Dubai

Harvard Medical School Center for Global Health Delivery — Mohammed Bin Rashid Academic Medical Center Building 14 Healing Life. Dubai Healthcare City Dubai,

MAILING ADDRESS Delivering Care. PO Box 505276 Dubai, United Arab Emirates BUILDING AN ECOSYSTEM FOR CHANGE OFFICE +971 4 422 1742 2016–2018 EMAIL [email protected]

Boston

Harvard Medical School Center for Global Health Delivery—Dubai 641 Huntington Avenue Boston, Massachusetts 02115

OFFICE +1 617.432.0088 EMAIL [email protected]

GHD-DUBAI.HMS.HARVARD.EDU

A CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. B PHOTO: SHEHZAD NOORANI SHEHZAD NOORANI PHOTO: Contents

INTRODUCTION 3 Welcome Letter 5 About Us

APPROACH AND STRATEGY 7 Our Approach 8 Our Mission 10 Highlights

RESEARCH 12 Faculty Research Contracts 15 Cooperative Research Award Program

EDUCATION 34 Workshops and Symposia 36 Courses 38 Scholars 42 Awards 43 Interns

OUR PROGRESS 44 Looking to the Future 46 Our Global Footprint

ABOUT US 48 Faculty 50 Steering Committee, Senior Advisors, Harvard Medical School Advisory Committee, Leadership Team, and Staff

C CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 1 INTRODUCTION

Dear Friends,

The Harvard Medical School Center for Global Health Delivery—Dubai has been created with the express aim of building a robust ecosystem of researchers and practitioners committed to addressing the gap in delivery of high quality health care to individuals in the communities where they live and work.

This gap is a translation gap: academic medical centers have As we mark the end of the fourth year of activities for the excelled in translating laboratory findings into clinically Harvard Medical School Center for Global Health Delivery— useful tools; but we have had limited success in the next step Dubai, we remain committed to our aim of strengthening of translation, which is ensuring that individuals, families, the ecosystem of people thinking about how to better deliver and communities with health needs have access to the fruits heath care to individuals, families and communities suffering of modern medicine. Unsurprisingly, this care-delivery gap from preventable and treatable diseases. Our conviction is exists across disease groupings—from diabetes, obesity, that people, rich or poor, in both the east and the west, deserve mental health, hepatitis C, and tuberculosis to access to timely high quality, affordable care, so that they can reach their full surgical care — and across geographies ranging from Dubai human potential. We have put this report together to share to Boston, and from Cape Town to Beijing. with you a number of important milestones as we pioneer our unique model to foster change. Dubai is an important global crossroads and hub for innovation. The aim of our Center was to develop a program The challenges we face in global health delivery can be in Dubai that would draw from the spirit on which Harvard solved, but will require progress in our thinking about health, University was founded—the pursuit of knowledge and care-giving, care-delivery, and the systems through which the betterment of human kind—and Dubai was built— those who need health care are able to access it. Achieving as a crossroads for innovation and human development. this will require progress in both our understanding of how In order to achieve this goal, we specially designed a social to better deliver health care to those in need, and moral clarity strategy that would foster change in the way care is delivered. about viewing health as an inalienable human right. In the We created a mechanism to link Harvard researchers with UAE, 2018 is the “year of Zayed,” or year of giving, in honor local practitioners and scientists so that they could work of Sheikh Zayed Bin Sultan Al Nahyan, the UAE’s founder. together to ask important questions and generate new A visionary thinker who placed a great deal of emphasis on knowledge around the myriad delivery gaps being faced. education and social development, Sheikh Zayed recognized To date, we have funded more than five million dollars of that, “No matter how many buildings, foundations, schools cooperative research awards from our Center. We have also and hospitals we build… all these are material entities.” offered more than 100 scholarships to individuals in the UAE Instead, he said, “The real spirit behind progress is the human and the region to study in Harvard programs that are designed spirit, the able man with his intellect and capabilities.” As we to increase capacity to conduct important research on health enter 2018, we honor this vision, and strive for a world where OUR PROGRESS delivery. Through our workshop series, we also have brought all people have the opportunity to achieve their full potential. together more than 1,500 scientists, practitioners and policy makers to translate state-of-the-art knowledge about care We hope you share in our collective achievements as we delivery into policies. work together to improve health care-delivery globally. We are eager for your input and your engagement. “The challenges we face in global health delivery can be solved, but will require progress in our thinking about health, care-giving, SALMAAN KESHAVJEE, MD, PhD care-delivery, and the systems through which those who need Director, Harvard Medical School Center health care are able to access it.” for Global Health Delivery—Dubai SALMAAN KESHAVJEE, MD, PhD Professor of Global Health and Social Medicine

HEALING LIFE. DELIVERING CARE. 3 INTRODUCTION

Center for Global Health Delivery

The Harvard Medical School Center for Global Health Delivery—Dubai is addressing some of the most pressing health challenges in the region by focusing on research, medical education, and training. These activities together promise to improve health care delivery systems and patient outcomes for diseases prevalent in the United Arab Emirates, Middle East, North Africa, and neighboring regions in Africa, Asia, and Europe. The Center, established by Harvard Medical School in Boston and Dubai in 2014, is a hub for training, research, analysis, and policy formation that optimizes the last phase of health care delivery, ensuring that care providers have the systems and tools necessary to alleviate human suffering caused by disease.

ABOUT US

4 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 5 APPROACH AND STRATEGY

OUR APPROACH Driving Change in Global Health Care Delivery

We build capacity with the aim of improving health care delivery in diverse communities where people live and work. Through research, education, and collaboration, we are addressing some of the most pressing health care delivery challenges facing our world today. We do this with a focus on disease areas that are emblematic of the challenges faced in delivering high quality health care.

STEP 1 STEP 2 Training is vital to our Our approach relies efforts to build capacity s D on a unique model of for better health care her eli accompaniment—pairing rc ve delivery research and a ry regional investigators se R implementation. e e with Harvard faculty. R s e g a n i r c n i h a r

T

Lifecycle of

Improving Global

Health Delivery

P o l i c y s p F o o h rm s a rk ti o on W

STEP 4 STEP 3 Policy drives local and national Expertise is exchanged, connections governments to take action on are made, and blueprints for progress specific health care delivery topics. are disseminated.

6 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 7 OUR MISSION ALLEVIATE HUMAN SUFFERING

Harvard Medical School’s mission is “to create and nurture a diverse community of the best people committed to leadership in alleviating human suffering caused by disease.” The Center fulfills this mission through a focus on optimizing the last phase of health care delivery.

8 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 9 APPROACH AND STRATEGY

Dr. Ammar Albanna and his team conduct a workshop on ADHD for medical doctors at Al Jalila Children’s Specialty Hospital, Dubai.

