promotion and prevention activities, the need for policy interventions, better training of health professionals, task shifting, use of “m” and “e” health, etc. None of the presentations I attended mentioned two of the cornerstones of the COHESION project namely Primary Health Care or the community.

This made me realise the importance of the COHESION project in not only addressing the specific NCDs and NTDs we are working on, but also wider health system issues. Also seeing my two co-Investigators discuss the work they do in parallel to COHESION highlighted the quality of the individuals we have and how they truly are at the forefront of their fields. Hopefully, in the future, the COHESION team will be able to present its results in such a forum highlighting lessons learnt from NCDs and NTDs in improving PHC for other conditions.

Cardiology congress_mexico 2016

Jaime Miranda, David Beran, Albertino Damasceno