Addressing the double burden of disease:
Improving health systems for Non-communicable and Neglected Tropical Diseases

The Problem

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 Project

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.

Our Hypothesis and Objectives

Our hypothesis is that sustainable, gender and context appropriate interventions at policy, health system, and community level can be developed and integrated into PHC responses once there is a clear understanding of barriers and enablers of the diagnosis, management and care of NCDs and NTDs at each level.

Objective 1

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

Objective 2

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

Objective 3

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

Objective 4

Enable change in delivery of services for NCDs and NTDs at PHC through engaging policy makers, health professionals and communities throughout the project


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

Health Systems
Assessment of health systems in three countries using the Rapid Assessment Protocols (RAP)

Assess factors at the community and household level

Intervention Development
Develop interventions based on local and global evidence and a co-creation process

Intervention Implementation
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

Our COHESION video

Click on the left to watch our video about the double burden of NCDs and NTDs in low and middle-income countries

Why COHESION matters?

A few reasons from the lead persons in each country (more to come soon.)

Funding source

COHESION is funded by the Swiss National Science Foundation and the Swiss Development Cooperation under the Swiss Program for Research on Global Issues for Development.

Mandated by the federal government, the Swiss National Science Foundation (SNSF) supports basic science in all academic disciplines, from history to medicine and the engineering sciences. The SNSF is Switzerland’s foremost research funding organisation and supports approximately 8,500 researchers every year.

The Swiss Agency for Development and Cooperation (SDC) is Switzerland’s international cooperation agency within the Federal Department of Foreign Affairs (FDFA). The goal of development cooperation is that of reducing poverty. It is meant to foster economic self-reliance and state autonomy, to contribute to the improvement of production conditions, to help in finding solutions to environmental problems, and to provide better access to education and basic healthcare services.

The Swiss Programme for Research on Global Issues for Development (r4d programme) is a joint funding initiative by the Swiss Agency for Development and Cooperation (SDC) and the Swiss National Science Foundation (SNSF). The r4d programme supports research aimed at solving global problems with a focus on least developed, low and middle income countries.