TO DATE, THE CENTER HAS AWARDED 81 Scholarships + Fellowships

To Harvard students, students from the UAE and the Center’s region

$1.6 million Funds awarded

HIGHLIGHTS These awards have included funding for the Harvard Medical School MMSc Program in Global Health Delivery, Harvard T.H. Chan School of Public Health Masters of Public Health, the Global Health Delivery Building a knowledge Since our founding in 2014, the Harvard Medical School Center for Global Health Intensive summer program, the Program in Clinical ecosystem is critical Delivery—Dubai has been catalyzing a movement to translate knowledge into systems, Effectiveness, and scholarships for Harvard Medical to Harvard Medical tools, and policies that improve the last phase of health care delivery around the world. School and Harvard University scholars to study in School’s mission and the the region, as well as Global Education programs. THE CENTER CURRENTLY HAS In keeping with Harvard Medical School’s mission, ‘to create and nurture a diverse cornerstone of our work. community of the best people committed to leadership in alleviating human suffering 19 Cooperative Awards caused by disease’ the Center addresses some of the most pressing health challenges, + 6 Faculty Awards assists with building local and regional research capacity through research and education, and advances the global health care delivery equity agenda by creating Research an environment where the best minds can come together to challenge the status quo. Projects 25 Underway

IN THE PAST 48 MONTHS, THE CENTER HAS HOSTED $5.4 million Workshops Funds awarded 40 + Symposia Attendees

Major 2,685 10 Courses

During TB patient’s visit for contact investigation and post-exposure therapy initiation, a doctor checks patient’s digital x-rays and enters her observations on a tablet at the Indus Hospital in Karachi, Pakistan.

10 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 11 RESEARCH

MERCEDES BECERRA, SCD

Tuberculosis kills more adults worldwide than any other infectious disease. And, although it has been treatable for years, rising levels of drug-resistant tuberculosis pose an ever-growing threat. By identifying, treating, and monitoring household contacts BYRON GOOD, PhD of patients diagnosed with drug-resistant tuberculosis at Pakistan’s Indus Hospital, this study will test the effectiveness of preventive therapy in children and adults who have been exposed to MARY-JO DELVECCHIO GOOD, PhD drug-resistant tuberculosis and who are at risk for developing tuberculosis disease. Moreover, it will illuminate the feasibility of preventive therapy implementation in a programmatic setting. Yogyakarta, Indonesia, with a population of nearly 3.5 million people, is a middle-income province with a rich set of universities, ghsm.hms.harvard.edu/person/faculty/mercedes-becerra public and private hospitals, and a public health system. However, its small pool of psychiatrists and lack of integrated mental health services severely hinder its ability to serve the mentally ill. This study—which is linked to a larger program attempting to build In 2014, the Center awarded grants to three faculty members from Faculty comprehensive service systems in five primary health care the Harvard Medical School Department of Global Health and Social ­­­centers—endeavors to construct and evaluate culturally compatible Medicine to conduct health care delivery research in the region alongside JOHN G. MEARA, MD, DMD, MBA models for improving services for people with a psychotic illness in Research local project investigators. In 2017, two additional grants were awarded. settings with extremely limited resources. As a result, it will help to increase the percentage of people with psychotic illness that This work is establishing the Center’s reputation as a global innovation A surgical site infection (SSI) is a wound infection that occurs at a surgical incision and is common in countries around the receive regular, appropriate care. Contracts hub, strengthening the region’s research ecosystem, and addressing world. Although SSI rates are declining in high-income settings, ghsm.hms.harvard.edu/person/faculty/byron-good some of the world’s most pressing health problems. low-income countries continue to suffer from high rates of infection. ghsm.hms.harvard.edu/person/faculty/mary-jo-good Furthermore, post-operative screenings for SSIs can be difficult, time-consuming, and expensive for patients and health care systems where resources are limited. This project evaluates the validity STUDY LOCAL PI HARVARD PI AFFILIATION and predictive value of patient SSI self-assessment tools and health Patient Monitored Assessment of SSI: A Pilot Study Lubna Samad John Meara worker screenings in an effort to identify safe, effective, simple, and time-saving methods of diagnosis. Findings could preserve health Pakistan NORMA WARE, PhD care resources and, more importantly, decrease patient morbidity. Tracking the Lancet Indicators in a LMIC Setting Lubna Samad John Meara

The goal of tracking the Lancet indicators in a LMIC setting is to The development of strategies to make quality health services Time Driven Activity Based Costing (TDABC) Hamidah Hussain John Meara track four of the six global surgery indicators recommended by available to isolated, high-risk populations without access to the Lancet Commission on Global Surgery (LCoGS): access to a health facilities remains a major challenge for health care delivery surgically-capable facility (indicator 1), surgical workforce density in low-resource settings. A prime example is the 1.25–1.5 million Screening and Treatment of Children and Adults Hamidah Hussain Mercedes Becerra (indicator 2), and the financial burden of seeking surgical care people living in fishing communities scattered across the islands Exposed at Home to Drug-Resistant TB (indicators 5 and 6). By assessing these indicators in the Pakistani and shores of Lake Victoria—in Tanzania, Uganda, and Kenya. context, we hope to describe and evaluate the surgical care seeking The health of people living in East African fishing communities experience of the population and the infrastructural, human has attracted attention recently as the high prevalence and incidence STUDY LOCAL PI HARVARD PI AFFILIATION resource, and financial barriers they face when seeking surgical care. of HIV infection in these communities has been revealed. This project aims to deliver basic health services to residents of fishing Building a Model for Comprehensive Mental Subandi and Byron Good, Mary-Jo Sometimes surgical interventions are more affordable and effective Health Care in Yogyakarta, Indonesia Carla Marchira Delvecchio Good communities bordering Lake Victoria in Kisumu County, Kenya. than non-operative management. This is often the case for total knee Indonesia The project draws on a “differentiated care” model of HIV service arthroplasty (TKA), or knee replacements. Nevertheless, perceived delivery for low-resource settings that emphasizes adapting high costs have led to rationed services at Pakistan’s Indus Hospital, and simplifying the organization of services to meet the varying STUDY LOCAL PI HARVARD PI AFFILIATION where patients routinely wait five years for TKA. In an effort to prove needs of recipients. and improve the value of TKA delivery at Indus, this study maps the Delivering Health Services to Lake Victoria Fishing Elizabeth Bukusi, Norma Ware Communities in Kisumu County, Western Kenya: Zachary Kwena process from beginning to follow-up. Findings will clearly define ghsm.hms.harvard.edu/person/faculty/norma-ware Kenya A Pilot Project costs versus benefits, illuminate potential efficiencies, and inform removal of impediments to care delivery.

ghsm.hms.harvard.edu/person/faculty/john-meara

12 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 13 RESEARCH

The Center has funded research across four areas of focus:

MENTAL 7 HEALTH

SURGICAL 2 CARE

INFECTIOUS 5 DISEASE

OBESITY + 5 DIABETES

TOTAL 19 PROJECTS

Cooperative Research Award Program

The Center is focused on strengthening local health care delivery research through a cooperative award mechanism. The mechanism is designed to build collaborative research capacity in Dubai and the region. The Center uses a cooperative award agreement as a support mechanism that involves substantial grantor involvement (in this case, the Harvard Medical School Center for Global Health Delivery—Dubai). For each research award, the Center links a local/regional collaborator with an established researcher from Harvard University or from one of Harvard’s 16 affiliated hospitals. The Harvard faculty member works closely with the local/regional STRENGTHENING LOCAL collaborator on all aspects of the research. HEALTH DELIVERY

14 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 15 RESEARCH

Cooperative Research Awards Nepal

STUDY LOCAL PI HARVARD PI AFFILIATION Bangladesh Bundled Intervention Integrating Mental Health Services into Bibhav Duncan STUDY LOCAL PI HARVARD PI AFFILIATION Rural Primary Care in Nepal: Implementation Research Study Acharya Maru

