COHESION @ ICRD

At the beginning of September 2017 in Bern the 4th International Conference on Research for Development (ICRD) was held. The aim of the conference was to present “visionary contributions that will enhance transformations towards sustainable development in countries of Africa, Asia, and Latin America.” (www.icrd.ch)

COHESION was of course present at this important event. COHESION co-organised two sessions on partnerships with the Council on Health Research for Development (www.cohred.org) and Commission for Research Partnerships with Developing Countries (www.kfpe.ch). Maria Amalia Pesantes from the COHESION Team in Peru was a panelist during a session on increasing equality in partnerships. These sessions on partnerships highlighted a variety of challenges in establishing partnerships, but also tools developed to help address these and the role funders can have in helping facilitate partnerships. One interesting aspect was thinking about the process of partnerships and how there are “Hard elements”, such as shared vision, setting the agenda together, fairness and sharing of process and capacity building. In parallel “Soft elements”, such as trust, respect, being open and cultural differences are equally important. Both hard and soft elements are essential to ensure success, but require different approaches to be established. It was interesting to reflect on these as COHESION as a project and a partnership evolves.

Silvana Perez Leon also from the Peru Team won a grant to present some of her work at the conference. During the session “Building transformative partnerships between health services and communities as a means to advancing the Agenda towards Sustainable Development: A pathway forward”, she presented her experience engaging with primary health care workers and community members in the COHESION project. She pointed out some of the enablers and challenges the Peru team had in building transformative partnership. Lessons from this session were that the WHO is preparing a community engagement framework that can be used for projects like COHESION. Recommendations were also that as a project we should systematically document our process of engagement which can later be used as evidence for other initiatives.

Besides COHESION’s direct contribution to the content of the conference, this was a unique opportunity to link the work being done in Mozambique, Nepal, Peru and Switzerland to the wider development agenda. A message that was mentioned frequently was the unfinished Millennium Development Goals (MDG) Agenda. Another element discussed widely was the link between economic development and health in parallel to progressing political processes and the role of communities and civil society in this.

These aspects are interesting in thinking about COHESION’s approach in dealing with diseases of poverty (NTDs) and diseases that are intimately linked to development (NCDs) by focusing attention on communities to develop interventions.

Being based in Switzerland it also emphasised the importance of Switzerland as a donor, funding such projects as the r4d scheme as well as that the Sustainable Development Goals (SDG) unlike the MDGs are for all countries and not just low income countries. This requires a change in approach from one of high income settings coming with solutions to MDG related problems to, as stated in SDG 17, partnership. The SDGs are integrated and inseparable in that many of the goals are interlinked.

The banner at the entrance of the conference had the following three words:
– Evidence
– Engagement
– Policies

Thinking about these three words and the SDGs, COHESION is increasing the evidence base in terms of burden of NCDs and NTDs at policy, health system and community level. To address these challenges, COHESION by engaging local stakeholders will develop innovative interventions to address these challenges. Based on the COHESION research to date the issue of policies is of concern in that although many aspects of NCDs and NTDs are being addressed in health systems through the delivery of care, but policies are lacking to help guide these responses and involve communities. From a COHESION perspective, a fourth element to the ICRD list would be implementation. In that evidence, engagement and policies without implementation are meaningless. As COHESION moves from formative research, engaging local stakeholders and understanding global and national policies, its next step will be to implement innovative interventions to contribute to the achievement of the SDGs.

COHESION PI reflects on “Meu regresso a Moçambique”

Meu regresso a Moçambique – My return to Mozambique

Mozambique is a special place for me. It was the first country I visited in sub-Saharan Africa, my first project in looking at diabetes management in a low-income country and also a country where I was able to work for close to 7 years with the Ministry of Health and Diabetes Association. Besides the professional aspect, it was also a place where I made long lasting friendships with unique people who not only shared their passion for the work we were doing together, but also imparted me with the love of their beautiful country.

So the question I got from everyone after my recent trip to Mozambique for COHESION, how was it going back? AMAZING was my answer.

Going back to Mozambique was like seeing an old friend after a long time. The link, fondness and memories were there. Both Mozambique and I had moved on since my last visit. Economic development in Mozambique, but with current economic turmoil, more projects including the launch of COHESION and my move back to Geneva on my end.

