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.

COHESION Publication: Gender & Development

Our most recent article by Claire Somerville and Khatia Munguambe was recently published in the journal Gender & Development. The publication entitled: The rise of non-communicable diseases (NCDs) in Mozambique: decolonising gender and global health is available at...

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r4d publication: Health Research Policy and Systems

A new publication from researchers of various r4d projects, including the COHESION Project, is available. The article entitled: How to bring research evidence into policy? Synthesizing strategies of five research projects in low-and middle-income countries, was...

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COHESION Publication: The BMJ

Our most recent publication in The BMJ discusses research processes in LMICs to strengthen co-production. The title of this contribution lead by D. Beran, PI of the COHESION Project, is "Rethinking research processes to strengthen co-production in low and middle...

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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


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 working Dr. 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


Our Activities

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

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.