Feasibility of Implementing a Mental Health Care Program Aliya Kerim Mobile Surgical Scouts: Decentralizing the Surgical Screening Shankar David and Home-Based Training for Mothers of Children with Autism Naheed Munir Process for Nepal’s Rural Cleft Lip and Palate Patients Rai Shaye Spectrum Disorders in an Urban Population in Bangladesh

Pakistan STUDY LOCAL PI HARVARD PI AFFILIATION STUDY LOCAL PI HARVARD PI AFFILIATION Developing an Integrated Practice Unit for Mental Health Services Aneeta Aamir Task-Based Credentialing for Medical Officers in Spinal Anaesthesia: Nandakumar Craig within Existing Tuberculosis, Diabetes and Antenatal Care Programs Pasha Khan An Innovative Approach to the Specialist Workforce Crisis in Rural Menon McClain Indian Hospitals Extension of Hepatitis C Screening, Diagnosis and Treatment Saeed Camilla into the Community: A Low Cost, Point-of-Care, Test-and-Treat Hamid Graham Assessing Pathways to Care Among Tuberculosis (TB) and Sachin Maha Model for Pakistan Drug-Resistant Tuberculosis (DR-TB) Patients in Pune City, India: Atre Farhat A Biosocial Inquiry The Effect of Using Vaccine Reminder and Tracker Bracelets Danya Aamir to Improve Routine Childhood Immunization Coverage and Arif Khan Timeliness in Pakistan: A Randomized Controlled Trial LEBANON Kenya

STUDY LOCAL PI HARVARD PI AFFILIATION South Africa KUWAIT PAKISTAN Developing a Community Health Worker-Based System for Janet Agaya Courtney STUDY LOCAL PI HARVARD PI AFFILIATION Tuberculosis Case-Finding and Infection Control in Health Yuen NEPAL Facilities in Kisumu, Kenya Shared Air Fraction Estimate (SAFE): Correlating a Novel Grant Edward Metric of TB Infection Risk and Occupancy with Health Worker Theron Nardell QuantiFERON-Plus Conversion in South Africa

Kuwait UAE INDIA BANGLADESH

STUDY LOCAL PI HARVARD PI AFFILIATION United Arab Emirates

Development and Evaluation of a Smartphone Application as an Nadia Edgar STUDY LOCAL PI HARVARD PI AFFILIATION Innovative Tool in Risk-Assessment and Screening for Pre-Diabetes Zghoul Ross in Kuwait to Prevent or Delay the Onset of Type 2 Diabetes Enabling Early Intervention Window for ‘At Risk’ ASD/ Mohammed Christopher Neurodevelopmental Disorders in Children: Applying Uddin Walsh Targeted Genetic Testing

Lebanon Effectiveness of Collaborative Tele-Mental Health Services Ammar Hesham KENYA for ADHD in Primary Care: A Randomized Trial in Dubai Albanna Hamoda STUDY LOCAL PI HARVARD PI AFFILIATION (ECTSAP-Dubai Trial)

A School-Based Emotional Resiliency Program for Middle School Fadi Anne Gulf Population Risks and Epidemiology of Vascular Events Alawi A. Samia Students in Lebanon: Evaluation of Implementation and Effectiveness Maalouf Becker and Treatment: Understanding Premature Myocardial Infarction Alsheikh-Ali Mora in Reducing the Burden of Depression and Anxiety Implementing Diabetes and Cardiovascular Disease Risk Screening Hamzah Rifat Teacher-Led Intervention to Build Resilience in Lebanese School-Age Fadi Anne Program in Community Pharmacies in the United Arab Emirates Al Zubaidi Atun SOUTH AFRICA Children: Acceptability, Effectiveness and Predictors of Outcome Maalouf Becker Shared Decision-Making and Delivery of Care at Outpatient Mohamad Amil Engaging with Patients in Addressing Hypertension: Patient Hala Wafaie Clinics in Dubai: Does the Gender of the Patient and the Alameddine Shah Experience with Self-Monitoring of Blood Pressure Ghattas Fawzi Provider Make a Difference?

16 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI MENTAL HEALTH MENTAL HEALTH

Bundled Intervention Integrating Mental Health Services into Rural Primary Care in Nepal Implementation research study

STUDY SITE: Nepal LOCAL PI: Bibhav Acharya, MD Assistant Professor, University of California, San Francisco

HARVARD PI: Duncan Maru, MD, PhD Instructor in Medicine, Brigham and Women’s Hospital

STUDY SITE Dr. Acharya is conducting a longitudinal mixed-methods study A School-Based Emotional Resiliency Feasibility of Dhaka, Bangladesh implementing a task-sharing model for mental health services. Program for Middle School Students The study evaluates the change in skills, knowledge, and attitude in Implementing a Mental LOCAL PI non-specialist providers, identifies key mechanisms for a continuum of in Lebanon Aliya Naheed, MBBS, MPH, PhD Health Care Program and mental healthcare delivery; and evaluates efficacy and cost-effectiveness Evaluation of implementation and effectiveness Head, Initiative for Non-Communicable Diseases, for such a model. Outcomes of this study will focus on the efficacy of in reducing the burden of depression and anxiety Home-Based Training International Center for Diarrhoeal Disease this model to appropriately identify, counsel, and treat patients with Research Bangladesh (icddr,b) depression, psychosis, and post-traumatic stress disorder (PTSD) through an integrated rural mental healthcare delivery intervention. STUDY SITE: Beirut, Lebanon For mothers of children with Autism HARVARD PI This study will contribute to a better understanding of the mental LOCAL PI: Spectrum Disorders in an urban population Kerim Munir, ScD, MBBS Fadi Maalouf, MD health training needs of the non-specialist providers to address Associate Professor of Psychiatry, American University of Beirut in Bangladesh Associate Professor of Psychiatry, the mental health care delivery gap. Boston Children’s Hospital HARVARD PI: Anne Becker, MD, PhD Maude and Lillian Presley Professor of Global Health and Social Medicine, Harvard Medical School Mothers of children with Autism Spectrum MENTAL HEALTH Enabling Early Intervention Window Recent data indicate that the prevalence of mental disorders among Disorder (ASD) have reported higher levels for ‘At Risk’ ASD/Neurodevelopmental adolescents in Lebanon is 26%. Nearly half of those adolescents with of depression as compared to mothers of Disorders in Children mental disorders are diagnosed with an anxiety disorder. In Lebanon, children with other developmental disorders. Applying targeted genetic testing there are only three mental hospitals and five psychiatric units with The prevalence of ASD is high in Asian Dr. Naheed is conducting a pilot feasibility study of a 43 psychiatric beds per 10,000 individuals. Dr. Maalouf aims to assess countries. A survey conducted in urban package intervention including mental health care and the effectiveness of the FRIENDS program, a cognitive behavioral STUDY SITE: Bangladesh has documented that 45% a home-based training program for the mothers with Dubai, United Arab Emirates school-based intervention that has been shown to be effective in of the mothers with children enrolled in a children diagnosed with ASD integrated into the regular LOCAL PI: Mohammed Uddin reducing anxiety symptoms in youth. A randomized, wait-list-control special school for ASD suffer from a major activities of the special schools that offer ASD care in Assistant Professor, Mohammed Bin Rashid trial is used with an unblinded outcome assessment. This design University of Medicine and Health Sciences depressive disorder, and about 50% of them Dhaka city in Bangladesh. The study aims to address randomizes eight schools to either receive the intervention or serve as control. The goal of this study is to enhance access to mental health have suffered from a major depressive major depressive disorder among mothers of children with HARVARD PI: Christopher Walsh, MD, PhD Bullard Professor of Pediatrics and Neurology, services in community-based settings for adolescents to address episode. High burden of depression can ASD in two schools over a 15-month period in Bangladesh. Boston Children’s Hospital current gaps in mental health care. have an adverse impact on a mother’s ability A psychiatrist and a special educator have been deployed to provide care for a child with ASD and as in each school to provide counseling and training sessions The term “Autism Spectrum Disorder” (ASD), which includes mothers tend to be the lifelong caregivers to for mothers in the intervention. The impact of this impairments in social-communication, repetitive behaviors, such children, scale up of services to address intervention will be evaluated with a qualitative survey. and restricted interests that impact every day functioning. With their needs is necessary. The primary outcome of the study is to assess the feasibility increased recognition of ASD, there is now major demand for support services and interventions, particularly for children. This places of institutionalizing the combined intervention of mental great demands on the health care delivery system to ensure timely health care supports and the home-based training program and accurate access to diagnostic services, and then provision of of the mothers who would be diagnosed as having a major subsequent care for those diagnosed. Dr. Uddin is implementing Salmaan Keshavjee and depressive episode. Dr. Naheed hopes to address the gap a health delivery pathway to improve therapeutic outcomes for Nasreen Adamjee visit in mental health care delivery that is faced by mothers a health care program ASD/neurodevelopmental disorders ‘at risk’ children by integrating of children with ASD in Bangladesh. and home-based training targeted genetic testing. Early intervention leads to better outcomes in Bangladesh. in behavioral, educational and learning settings.

