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A nurse takes the blood pressure of an expectant mother at the Kuchigoro Primary Health Centre, Abuja.

NCDs in Humanitarian Settings

A knowledge hub presenting the key resources around NCDs in humanitarian settings accessibly in one place.

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About

The knowledge hub collates key resources to support the community of humanitarian organizations and academic institutions committed to improving the lives of people living with noncommunicable diseases in humanitarian settings.  The hub’s core team are members of the Centre for Global Chronic Conditions at LSHTM. The centre works in partnership with leading international NGOs, key UN agencies, and academic partners to improve NCD care delivery in humanitarian settings.

Resources and tools

The hub acts as a repository of resources and tools to support practitioners delivering and evaluating NCD care in fragile and conflict settings. We have included clinical, operational and training guidelines and tools, as well as monitoring, evaluation and research tools.

Research publications

We have gathered published research, reports, commentaries and opinion pieces related to NCDs in humanitarian settings. All items are open-access publications and the list will be continuously updated with emerging research to keep it relevant to the community.

Research projects

LSHTM undertakes implementation research and mixed methods evaluations, developing methods around the use of routine clinical data in the context of interrupted health care delivery. Current projects focus on diabetes, hypertension and cardiovascular disease, integrating mental and physical NCD care and the impact of Covid-19 on NCD care delivery. We also feature research projects undertaken by other organisations. 

About
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A nurse takes the blood pressure of an expectant mother at the Kuchigoro Primary Health Centre, Abuja.

The knowledge hub

The knowledge hub collates key resources to support the community of humanitarian organizations and academic institutions committed to improving the lives of people living with noncommunicable diseases in humanitarian settings. The repository includes materials, tools, publications and other resources to facilitate access, knowledge sharing and mutual learning amongst actors in the field. The knowledge hub is facilitated by the Global Centre for Chronic Conditions at LSHTM, with a cross-disciplinary core team.

The CGCC

The Global Centre for Chronic Conditions collaborates with partners to improve NCD care delivery in humanitarian crises, including fragile health systems, disaster and conflict settings. We aim to:

  1. Grow the knowledge base via pragmatic evaluations, implementation research, quasi-experimental and innovative approaches to research in fragile humanitarian settings
  2. Support practitioners designing and delivering NCD care in fragile health systems, disaster and conflict settings
  3. Work on innovative approaches to chronic care delivery in the setting of healthcare disruption
  4. Collate evidence, guidelines and tools to manage NCDs in humanitarian settings
  5. Convene different actors (academia, NGOs, UN agencies, governments)
  6. Engage in shared learning with partners and building research capacity as relevant

We work with academic partners in Lebanon, Jordan, Iraq, UK and US and with major international humanitarian NGOs and UN agencies. We undertake implementation research, mixed methods evaluations and have developed methodology around the use of routine clinical data in the context of interrupted health care delivery. The focus of our work is on diabetes, hypertension and cardiovascular disease, integrating mental and physical NCD care and the impact of Covid19 on NCD care delivery.

Partners and funders

The NCDs in Humanitarian Setting Special Interest Group of the Global Centre for Chronic Conditions at the London School of Hygiene and Tropical Medicine works with a variety of partners. These include humanitarian implementing organisations, academic institutions, UN bodies and funding bodies, such as the Global Alliance for Chronic Conditions and the private sector.

The knowledge hub is hosted and maintained by the CGCC at LSHTM. Seed funding for site development was provided by Novo Nordisk A/S. The funder has had no role in the design, selection of content or governance of the site.

American University of Beirut, Hawler Medical University, Health in Humanitarian Crises Centre, Centre for Global Chronic Conditions, Harvard Humanitarian Initiative, Geneva Centre of Humanitarian Studies, Global Alliance for Chronic Diseases, International Alliance for Diabetes Action, Medicines Sans Frontiers, United Nations, High Commissioner for Refugees, International Rescue Committee, International Committee of the Red Cross, Croix Rouge Libanaise, Danish Red Cross, and Novo Nordisk logos

 

Resources and tools
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Screening for diabetes, Kanyama clinic TB corner, Lusaka.

The knowledge hub has collated the following tools and resources for use by humanitarian actors and researchers. The list will be updated with new resources and tools continuously. Most resources are open access, while some may require consultation with the originator, as indicated.

Clinical and operational guidelines
Clinical and operational tools
Training materials and tools 
Monitoring, evaluation and research tools

This page is regularly updated with new resources. If you are aware of any materials that are missing from this page or would like to contribute your organisation’s tools, please contact Dr Éimhín Ansbro at eimhin.ansbro@lshtm.ac.uk.

Research publications
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This page collates key publications and reports on NCDs in humanitarian settings. We have structured these according to their main themes such as disease burden, access to care, models of care and NCD policy and strategy.  

