Addressing the Double Burden of Disease:
Improving Health Systems for Non-Communicable
and Neglected Tropical Diseases
Low and middle-income countries are confronting a change in the diseases they face with decreasing burden due to viruses and bacteria but more with diseases linked to changes in lifestyle. This means that health systems now need to manage a diverse range of diseases with most of the burden of treatment needing to focus on poor and vulnerable populations. The chronic nature of NCDs and NTDs is a burden on individuals and families in terms of lost productivity, cost of care, disability, death, and stigma. Women are particularly vulnerable given the social, gender and economic inequalities.
The COHESION project is addressing health challenges faced in low and middle-income countries related to neglected and tropical diseases (NTDs) and non-communicable diseases (NCDs).
Funded by SNSF and SDC’s Research for Development programme, COHESION is led by Dr. David Beran of the Geneva University Hospitals and the University of Geneva in collaboration with partners in Mozambique, Nepal and Peru as well as the Graduate Institute in Geneva and the Università della Svizzera italiana in Lugano.
1st COHESION blog post: Dr. David Beran explains “who is the COHESION Project”read more
COHESION team members; Dr. Claudia Rutte, SNF r4d Project Coordinator; Prof. Dr. Joanna Schellenberg and Dr Andrew Cassels, SNF r4d Advisors met for a first site visit to Nepal from November 27th to December 2nd 2017. The goal of the one-week meeting was to share...read more
The SDC Health Network just published in January Newsletter and it includes a story about COHESION. On behalf of the project, David Beran describes “Tackling NCDs and NTDs: the COHESION approach to addressing the SDGs”. He states: “The COmmunity HEalth System...read more
At the beginning of November 2017, COHESION presented the results of its global policy analysis on NCDs at the annual symposium of Medicus Mundi Switzerland entitled «No business as usual against non-communicable diseases » (see here). The aim of this year's symposium...read more
Our Hypothesis and Objectives
Assess the barriers, enablers and lessons for the management of NCDs and NTDs from the policy, health system and community levels to support a PHC response for NCDs and NTDs
Develop and test a package of scalable, sustainable, gender and context appropriate interventions at policy, health system and community levels to support PHC responses to NCDs and NTDs
Develop a plan for scaling up interventions based on the proof of principles resulting from the evaluation of the impact of the interventions and the implementation of this project
Enable change in delivery of services for NCDs and NTDs at PHC through engaging policy makers, health professionals and communities throughout the project
Why COHESION Matters?
A few reasons from the lead persons in each institution:
As we start the era of the Sustainable Development Goals, two health areas neglected by the Millennium Development Goals need to be addressed, namely NTDs and NCDs. These conditions impact the poorest of the poor and require a complete understanding of health systems and local contexts in order to develop effective interventions. I believe that we have assembled a unique multi-disciplinary team across the four partner countries to be able to truly impact the health and well-being of the communities where we will be workingDr. David Beran
The gendered dimensions of both NCDs and NTDs have long been overlooked and COHESION research will address this gap with a wide-angled gender lens beginning with fully disaggregated data. From the household to the healthcare system gender matters for health outcomes; not only for women and men as patients and system users, but also as carers and employees. Nearly 80% of the world’s health workers are women! COHESION contributes to the SDG health goal and will provide data and analyses that feed into achieving Goal 5- The gender equality goal.Dr. Claire Somerville
COHESION will be particularly important for Mozambique where NCDs and NTDs, although recently recognized as proprietary areas of interest by the Ministry of Health still have to compete at the primary health care level with HIV AIDS, Malaria and TB that for some time have received much more attention. This project will allow us to identify constrains and gaps found in the field and will be important to move forward.Prof. Dr. Albertino Damasceno
Communication is at the core of all of COHESION research activities, including stakeholder engagement, data collection, co-creation of interventions, and the dissemination of our efforts and results. I am delighted to lead the communication activites of COHESION, in partnership with an amazing team of dedicated public health scientists who aim to make equitable and sustainable access to health and heathcare for all.Prof. Dr. Suzanne Suggs
Any person suffering from NTD or NCD needs better quality care from one door in existing primary health care delivery system. COHESION will assist in helping the marginalized & poor people with regard to these health issues.Prof. Dr. Nilambar Jha
For any given individual, when you approach the healthcare system, you expect a service of quality. Whether you have an NTD or an NCD, as a user, you expect a great service. Both conditions can allow us to learn from their chronicity. Instead of rediscovering the wheel, COHESION will allow us to learn between and across fields, NCDs and NTDs.Dr. Jaime Miranda
COHESION uses multiple research methods to assess: global and national policies; national, urban/peri-urban and rural health systems; and community barriers and enablers to care for different diseases. This will enable interventions to be developed and tested that address the challenges identified. They will be developed in partnership with local stakeholders taking into account issues of culture and gender.
Analysis at Global, National and local levels including content, context, process and actors
Assessment of health systems in three countries using the Rapid Assessment Protocols (RAP)
Assess factors at the community and household level
Develop interventions based on local and global evidence and a co-creation process
Implement interventions in each country at the policy, health system, and community levels
Evaluate effectiveness of project and of the interventions including a plan for scaling up