HEALING LIFE. DELIVERING CARE. 17 18 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 19 MENTAL HEALTH

Developing an Integrated Practice Unit for Mental Health Services Within existing tuberculosis, diabetes and antenatal care programs

STUDY SITE: Karachi, Pakistan Teacher-Led Intervention to LOCAL PI: Aneeta Pasha, MA Build Resilience in Lebanese Manager, Mental Health Interactive Research and Development School-Age Children

HARVARD PI: Aamir Khan, MBBS, PhD Acceptability, effectiveness Lecturer on Global Health and Social Medicine, and predictors of outcome Harvard Medical School

Increasing numbers of patients are being left undiagnosed, STUDY SITE: Beirut, Lebanon misdiagnosed or untreated for mental illnesses due to the stigma LOCAL PI: Fadi Maalouf, MD associated with such diseases as well as a lack of integration of such Associate Professor and Interim Chairperson, services in public and private health care programs. Ms. Pasha is American University of Beirut implementing a mixed-methods design to determine if the process HARVARD PI: Anne Becker, MD, PhD of integrating mental health services with private and public provider Maude and Lillian Presley Professor of Global Health settings improves mental health service efficiency and uptake for TB, and Social Medicine, Harvard Medical School diabetes and antenatal care patients. This team is evaluating the efficacy of a previously developed mHealth app for mental health screening, Anxiety disorders are very common in children and adolescents yet in six TB, diabetes, or antenatal programs across Pakistan. The goal of remain largely untreated. In Lebanon, anxiety disorders comprise this study is to develop and evaluate a practical and replicable model 50% of mental disorders among youth. Yet, only 9% of those suffering for integrating mental health screening and treatment services by from anxiety seek and receive help. Dr. Fadi Maalouf is studying the establishing and evaluating the performance of an integrated practice effectiveness of a school-based intervention, “FRIENDS for life”. unit (IPU) for mental health services embedded within existing TB, This intervention has shown significant effect in reducing anxiety diabetes and antenatal care programs in both public and private and depressive symptomology in middle school children in Beirut, Dr. Ammar Albanna seeks to test the efficacy of a weekly training and telehealth program in which pediatricians provider settings. as witnessed in a recent school-based randomized controlled trial. at primary health facilities will be trained in basic ADHD screening and care by trained mental health specialists.

Effectiveness of Collaborative STUDY SITE: Dubai, United Arab Emirates Tele-Mental Health Services LOCAL PI: Ammar Albanna, MD Consultant Child and Adolescent Psychiatrist, for ADHD in Primary Care Al Jalila Children’s Specialty Hospital

A randomized trial in Dubai HARVARD PI: Hesham Hamoda, MD (ECTSAP-Dubai trial) Assistant Professor of Psychiatry, Boston Children’s Hospital

Dr. Albanna is conducting a randomized controlled trial to determine whether a tele-mental health program improves the clinical and functional outcomes for children with Attention Deficit Hyperactivity Disorder (ADHD) in Dubai. 67 patients are being recruited for treatment by pediatricians trained in ADHD screening and treatment methodology, with an additional 67 patients included as a comparator arm. As a result of this study, Dr. Albanna hopes to bridge the Gul Ahmad, 30 years old, holds his two year old daughter, Mugul, and waits to gap between the high prevalence and burden of ADHD in Dubai and the shortage see a doctor outside TB clinic at Sindh of mental health professionals. Government Hospital (SGH), Karachi.

20 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 21 SURGICAL CARE

Mobile Surgical Scouts Decentralizing the surgical screening process for Nepal’s rural cleft lip and palate patients

STUDY SITE: Nepal LOCAL PI: Shankar Man Rai, MD STUDY SITE Head, Department of Plastic Surgery, SURGICAL Gudalur, Tamil Nadu, India Kirtipur Hospital, Public Health Trust HARVARD PI: David Shaye, MD LOCAL PI Instructor of Otolaryngology, Nandakumar Menon, MBBS Massachusetts Eye and Ear Infirmary CARE Director, Gudalur Adivasi Hospital Access to surgical care in rural areas has been HARVARD PI neglected in the global health narrative, despite Craig McClain, MD research showing that up to 32% of the global Assistant Professor of Anaesthesia, burden of disease is attributable to surgical Boston Children’s Hospital disease. Dr. Rai is conducting a pre-post Task-Based Credentialing for Medical interventional study to improve cleft surgery access and care in the 22 most rural districts of Officers in Spinal Anaesthesia Nepal through a cleft surgical scouting program. Pairs of surgical scouts have been trained in An innovative approach to the specialist workforce crisis in rural Indian hospitals identifying potential patients for cleft surgery. A total of 156 cases have been screened. Outcomes of interest include the number of patients screened by the scouts, the number Access to surgical care is extremely limited in developing Dr. Menon is conducting a training program for medical of screened patients referred to the outreach countries, driven in part by a parallel gap in access to officers in the application of spinal anaesthesia, subsequently hospital or Nepal Cleft and Burn Center, the anesthetics. The Lancet Commission on Global Surgery conducting a noninferiority study of the medical officers vs. number of patients undergoing surgery in A woman working in a paddy field in estimates that anesthesiologists make up less than 20% of anesthesiologists in administering the procedure. Following participating hospitals before the initiation Sakayal village of Dadeldhura district surgical care providers globally. One qualitative study showed the training program, Dr. Menon is attempting to procure of the program vs. after, the number of patients in a far-western region of Nepal. that in rural and under-resourced areas, there were rarely a credentialing for the trainees following completion of the remaining in the district or surgical outreach surgeon and an anesthesiologist available in the same place. training program and noninferiority study. Five medical level for surgery, and the number of patients who require referral to the central Nepal Cleft In rural India, it is uncommon for hospitals to be staffed with officers have been recruited as trainees, and, following and Burn Center. This study aims to address the both a surgeon and an anesthesiologist, resulting in poor completion of their training, will perform spinal anaesthesia high rate of unmet surgical needs resulting from access to surgical care and patient morbidity and mortality. on 288 patients for the non-inferiority study. Outcome limited access to surgical services by training Spinal anaesthesia, which is far simpler to perform than measures of interest will include the rates of inadequate surgical scouts to identify potential patients general anaesthesia, offers an opportunity to significantly analgesia, complications at 72 hours, and adherence to safety for cleft surgery. increase access to surgical care through task-shifting to checklists by medical officers. non-anesthesiologist medical officers.