Perspectives and commentaries
Reviews
Burden of disease
Access to care
Models of care
Research projects
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A family sat in a circle on the floor with medicine packets in the middle of them

LSHTM research projects 

NCD Care in Humanitarian Settings during Covid19 Disruption

This study aimed to support the continuation of primary health care delivery for people with hypertension and/or diabetes in humanitarian crises settings, in the context of Covid-19 and inform future similar healthcare delivery disruptions. With an advisory committee of humanitarian implementing organisations, we have identified priority service delivery approaches for maintaining access to care for people with hypertension and/or diabetes in low- and middle-income countries and humanitarian contexts. We have reviewed the evidence on factors affecting implementation processes and the effectiveness of these approaches. Via an online survey and follow-up interviews, we are collating experiences at the project level of adapting NCD service delivery to Covid-19 related disruption. 

CHANGE: Alcohol misuse and associated adversities among conflict-affected populations

CHANGE is a five-year multi-stakeholder research project which started in July 2020. It aims to address alcohol misuse and associated adversities among conflict-affected populations in Uganda and Ukraine. We seek to further develop Problem Management Plus (PM+). an evidence-based psychological intervention. We will complement PM+ by adding an additional psychological component addressing alcohol misuse. These country settings represent very different socio-economic, cultural and humanitarian characteristics and populations which supports understanding of the contextual influences on adapting and implementing PM+A. The comparison of outcomes and processes between the two sites will also help inform the future development and application of PM+A with other conflict-affected populations.

The GOAL partnership: Supporting government and partners in health system strengthening for better mental health of Syrian refugees and host communities in Lebanon

GOAL is a three-year multi-stakeholder research project which began in February 2020. The aim of GOAL is to support government and partners in strengthening the ability of health systems to meet the mental health needs of refugee and host communities affected by protracted displacement, focusing on Lebanon. GOAL consists of five Work Packages focusing on governance (transparency, accountability, and integrity), governance (participation), financing, and capacity strengthening. Co-production is also central to the GOAL approach, particularly involving the National Mental Health Program of Lebanon and mental health service users in the co-design and co-implementation of the project activities and outputs. We will also examine the benefits and challenges of co-production for the research in GOAL.

MSF Cardiovascular Polypill Implementation Study

The primary objective of this research project was to evaluate the implementation of treatment with a fixed-dose combination strategy for patients with ASCVD in a humanitarian refugee setting. It specifically assesses the impact on adherence and the acceptability, fidelity and sustainability, including costs, of this strategy. The research project utilises a mixed-method design with a prospective before and after study as well qualitative and descriptive costing components. The study sites were two MSF-run clinics in North Lebanon. The analysis is currently underway and will result in three papers submitted for peer-reviewed publication.

Partnership for Change (ICRC/DRC/Novo Nordisk) Models of care for NCDs in humanitarian settings

The research component of the partnership aims to review diabetes and hypertension services and gaps in humanitarian settings in LMICs and design an enhanced service delivery approach to support access to context-appropriate management and prevention activities for diabetes and hypertension. It consists of multiple streams, including a global assessment of existing evidence on models of care for hypertension and diabetes in humanitarian settings, a global review of expert opinions, and two case study assessments (in Lebanon and Iraq). The findings of these activities will inform the development of new approaches to diabetes and hypertension models of care and their evaluation in these settings.

STRENGTHS project: Scaling up psychological interventions with Syrian Refugees

The STRENGTHS project will train Syrian refugees to provide a mental health intervention called Problem Management+ (PM+) to fellow Syrian refugees. PM+ is developed by the WHO. It is a short programme that does not target a single disorder but the symptoms of common mental disorders. The STRENGTHS project will translate, adapt, test and implement the PM+ programmes Individual, Group, Early Adolescent Skills for Emotions (EASE) and an internet-delivered version. STRENGTHS will - in eight different countries in Europe and the MENA region - evaluate whether the intervention works, explore how it can be implemented in the specific context and whether it is cost-effective.

Mixed Methods Evaluation of MSF NCD Multidisciplinary Primary Care Service in Irbid, Jordan

This research project aimed to evaluate a primary care-based model of NCD care implemented by Medecins sans Frontieres in Irbid, Jordan in order to refine the model and to generate evidence on its feasibility, acceptability and effectiveness with a view to translating a similar model to comparable humanitarian settings. The study utilised a mixed-methods design based upon the RE-AIM framework. The data collection included a pre-existing cross-sectional health service access survey, routine cohort data, key stakeholder interviews and a medication adherence survey. The data were analysed using descriptive statistics, multivariate regression analysis, costing analysis and qualitative thematic analysis. The key findings included: the MSF programme is highly acceptable to patients, staff and stakeholders and is achieving good clinical outcomes. However, the costs are high, and it seems plausible to simplify the model of care for patients and staff. We proposed potential opportunities around referral pathways, task shifting, or the simplification of treatment.

