Center for Methods in Implementation and Prevention Science (CMIPS) researchers Archana Shrestha, PhD, Associate Professor at Kathmandu University School of Medical Sciences and Director of Nepal’s Institute for Implementation Science and Health, CMIPS Director Donna Spiegelman, ScD, and Elizabeth Rhodes, PhD, Postdoctoral Associate at the Yale School of Public Health, were recently awarded a grant from the Fogarty International Center at the National Institutes of Health for their study entitled “Building Capacity to Evaluate a Package of Essential Non-Communicable Disease Interventions (PEN) in Nepal,” which will train health coordinators, evaluate implementation outcomes, and explore facilitators and barriers to the PEN program’s implementation.
In 2016, the government of Nepal adopted the World Health Organization’s PEN program, which includes population and individual-level strategies to address non-communicable diseases (NCD), the leading cause of premature death and disease burden globally, in low-resource settings. Dr. Shrestha recognized that PEN was not being properly evaluated, which limited its impact and proper scalability. “For me, it was an alarm,” she said. “We should be able to know what this program is actually doing. This is the only program that is designed and implemented for NCDs in Nepal.” Seeking to generate data on PEN’s feasibility, acceptability, and sustainability, Dr. Shrestha reached out to her colleagues, Drs. Spiegelman and Rhodes of CMIPS, as experts in qualitative and quantitative public health research and training.
This grant will strengthen the Nepal government’s limited resources by increasing the capacity of primary health care workers through training to implement, monitor, and evaluate PEN, currently targeting diabetes, stroke, hypertension, cancer, and chronic respiratory diseases. As Dr. Shrestha explained, “Our Nepali counterparts have embraced this project as their own. It's a really great opportunity for us to have such a close collaboration.” In the second phase, the study will evaluate 16 pilot districts, estimating acceptability, adoption, feasibility, fidelity, penetration, cost, and sustainability. Dr. Rhodes emphasized that the study exemplifies “the strength of CMIPS in the development and application of innovative methods for implementation science.” By identifying facilitators and barriers to implementation from the provider and client perspectives, this evaluation will be able to suggest modifications to the processes of NCD programs like PEN across health systems in Nepal.
“This grant provides us at CMIPS an exceptional opportunity to deepen our ties to our Nepali counterparts, strengthen our collaborative footprint in South Asia, and address global health inequities with respect to non-communicable diseases in this low-income but rapidly developing country,” Dr. Spiegelman noted.
Drs. Shrestha, Spiegelman, and Rhodes hope to collaborate further with Nepal on the national level as the grant opens avenues for health program evaluation, new health policies, and new health programs within the Ministry of Health. Their implementation study is the latest example of the capacity and commitment of CMIPS researchers to implement novel study designs to identify effective intervention strategies in resource-constrained settings.