22 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 23 INFECTIOUS DISEASE

Shared Air Fraction Estimate (SAFE) Developing a Community Health Correlating a novel metric of TB infection risk and Worker-Based System occupancy with health worker QuantiFERON-Plus For tuberculosis case-finding and infection conversion in South Africa control in health facilities in Kisumu, Kenya

STUDY SITE: Cape Town, South Africa STUDY SITE: Kisumu, Kenya LOCAL PI: Grant Theron, MSc, PhD LOCAL PI: Janet Agaya, MPH Associate Professor, Division of Molecular Biology and Head of KEMRI Operational Research Section: Human Genetics, University of Stellenbosch, South Africa TB Research Branch in KEMRI—Kisumu, Kenya

HARVARD PI: Edward Nardell, MD HARVARD PI: Courtney Yuen, PhD INFECTIOUS Professor of Medicine, Brigham and Women’s Hospital Instructor in Medicine, Brigham and Women’s Hospital Health workers who spend time working in close contact with Healthcare facilities in places like Kenya, which has high burdens Tuberculosis (TB) patients face a high risk of contracting the of both tuberculosis (TB) and HIV, represent prime settings for DISEASE disease. Since TB is transmitted by air, the ventilation conditions TB transmission. Western Kenya demonstrated a 50% increased in a treatment setting could influence the spread of TB within risk of TB infection in healthcare workers as compared to school health centers. Dr. Theron seeks to explore the role of building teachers of the same community with the risk of infection increasing design in preventing the spread of TB by measuring the Shared as a function of time spent in a health facility. Ms. Agaya is piloting a Air Fraction Estimate (SAFE) for health workers, and the rate of system for screening patients entering health care facilities to identify QuantiFERON-TB Plus (QFT-Plus) conversion in health workers TB suspects, expedite diagnosis, and reduce exposure to TB for other Hepatitis C is a viral disease of the liver that kills up to 700,000 people Extension of Hepatitis C after one year. Dr. Theron is conducting a prospective observational patients to address the gap in TB diagnosis among people within per year. The Hepatitis C virus (HCV) is particularly prevalent in low cohort study in a hospital in South Africa, enrolling 240 health health care facilities. The aim of this study is to develop a system Screening, Diagnosis and middle-income countries, with Pakistan estimated to have up to workers from six departments to wear personal air monitors, and that ensures systematic screening for tuberculosis among health care and Treatment into 8 million people with HCV, making Pakistan home to the second largest using a series of stationary CO² monitors to measure rebreathed facility clients and basic infection control in waiting areas in an effort HCV-infected population in the world. There are as many as 230,000 new air among patients. The health workers are also tested for QFT-Plus to reduce transmission within health care facilities. infections taking place each year, with the main driver of this epidemic conversion over the course of the study, as a marker for TB infection. the Community Upon completing this study Dr. Theron hopes to have a more being reuse of needles. The introduction of generic drugs at affordable comprehensive understanding of building design and its influence prices has provided an opportunity to scale up treatment of HCV in A low cost, point-of-care, on TB transmission in health facilities. test-and-treat model for Pakistan Pakistan. However, currently only 5% of HCV patients in Pakistan are thought to be diagnosed. This study aims to find undiagnosed HCV patients by developing and piloting a low-cost, test-and-treat strategy at community medical centers serving high-risk areas of Karachi. STUDY SITE Karachi, Pakistan Dr. Hamid seeks to: raise awareness of HCV diagnosis and treatment

LOCAL PI in communities; assess the sensitivity and specificity of locally available Saeed Hamid, MBBS, FRCP, FRCPI, rapid HCV tests, assess the sensitivity of the GeneXpert system for HCV FACP, FACG, FAASLD RNA detection, and pilot the Extended Community Health Outcomes Ibn-e-Sina Chair and Professor, (ECHO) model to evaluate the effectiveness of a low-cost community care Department of Medicine, model for HCV patients in Karachi. To test the sensitivity and specificity Aga Khan University, Pakistan of locally available rapid and GeneXpert tests, 11,800 patients are being screened for HCV using rapid tests. Individuals testing positive for HARVARD PI Camilla Graham, MD HCV then undergo GeneXpert testing and assessment for liver fibrosis. Assistant Professor of Medicine, Dr. Hamid aims to decrease the prevalence of HCV in Pakistan and also Beth Israel Deaconess Medical Center determine the clinical efficacy of generic HCV treatment. A young Turkana sits with her sick child near a satellite clinic at Nakalala, a temporary nomadic settlement for the people of Turkana tribe (Kenya).

24 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 25 INFECTIOUS DISEASE

Assessing Pathways to Care Among Tuberculosis (TB) and Drug-Resistant Tuberculosis (DR-TB) Patients in Pune City, India A biosocial inquiry

STUDY SITE: Pune, India LOCAL PI: Sachin Atre, PhD Research Consultant, Dr. D.Y. Patil Vidyapeeth, India The Effect of Using Vaccine Reminder HARVARD PI: Maha Farhat, MD Assistant Professor of Biomedical Informatics, and Tracker Bracelets to Improve Routine Harvard Medical School Childhood Immunization Coverage and

Inadequate or incomplete treatment, or low-quality medicines, Timeliness in Pakistan can lead to the spread of drug-resistant (DR) TB. The TB and DR-TB A randomized controlled trial burden is particularly severe in India, which accounts for a quarter of the world’s cases of TB disease, and has the highest burden of multidrug-resistant TB (MDR-TB) of any country. Dr. Atre seeks STUDY SITE: Karachi, Pakistan to assess pathways to TB treatment in India through a prospective LOCAL PI: Danya Arif, MSc observational cohort study. A total of 400 suspected TB patients Senior Program Manager: Maternal and Child Health, Far Left: During Tuberculin Skin Test (TST) and 800 sputum smear-positive patients are being screened using Interactive Research and Development, Pakistan also know as Montoux Test, a phlebotomist injects serum into subcutaneous layer of GeneXpert technology. The study team is following up with those HARVARD PI: Aamir Khan, MBBS, PhD skin and marks area on child’s arm to see whose TB shows signs of being drug-resistant. Patients’ experiences Lecturer on Global Health and Social Medicine, any reaction in next 48–72 hours. with TB and DR-TB care are assessed through semi-structured Harvard Medical School interviews of up to 300 patients diagnosed during the screening study. Above: Patients collect prescribed free Outcome measures will include the proportion of TB cases identified Pakistan has one of the highest infant mortality rates in the world. TB medication from a pharmacy at the Indus Hospital in Pakistan. through GeneXpert screening to be drug-resistant, time from sample This is in part due to the low coverage (54%) of all basic vaccinations. collection to treatment initiation, and common themes in patient Some of the key factors hindering improvement in uptake of Left: A clinician examines family members experiences and behavior during their treatment experience. immunization services include low uptake, lack of awareness among of a TB patient that have come in for clinical This study aims to improve early diagnosis and treatment of parents of immunization schedules, and inability to remember evaluation and post-exposure treatment Rifampicin-resistance (RR) and MDR-TB. vaccine appointments. Ms. Arif is testing simple silicon bracelets initiation at TB clinic at the Indus Hospital in Pakistan. for children to increase immunization and simultaneously address issues in supplier verification. These bracelets can serve as effective reminders for mothers for timely immunization of their child and as a tool for vaccinators to verify vaccine administration and coverage. The bracelets, designed for illiterate or uneducated mothers, are low-cost and adaptable to most local settings. The expected outcome of this study will be an improvement in the proportion of fully immunized children (having received pentavalent-3, polio-3, pneumococcal conjugate vaccine-2, and measles-1 vaccines) and timely immunizations in children under 2 years of age.