Mixed Methods Evaluation of MSF integration of NCD care into general OPD and HIV/TB services at primary care level in Eswatini

MSF provided primary care services, HIV and TB programmes at a comprehensive clinic from 2011 to 2018 in Eswatini. With MOH collaboration, MSF integrated NCD care into general outpatient HIV and TB services in April 2016. The aim of the research project was to examine the processes, effectiveness and costs in order to strengthen the service, facilitate handover to another NGO and inform MSF and MOH policy and scale-up. We undertook a retrospective evaluation of routine facility-level data. This comprised: care model description; routine cohort data; and incremental costing analysis. The main research conclusion was that NCD care could be integrated into an HIV department and OPD setting and could achieve acceptable intermediate clinical outcomes and retention rates at a cost that was similar to HIV programmes. We proposed ways for improving the model of care around the themes of supply chains, counselling, advocacy and collaboration.

Support and Evaluation of MSF Diabetes Outpatient Services in Mweso Hospital, DRC

MSF implemented an Integrated Diabetic Clinic within the Outpatient Department in North Kivu, Democratic Republic of Congo. We examined the effectiveness of this diabetes programme, the challenges and facilitators, and the lessons learnt from implementation that could be generalised to comparable settings. A retrospective cohort study of routine data from patients enrolled in the programme from January 2014 to February 2017 was undertaken and complemented by a descriptive costing analysis as well as focus group discussions and semi-structured qualitative interviews. The implications of the study findings were the observed deterioration in clinical target attainment during periods of service disruption due to insecurity highlighted the need for diabetes programmes in insecure settings to engage in emergency preparedness, including prioritising a sustained medication supply. The qualitative findings emphasized the importance of community awareness of diabetes and the value of treatment support. The costing results indicated that increased efficiencies in terms of supply use and patient throughput can reduce unit costs. 

Partner research projects

Rights Based Self Learning to Promote Mental Health after Disasters
This study will test a hypothesis that these e-tools on psychosocial support as well as rights of persons with mental or psychosocial disabilities can increase knowledge on mental health and disability, as well as resilience to disaster.

Refugee Emergency: (RE-DEFINE)
Refugee Emergency: Aim is to adapt, test and implement the Self Help Plus (SH+), a novel trans-diagnostic self-help preventive psycho social intervention developed by WHO to prevent the onset of mental disorders in refugees and asylum seekers resettled in middle-income and high-income countries.

Core team

These are the core people working on NCDs in humanitarian settings across the different departments and faculties at LSHTM.

Team Block

Pablo
Perel

Professor

Eimhin
Ansbro

Research Fellow

Adrianna
Murphy

Assistant Professor

Ruth
Willis

Research Fellow

David
Prieto-Merino

Associate Professor

Daniela
Fuhr

Associate Professor

Alessandro
Massazza

Research Fellow

Michelle
Lokot

Research Fellow

Ruwan
Ratnayake

Research Degree Student

Caroline Favas

Benjamin
Schmid

Research Assistant
Events
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Past events

MSF Scientific days. Médecins Sans Frontières. Conference, 2021.

MSF Scientific Days bring together researchers, practitioners, academics and patient representatives to catalyse improvements in the quality of care provided to patients and communities at risk. The presentations include a wide range of subjects, including non-communicable disease care.

Caring for people with NCDs in humanitarian settings during the COVID-19 pandemic. Ready Initiative. Webinar, 2020.

In this webinar, experts from humanitarian organizations and the World Health Organization shared their experiences with challenges, current responses, lessons learned, and the pending agenda for non-communicable diseases in COVID-19.

2nd Annual Symposium on Diabetes in Humanitarian Crisis. Harvard Humanitarian Initiative, London School of Hygiene & Tropical Medicine, International Alliance for Diabetes Action, Brigham and Women’s Hospital. Symposium, 2020.

This 2nd Annual Symposium on Diabetes in Humanitarian Crises followed up on the progress that has been made over the past year since the Boston Declaration. Discussions covered major global events of the past year that changed the humanitarian health agenda, and a way forward.

1st Annual Symposium on Diabetes in Humanitarian Crisis. Harvard Humanitarian Initiative, London School of Hygiene & Tropical Medicine, International Alliance for Diabetes Action, Brigham and Women’s Hospital. Symposium, 2020.

In April 2019, Harvard University convened a meeting in Boston with humanitarian and other organizations in global health to discuss the immediate needs and barriers to tackling diabetes in humanitarian crises and push a unified agenda. The meeting resulted in the Boston Declaration which was signed by 64 signatories from over 40 international organizations.

Chronic care in humanitarian crises. International Committee of the Red Cross (ICRC), the Danish Red Cross, Novo Nordisk, London School of Hygiene & Tropical Medicine. World Health Assembly 19 side-event, 2019.

As a WHA72 side-event, the impact partnership between the ICRC, DRC and Novo Nordisk brought key stakeholders together in a panel discussion to explore the current state of NCD care in humanitarian settings. Moderator: Pablo Perel.

Fixed Dose Combination Pills for NCDs Symposium. George Institute for Global Health, London School of Hygiene & Tropical Medicine, Médecins sans Frontières. Symposium, 2018.

This international symposium brought together experts working on fixed-dose combinations for CVD and hypertension together with experts working in the fields of HIV and TB, as well as representatives from governmental, non-governmental organizations, civil society, industry and funders. The aim was to provoke a lively discussion around the barriers, next steps, and an agenda for further research, advocacy and policy change.