My reunion with Mozambique was also positive in that the Mozambique COHESION Team had progressed with the research, been able to involve high-level individuals in the Advisory Boards as well as gain the support for our project in the two areas where our work will take place. I had a chance to visit Xipamanine and Moamba and speak to health professionals and local members of the community. In parallel Dr. Claire Somerville (Graduate Institute and COHESION Project Lead on the Policy Analysis component) and Sarah Lachat (University of Geneva, COHESION Project Manager) had the opportunity with our colleagues to work on and carry out some interviews regarding the Policy Analysis. We were also able to meet with the Swiss Cooperation Office in Maputo. The result of all of these discussions is that COHESION has a huge role to play in Mozambique to help improve the management of Noncommunicable (NCD) and Neglected Tropical Diseases (NTD).

Being back in Mozambique not only enabled me to see progress and continuing challenges based on my previous work, but mainly the importance of the current work of the COHESION Project. There are many challenges in Mozambique with a life expectancy of 53; high prevalence of HIV/AIDS and malaria; high maternal mortality, etc. NCDs and NTDs have been neglected by policy makers and donors. This results in a lack of capacity at the level of the health system to respond, leading to challenges for individuals and communities. The interventions that our project will develop will hopefully address these and help improve the conditions for people with NCDs and NTDs.

Até a proxima (until next time) Moçambique,

Dr. David H. Beran, Principal Investigator of COHESION

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.

COHESION @World Health Assembly 2016

The COHESION project was at the World Health Assembly,

“the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget. The Health Assembly is held annually in Geneva“ (http://www.who.int/mediacentre/events/governance/wha/en/).

Six members of the COHESION team (David Beran, Claire Somerville, L. Suzanne Suggs, François Chappuis, Jorge Correia, and Sarah Lachat) attended various sessions on NCDs, NTDs, patient safety and more. In this blog post, Sarah and Jorge highlight some of their key take home messages relevant to COHESION.

  1. The opportunity to integrate NCDs and NTDs care into PHC as well as to address their risk factors is clear. The growing political engagement and promising initiatives at global and regional levels to ensure that “no one is left behind” (UHC approach) and to improve global health security after the Ebola crisis make addressing the double burden of NTDs and NCDs not only appropriate but also essential. For example:
  2. At the same time, there is a need for making an investment case for NCDs and NTDs integration due to difficulties to obtain quality data in terms of socio-economic related costs at country level (e.g. loss of productivity, DALYs, etc.).
  3. In alignment with the SDGs, there is a global shift from vertical approaches to integrated care and shared agreement on the necessary multi-sectorial integrated approach to tackle prevention of NCDs. However, there is difficulty in introducing systemic primary prevention measures due to conflicting interests.
  4. There is an underestimated bidirectional link between health and climate change: e.g. growth of vector born diseases due to global warming; increased chronic respiratory diseases linked to air pollution.
  5. Health policy is essential to tackle disease but community and individual initiatives bottom-up approach are equally important.

Click here to read more about the World Health Assembly 2016

 

Photo of Mrs. Lachat and Dr. Correia at the WHA 2016

JCandSL_WHA2016

 

FeaturedWHO is the COHESION Project?

COHESION is the acronym of COmmunity HEalth System InnovatiON Project. It brings together institutions from Mozambique (Universidade Eduardo Mondlane), Nepal (B.P. Koirala Institute of Health Sciences), Peru (Cronicas Centre of Excellence in Chronic Disease at the Universidad Peruana Cayetano Heredia) and Switzerland (University of Geneva, Geneva University Hospitals, Graduate Institute and the Università della Svizzera italiana) with a focus on improving the management of Noncommunicable (NCD) and Neglected Tropical diseases (NTD) at Primary Health Care (PHC) for vulnerable populations.

Rather than focus on the “what” of the project: NCDs, NTDs and PHC; or the “how”: mixed methods, co-creation, innovative, adapted interventions at the community level and active communication with a variety of stakeholders, the first blog post of the COHESION Project will be on the “who”.

So who is the COHESION Project? The core team is comprised of leading academics in the fields of public health, epidemiology, clinical medicine, economics, sociology, gender, social marketing, communication, and anthropology. With many years of experience in different settings and across disease areas, the COHESION Team brings together a unique group of people. The sum of these individuals is an exceptional team with a unique set of skills and experience.

How did this team come together? This team is brought together by long-standing working relationships, joint projects, membership of similar networks, but most importantly a shared vision of:

  1. Mutual learning
  2. A focus on the most vulnerable
  3. Health systems strengthening
  4. Robust design and evaluation of complex interventions

The proposal and its approach were developed by the whole team building on the needs of the most vulnerable populations in the three countries as well as on the skills and expertise of the country groups and their members. Together we agreed on the proposal and its approach and in doing so became a cohesive team and highly motivated to make the COHESION Project a success.

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