26 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 27 OBESITY + DIABETES

Gulf Population Risks and Epidemiology of Vascular Events and Treatment

Understanding premature myocardial infarction STUDY SITE , UAE

LOCAL PI A major feature of the cardiovascular disease crisis in Alawi Alsheikh-Ali, MD, MSc, FACC the Middle East and North Africa (MENA) region is that Dean, College of Medicine, its patients have the youngest age of first heart attack Mohammed Bin Rashid University OBESITY of any other region surveyed in the INTERHEART study, of Medicine and Health Sciences Below: Team photo of the study which examined 52 countries. Risk factors found to be HARVARD PI team at the Sheikh Khalifa prevalent in people who experience heart attacks early Medical City in Abu Dhabi. Samia Mora, MD + DIABETES in their lives include diabetes, obesity, smoking, and Associate Professor of Medicine, dyslipidemia. In the UAE, Dr. Alsheikh-Ali estimates Brigham and Women’s Hospital that 10% of the population has diabetes, due to high adiposity, unhealthy dietary habits, and physical inactivity. A previous study found that 76% of people screened in malls in the UAE were found to possess at least one uncontrolled risk factor. Dr. Alsheikh-Ali seeks Upon discharge, patients enrolled in the case-control to examine risk factors and delivery gaps associated with study are then tracked in a prospective observational cohort premature myocardial infarction (MI) in men younger study in order to explore the personal, financial, social, and than 55 and women younger than 65 in the UAE. geographic factors associated with poor adherence to treatment post-MI. Patients are contacted for follow-up Dr. Alsheikh-Ali is conducting a case-control study every three months. Dr. Alsheikh-Ali is recruiting 400 cases at Sheikh Khalifa Medical City in Abu Dhabi among and 400 matched controls from Sheikh Khalifa Medical patients being treated for premature MI to screen City (SKMC) for the case-control portion of the study; for suspected biological and lifestyle risk factors. the 400 cases will then be enrolled in the cohort study. The case-control study will assess links between premature MI and certain risk factors, while the cohort study component examines adherence to medications and lifestyle counseling, as well as barriers to adherence, and their relationship with cardiovascular outcomes. Dr. Alsheikh-Ali aims to reduce the overwhelming burden of cardiovascular disease by addressing gaps in treatment in the UAE region.

28 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 29 OBESITY + DIABETES

Development and Evaluation of a Smartphone Application as an Innovative Tool in Risk-Assessment and Screening Engaging with Patients for Pre-Diabetes in Kuwait in Addressing Hypertension To prevent or delay the onset of type 2 diabetes Patient experience with self-monitoring of blood pressure STUDY SITE: Kuwait City, Kuwait LOCAL PI: Nadia Zghoul, PhD STUDY SITE: Lebanon Scientist, Dasman Diabetes Institute LOCAL PI: Hala Ghattas HARVARD PI: Edgar Ross, MD Assistant Research Professor and Associate Director, Associate Professor of Anaesthesia, Brigham and Women’s Hospital American University of Beirut Pre-diabetes is a diagnosis given to people who have blood glucose HARVARD PI: Wafaie Fawzi, MBBS, PhD levels above normal, but not high enough to be diagnosed with type 2 Richard Saltonstall Professor of Population Sciences, diabetes mellitus (T2DM). Because pre-diabetes is asymptomatic, Professor of Nutrition, Harvard T.H. Chan School people often remain unaware of their condition, allowing it to of Public Health progress to full-blown T2DM. Intervening prior to this progression High blood pressure is a known risk factor for several serious is critical, as modifying behavioral risk factors through lifestyle conditions such as ischemic heart disease and stroke. Studies interventions aimed at encouraging weight loss can reduce the risk have shown that although nearly 33% of adults suffer from of developing T2DM, or delay the onset. Dr. Zghoul is piloting a hypertension globally, levels of treatment are low particularly feasibility assessment of a smartphone-based T2DM application within Arab countries where hypertension and high body-mass by determining the proportion of Kuwaitis willing to download the index are prevalent. Despite validated methods of diagnosis and app, estimating the proportion of app users at high risk for T2DM, treatment, only 13% of adults have adequate control over their assessing the compliance among high-risk participants in taking hypertension indicating a considerable delivery gap. Dr. Ghattas recommended diagnostic tests, and determining the correlation is exploring the potential for blood pressure self-monitoring to between application prompts, participant compliance, and engage patients and overcome obstacles to regular monitoring in lifestyle changes among participants in response to application Lebanon where the prevalence of hypertension has been found recommendations. An invitation to download the app and to be 37%. A pilot study is being conducted using mixed-methods participate in the program will be sent to 3,000 mobile phone to identify issues in self-monitoring, experienced by patients, numbers, of whom 100 are expected to download the app. and determine the current level of engagement amongst patients. Participants who download the app will be prompted to take a This study aims to address a delivery gap that is contributing to Centers for Disease Control-validated risk assessment. Based on the high rates of uncontrolled hypertension. their score, participants will be entered into appropriate weight loss programs directed by the app, and referred to Dasman Diabetes Institute for a blood test appointment, as appropriate. If effective, this app will be beneficial in changing behavior of those at risk of developing T2DM and preventing incidence of new cases of T2DM.

Taj Mohammad, Research Associate, collects blood sample for HCV test from a client in Karachi, Pakistan.

