Moving from formative research to co-creation of interventions: insights from a community health system project in Mozambique, Nepal and Peru.

Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach

Integrated health systems for chronic disease management: lessons from Type 1 diabetes in Low Income Settings

This thesis is a review of a series of articles looking at different aspects of diabetes management in low and middle incomes countries. From the lessons learnt this work aims to develop a model for integration of diabetes and chronic diseases

Developing a hierarchy of needs for Type 1 diabetes

The aim of this study was to use the concept of Maslow’s hierarchy of needs and apply this to Type 1 diabetes

Accès aux soins et aux traitements pour le diabète en Afrique : défis et opportunités

L'accès aux médicaments est un élément clé pour le traitement du diabète. L'accès reste problématique en raison de leur prix, de la disponibilité et si les médicaments sont abordables. Deux éléments inclus dans les objectifs du développement durable – la couverture sanitaire universelle (CSU) et les partenariats –, offrent une opportunité pour améliorer l'accès

Accès à l’insuline : le(s) rôle(s) des gouvernements

L’accès à l’insuline est complexe. L’Organisation mondiale de la santé (OMS) propose un cadre pour mieux comprendre cette complexité qui comprend : recherche, développement et innovation ; production ; réglementation ; mise sur le marché, détermination du prix et remboursement ; achat et approvisionnement ; prescription ; dispensation ; et utilisation. Pour chacun de ces aspects, les gouvernements jouent un rôle essentiel en garantissant la régulation et des ressources suffisantes. Une action concertée est nécessaire pour garantir l’accès à l’insuline, aux soins à un prix abordable, et aussi pour veiller à ce que les programmes et les interventions des gouvernements tiennent compte des besoins des personnes vivant avec le diabète. Les gouvernements ont également un rôle à jouer comme contrepoids au secteur privé. Une collaboration avec différents acteurs, y compris la société civile, est nécessaire, avec la mise en place de réseaux et d’espaces d’échange.Access to insulin is complex requiring global and national factors to be considered. The World Health Organization (WHO) proposes a framework to disentangle this. This includes: research & development and innovation; manufacturing; regulatory aspects; selection, pricing and reimbursement; procurement and supply; prescribing; dispensing; and use. For each of these, governments can play an essential role in guaranteeing an adequate allocation of resources as well as ensuring that diabetes care is properly structured within health systems. Concerted action is needed to guarantee access to affordable insulin and care and to ensure that the various needs of people with diabetes are included in government programs and interventions. Governments also have a role to play in being a counterweight to the private sector, working closely to establish networks and possibilities for exchanges between different actors including the civil society

Non-communicable diseases in Mozambique: risk factors, burden, response and outcomes to date

Mozambique is located on the East Coast of Africa bordering South Africa, Zimbabwe, Zambia, Malawi and Tanzania and is one of the poorest countries in the world. Currently NCDs account for 28% of deaths in Mozambique. Risk factors such as tobacco and alcohol use and poor diet are present in both urban and rural settings. Diseases such as hypertension and diabetes affect large proportions of the population, but people are often unaware of their condition or poorly managed. Data from studies on diabetes highlight the financial burden for NCD management in Mozambique for both the individual and health system. The National Strategic Plan for the prevention and control of NCDs in Mozambique has as its aim to create a positive environment to minimise or eliminate the exposure to risk factors and guarantee access to care. The plan has as its overall objective to reduce exposure to risk factors and morbidity and mortality due to NCDs and has 4 areas of intervention: 1) Prevention and health education with regards to NCDs; 2) Access to quality care, treatment and follow-up; 3) Prevention of disability and premature mortality and 4) Surveillance, research, monitoring and evaluation and advocacy for NCDs. The Ministry of Health developed projects for diabetes and hypertension and used these as key lessons that could then be applied to other NCDs. Mozambique, through political commitment from the Ministry of Health and the dedication of local champions, has been able to garner international support to improve care for people with diabetes and then use this to develop its National Plan for NCDs. Despite this increase in attention resources available do not match the challenge of NCDs in Mozambique. Mozambique's experience provides a practical example of actions that can be undertaken in a resource poor country to tackle the emerging burden of NCDs