TY - JOUR
T1 - Opportunities and challenges to non-communicable disease (NCD) research and training in Pakistan
T2 - A qualitative study from Pakistan
AU - Almas, Aysha
AU - Awan, Safia
AU - Bloomfield, Gerald
AU - Nisar, Muhammad Imran
AU - Siddiqi, Sameen
AU - Ahmed, Asma
AU - Ali, Asad
AU - Shafqat, Saad Hameed
AU - Bhutta, Zulfiqar Ahmed
AU - Mark, Daniel Benjamin
AU - Douglas, Pamela
AU - Bartlett, John
AU - Jafar, Tazeen H.
AU - Samad, Zainab
N1 - Funding Information:
Our study generates new knowledge and highlights important addressable barriers and opportunities that if fully leveraged will lay down the foundation of a future robust NCD training programme at leading institutions in Pakistan that have the necessary infrastructure to train the next generation of NCD researchers. The long-term sustainability of such programmes requires government support and investment. Also, these findings serve as a guide map for other LMICs that face a similar challenge in tackling the NCD burden, in developing research career paths in NCDs. We also call on international funding agencies like the Gates Foundation, Medical Research Council, National Institutes of Health, Wellcome Trust and others to support NCD projects in Pakistan.
Funding Information:
This study was funded by NIH-Fogarty Center D71 Planning Grant (grant number: 1D71TW011184-01).
Funding Information:
The United Nations General Assembly has placed NCDs high on the global health policy agenda and reiterated the responsibility of governments to tackle the NCD crisis by developing adequate national policy responses. Recently, the Lancet NCDs and Injuries Poverty Commission concluded that national governments should set and adjust priorities based on the best available local data on NCDs and address the needs of those NCDs which constitute the major threat. Even though all countries are signatories to this declaration, most LMICs like Pakistan are not adequately prepared to address this rising threat. Back in 2004, a National Action Plan for Prevention and Control of Non-communicable Diseases and Health Promotion in Pakistan was developed using a public–private partnership model. But data on its implementation and success are scarce and implementation of such programmes has become more challenging during the COVID-19 pandemic. On the other hand, the pandemic has also opened opportunities for collaboration between policymakers, researchers and NGOs. An NCD survey conducted in 2014 demonstrated a high prevalence of hypertension and risk factors such as physical inactivity, poor diet and smoking. Yet, to date NCDs are not mentioned in the list of priority diseases by the National Institutes of Health, Pakistan. The total health expenditure of 2.6% of the GDP or approximately US$45 per capita is a clear indication of the level of underspending and the need for enhanced funding to address the NCD burden in Pakistan. Besides lack of stable governance with consistent focus, limited resources, weak health systems and poor national capacity, a critical missing piece in the national NCD response in Pakistan is a skilled research workforce. This dearth has been recognised at the national level as it severely constrains Pakistan’s capacity to effectively address the NCD epidemic. Additionally, the focus on NCD research funding to LMICs like Pakistan in the last three to four decades has been very low compared with the size of the problem. Limited funding opportunities are available within universities and through the Higher Education Commission, Pakistan Science Foundation and the Ministry of Science and Technology at the national level. Also, a few international funding agencies such as the National Institutes of Health-Fogarty, Wellcome Trust UK and International Diabetes Federation have funded NCD-based projects in Pakistan. But more national and international funding bodies need to reprioritise funding for NCD research based on public health needs.
Funding Information:
ZS has receioved funding from Bill & Melinda Gates Foundation (INV-021944, INV-050389) Fogarty International Center of the National Institutes of Health (D43TW011625); NIHR, UK; Yale University; Duke University; Certara Inc; PHRI.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/12/19
Y1 - 2022/12/19
N2 - Introduction Most of the global non-communicable disease (NCD)-related death burden is borne by low and middle-income countries (LMICs). In LMICs like Pakistan, however, a major gap in responding to NCDs is a lack of high-quality research leading to policy development and implementation of NCDs. To assess institutional opportunities and constraints to NCD research and training we conducted a situational analysis for NCD research and training at Aga Khan University Pakistan. Methods We conducted a descriptive exploratory study using grounded theory as a qualitative approach: semistructured interviews of 16 NCD stakeholders (three excluded) and two focus group discussions with postgraduate and undergraduate trainees were conducted. A simple thematic analysis was done where themes were identified, and then recurring ideas were critically placed in their specific themes and refined based on the consensus of the investigators. Results The major themes derived were priority research areas in NCDs; methods to improve NCD research integration; barriers to NCD research in LMICs like Pakistan; design of NCD research programme and career paths; and NCD prevention at mass level, policy and link to the government. In general, participants opined that while there was an appetite for NCD research and training, but few high-quality research training programmes in NCDs existed, such programmes needed to be established. The ideal NCD research and training programmes would have in-built protected time, career guidance and dedicated mentorship. Most participants identified cardiovascular diseases as a priority thematic area and health information technology and data science as key methodological approaches to be introduced into research training. Conclusion We conclude from this qualitative study on NCD research and training that high-quality research training programmes for NCDs are rare. Such programmes need to be established with in-built protected time, career guidance and mentorship for the trainees to improve their research capacity in Pakistan.
AB - Introduction Most of the global non-communicable disease (NCD)-related death burden is borne by low and middle-income countries (LMICs). In LMICs like Pakistan, however, a major gap in responding to NCDs is a lack of high-quality research leading to policy development and implementation of NCDs. To assess institutional opportunities and constraints to NCD research and training we conducted a situational analysis for NCD research and training at Aga Khan University Pakistan. Methods We conducted a descriptive exploratory study using grounded theory as a qualitative approach: semistructured interviews of 16 NCD stakeholders (three excluded) and two focus group discussions with postgraduate and undergraduate trainees were conducted. A simple thematic analysis was done where themes were identified, and then recurring ideas were critically placed in their specific themes and refined based on the consensus of the investigators. Results The major themes derived were priority research areas in NCDs; methods to improve NCD research integration; barriers to NCD research in LMICs like Pakistan; design of NCD research programme and career paths; and NCD prevention at mass level, policy and link to the government. In general, participants opined that while there was an appetite for NCD research and training, but few high-quality research training programmes in NCDs existed, such programmes needed to be established. The ideal NCD research and training programmes would have in-built protected time, career guidance and dedicated mentorship. Most participants identified cardiovascular diseases as a priority thematic area and health information technology and data science as key methodological approaches to be introduced into research training. Conclusion We conclude from this qualitative study on NCD research and training that high-quality research training programmes for NCDs are rare. Such programmes need to be established with in-built protected time, career guidance and mentorship for the trainees to improve their research capacity in Pakistan.
KW - CARDIOLOGY
KW - DIABETES & ENDOCRINOLOGY
KW - PUBLIC HEALTH
UR - http://www.scopus.com/inward/record.url?scp=85144307522&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2022-066460
DO - 10.1136/bmjopen-2022-066460
M3 - Article
C2 - 36535721
AN - SCOPUS:85144307522
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 12
M1 - e066460
ER -