30 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 31 OBESITY + DIABETES

Implementing Diabetes and Cardiovascular Disease Risk Screening Program In community pharmacies in the United Arab Emirates

STUDY SITE: United Arab Emirates Shared Decision-Making and Delivery LOCAL PI: Hamzah Al Zubaidi, MSc, PhD of Care at Outpatient Clinics in Dubai Assistant Professor, University of Sharjah Does the gender of the patient and the provider HARVARD PI: Rifat Atun, MBBS make a difference? Professor of Global Health Systems, Harvard T.H. Chan School of Public Health STUDY SITE: Dubai, United Arab Emirates In -speaking countries, the prevalence of diabetes and LOCAL PI: Mohamad Alameddine, PhD cardiovascular disease (CVD) are increasing to alarming levels with Associate Professor of Health Management and Policy, high morbidity and mortality rates while the healthcare systems of Mohammed Bin Rashid University these countries generally have little capacity to conduct screening. People at high risk for diabetes or CVD need early detection to HARVARD PI: Amil Shah, MD initiate appropriate treatment and thereby delay progression Assistant Professor of Medicine, Brigham and Women’s Hospital and subsequent complications. Dr. Al Zubaidi aims to assess Enhancing patient-centered care through the promotion of the feasibility and performance of an evidence-based screening shared decision-making (SDM) in clinical settings is considered intervention for type 2 diabetes mellitus and CVD in community a top priority for health managers and policy makers in health pharmacy settings. This is the first time such a study is being systems. Gender has been known to play a key role in patient-provider conducted in an Arabic-speaking country. The study engages a interactions. Female physicians are reported to possess stronger representative sample of 12 community pharmacies in the UAE patient-centered communication styles, with patients who are more to recruit 672 screening participants from across the population. engaged in discussions and more likely to express themselves freely. Above: Pharmacy screening Outcomes include the percentage of participants who screen Dr. Alameddine seeks to assess patient and provider perceptions of for early diagnosis of diabetes positively for elevated diabetes risk or undiagnosed diabetes, shared decision making in outpatient clinics in Dubai, identify factors and heart diseases. elevated CVD risk, the percentage of positively-screened associated with favorable perceptions of SDM and explore the effect individuals referred for medical assessment, and the rate of uptake Right: Dr. Hamza Al Zubaidi of provider’s and patient’s gender on SDM through a cross-sectional of these referrals. Dr. Al Zubaidi hopes to introduce pharmacy at a local pharmacy in Sharjah. survey of patients and providers. Fifty clinicians, divided evenly based screening for diabetes and other chronic diseases into the by gender, are being selected. Following their appointments with UAE which can lead to improved health outcomes. participating physicians, 250 male and 250 female patients are being assessed on SDM from a patient perspective, as well as an assessment of general patient satisfaction. The study goal is to ensure that the treatment plan for common diseases such as hypertension, obesity, diabetes, and cardiovascular diseases is based on a shared decision between the physician and the patient, irrespective of gender, and to enhance patient satisfaction and compliance to treatment protocols.

32 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 33 EDUCATION

WORKSHOPS Workshops

Muslim Philanthropy Field Guide for Management Primary Care 2030 + SYMPOSIA and Sustainable Health of Multidrug-Resistant JUNE 21–22, 2018 Care Delivery in the Tuberculosis in Children Muslim World JULY 19–21, 2017 Scaling Up Community DECEMBER 1–2, 2016 Health Worker Delivered Rethinking the Interventions for Common Emerging Lessons from International System Mental Disorders Pakistan for the Zero of Health Governance JUNE 23–25, 2018 TB Initiative SEPTEMBER 15–17, 2017 FEBRUARY 22–24, 2017 Zero TB Initiative: First Global Consultation Strategies to Eliminate TB Determinants of Obesity on Progress Metrics for One Community at a Time and Diabetes in the Middle Zero TB Zones JULY 15–16, 2018 East: Systems Thinking SEPTEMBER 26, 2017 and Systems Change FEBRUARY 26–27, 2017 Global NCD Research: Perspectives from INDEPTH Symposia Obesity, Diabetes and and UAE Countries Breast Cancer Nexus DECEMBER 10–11, 2017 Keynote: The Role of TB in the MENA Region Infection in TB Elimination FEBRUARY 28–MARCH 1, 2017 Health System SEPTEMBER 27, 2017 Strengthening and Breast The Lancet Commission Cancer Care in the Middle TB Infection: Building a on Reframing NCDs East: Results of the Framework for Eradication and Injuries for the Harvard Research Study SEPTEMBER 27–28, 2017 Poorest Billion JANUARY 22–23, 2018 MARCH 9–10, 2017 New Strategies and Tools Advancing Global Nutrition for Treating Obesity in Systems of Care for for Adolescent and Family Primary Care Autism Spectrum Disorder: Health: Innovations in OCTOBER 8, 2017 A Global Perspective Research and Training MARCH 30–APRIL 1, 2017 FEBRUARY 16–17, 2018 Diabetes Update 2017 OCTOBER 9, 2017 WITHIN THE PAST 24 MONTHS, THE CENTER HAS HOSTED Outpatient Care Delivery National Surgical, Obstetric, in the Russian Federation: and Anaesthesia Planning Attendees Creating a Platform for MARCH 21–22, 2018 1,761 Improved Health Outcomes JUNE 28, 2017

Countries 89 Represented

34 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 35 EDUCATION

“One came away with new perspectives, an increased sense of responsibility and the hope to be able to properly utilize the tools and ideas generated to make sustainable impact and change.”

 JUSTINA SEYI-OLAJIDE  Lagos University Teaching Hospital, Nigeria Courses

Within the past 24 months, Strategy and Value the Center has hosted Measurement 10 major courses with 197 attendees representing for Global Health 26 countries. Care Delivery

Protocol Development From the vast open spaces of rural Siberia to the dense urban neighborhoods Led by Subhash Chandir, senior epidemiologist, this three session course introduces of Lima, Peru, the challenge is similar: basic research concepts to healthcare professionals interested in conducting research how to best deliver effective health care and methods to translate ideas into successful scientific protocols. Participants to those who need it. This past spring, included healthcare professionals, health scientists, and researchers. Harvard’s medical and business schools convened 68 senior clinical, financial, and administrative leaders from universities and health systems in 17 countries in Asia, PARTICIPANT INSTITUTIONS Europe, and the Americas at the Harvard Abu Dhabi Health Services Company Medical School Center for Global Health The work involves a broad discussion SPECIAL THANKS Ahalia Medical Group Delivery —Dubai for a three-day intensive of how to improve health outcomes for To the Thumbay Group for Dubai Diabetes Center course designed to teach the fundamentals tuberculosis, diabetes, heart disease, mental supporting the Thumbay Scholars Dubai Health Authority of strategy and value measurement for health, global surgery, non-communicable Gulf Medical University global health care delivery. disease and other challenges affecting FOR THE FULL STORY Khalifa University countries around the globe, and then the Please see: hms.harvard.edu/ Mohammed Bin Rashid University This course is one of the latest steps in a design of strategic global health initiatives news/crossing-borders-0 Mediclinic process that began when the Center was to tackle them. The participants came with Ministry of Health launched two years ago. In that short time, diverse experiences and perspectives, but University of Sharjah faculty and staff have cultivated a program shared a common goal. They came to learn University of Toronto of diverse international research and strategy and value measurement techniques education initiatives reaching 99 countries for global health care delivery. and bringing together researchers, clinicians, and students from around the globe for collaborative research projects, symposia, and educational programs. “This course is an exciting example of how health care delivery can be improved through optimization of different parts of the care delivery value chain.”

SALMAAN KESHAVJEE, MD, PhD Dir ector, Harvard Medical School Center for Global Health Delivery—Dubai Professor of Global Health and Social Medicine, Harvard Medical School

36 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 37 EDUCATION

During the last 24 months, the Center awarded scholarships to Scholars individuals to attend the Global Health Delivery Intensive Program and the Program in Clinical Effectiveness at Harvard Medical School.

PRATISTHA THAPA ABHA SHRESTHA BIKESH SHRESTHA ARADHANA THAPA, MPH POSHAN THAPA, MPH RAMYAMAJHI Program Lead, Rural Deputy Executive Community Impact Director of Research Senior Operations Health Services Division, Director, Nick Simons Manager, Nyaya and Evaluation, Nyaya Partnerships Manager, Dhulikhel Hospital Institute (NSI) Health/Possible Health Health/Possible Health Participated in the Global Health Delivery Intensive Course Possible Health Nepal Nepal Nepal Nepal Scholars 25 The course is a rigorous non-degree summer program Nepal that trains public health leaders and health practitioners.

REHAM IBRAHIM ABOU ARUN BAHULAYEN NAIR ARIFAH NUR SHADRINA NADA ABU-KISHK, MS LOISE NDONGA RABAB BATOOL CAROLINE MAE RAMIREZ AMANI SALEM GYANU TAMANG ARAL SURMELI, MD EL FADL, MPH, PhD Health Systems Chief Operating Officer/ Health Nutrition Officer, Medical Doctor, Research Coordinator, Consultant, Health ALQAHTANI, BSc, MPH Monitoring, Evaluation, Medical Doctor, Consultant, Social Researcher, ACCESS Physician, Kalitanjung United Nations Relief Cardiovascular Diseases, Department of Pediatrics Systems Management PhD Candidate in Public Accountability and Acıbadem University Research Center, Health International Child & Adolescent Clinic and Works Agency Kenya Ministry of Health and Child Health, Aga Philippines Health and Epidemiology, Learning Manager, School of Medicine American University India Founder, GoldenCare Jordan Kenya Khan University The University of Sydney Catholic Relief Services Turkey in Cairo Indonesia Pakistan Saudi Arabia South Sudan Egypt

RAWYA KHODOR, MPH BINOD DANGAL BIKASH GAUCHAN PRADIP LAMSAL, MS BHASKAR PANT, MD ALLA ABDALLA INAS ELSHAHAWI ENAS MOHAMMED NAUFA DAMDA, BPT DUAA SULIMAN Research Consultant, Medical Officer, Director of Medical Head of Hospital Orthopedic Surgeon, Project Manager, Specialist Dentist, ELZUBEIR Physical Therapist; Hospital Pharmacist, Issam Fares Institute Possible Health Education, Possible Pharmacy and Social Grande International Executive Team for Dubai Health Authority Authorization and AHA Life Support Al Barha Hospital for Public Policy and Nepal Health Medicine, Helping Hands Hospital Healthy Lifestyle United Arab Emirates Case Management Training Instructor at United Arab Emirates International Affairs Nepal Community Hospital Nepal United Arab Emirates Medical Officer, Health Clinical Training Center, Lebanon Nepal Insurance Company University of Sharjah United Arab Emirates United Arab Emirates

38 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 39 EDUCATION

The program is designed for physician-clinicians, fellows, and faculty who seek quantitative and analytic skills 4 Scholars needed for clinical research or are interested in health care administration. Three individuals took part in the first year of the Program in Clinical Effectiveness and one individual took part in the second year.

Participated in the Program in Clinical Effectiveness

HAITHAM SHOMAN MONTY KHAJANCHI, MBBS NUSRAT KHAN, USAMA ALBASTAKI Research Fellow, Program Assistant Professor, FCPS, MBBS Head of Radiology in Global Surgery and General Surgery, Seth Neonatologist, Tawam Department, Rashid Social Change, Harvard G.S. Medical College Hospital in Hospital Medical School and KEM Hospital Pakistan United Arab Emirates Egypt India

4 Scholars

Participated in the Master of Medical Sciences in Global Health Delivery Program

LISA PARVIN, MS HAMDA MOHAMMED FARZAD KASRAEI, MD NADEEM KARMANI, MD Research Assistant/ ALSUWAIDI Adjunct Associate Research Assistant, Project Coordinator, Clinical Quality Officer, Professor for Biomedical Department of Global School of Population Dubai Health Authority Engineering, Islamic Health and Social Health, University United Arab Emirates Azad University—Dubai Medicine, Harvard of British Columbia United Arab Emirates Medical School Bangladesh United Arab Emirates

1 Scholar

Participated in the ARAL SURMELI, MD Master of Public Health Medical Doctor, program at the Harvard Acıbadem University T.H. Chan School of School of Medicine Public School Turkey

40 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 41 EDUCATION

Awards

The Center provided 21 awards totaling $252,000 to Harvard medical and graduate students to address crucial global health care problems. The proposed research will lead to innovative interventions that will optimize the “last mile” of health care delivery.

OMAR ABU-QAMAR SORAYA AZZAWI YULIN HSWEN ECE OZCELIK Harvard Medical School Harvard Medical School Harvard T.H. Chan School Harvard T.H. Chan School Study: Assessing the Knowledge, Study: Getting Under the Skin: of Public Health of Public Health “This internship really made me Attitude and Practice of Patients A Dermatologic Health Needs Study: Leveraging Online Big Study: mHealth for Diabetes with Diabetes Regarding Eye Care Assessment and Teledermatology Data to Detect Environmental Prevention in Jordanians with understand how health care is delivered in Region III of the Philippines Trial in MENA Pollution and its Impact on Pre-Diabetes: A Developmental Study Population Health in India and how to partake in research.” DALIA ALNUAIMI FRANK BLIBO LISA PARVIN INTERN, SUMMER 2017 Harvard Medical School Harvard Graduate School FARZAD KASRAEI Harvard Medical School Study: Exploring the Impact of Arts and Sciences Harvard Medical School Study: A Mixed-Methods Study of Co-Payment System for Study: Cardiovascular Modernity: Study: Assessment of Delivery to Identify Vaccination Coverage Governmental Healthcare A Cultural History of Cardiac Problems of Mental Health Among Nomadic Bede Children on the Syrian Refugees in Care in Modernizing West African Services in Syrian Immigrants of Bangladesh Jordanian Camps States, 1960s-Recent Times and Refugees JIGYASA SHARMA HAMDA ALZUWAIDI NTOMBIFUTHI DENNIS MICHAEL LINDEBORG Harvard T.H. Chan School Interns Harvard Medical School Harvard Medical School Harvard Medical School of Public Health Study: Understand the Barriers Study: Understanding the Study: Comprehensive Post-Surgical Study: Beyond Coverage: Improving to Integration to Society Faced Factors that Shape Pre-Exposure Speech Therapy for Cleft Palate the Quality of Care During Childbirth The internship provided students NEAMAT IBRAHIM ALMASRI IMAN FAWAD ANUSHKA KHATRI by Former Addicts: A Qualitative Prophylaxis Uptake and Adherence Patients in Rural Nepal in Indian Public Health Facilities Gulf Medical University Mohammed Bin Altamash Institute Study in UAE Among High-Risk Women in Rural with a strong foundation in the Syria Rashid University of Dental Medicine, and Urban Settings in South Africa GOPAL MENON CLAIRE WAGNER DAVID ANGELSON basics of clinical and health delivery Egypt Pakistan Harvard T.H. Chan School Harvard Medical School PASCAL GELDSETZER AMEERA ALGHAFRI Pakistan Harvard Medical School of Public Health research and exposed them to the Study: Advancing Breast Cancer Mohammed Bin Rashid EMAN KHALAF Study: Climate Finance for Harvard T.H. Chan School Study: Childhood Malnutrition Diagnostics in East Africa: A Study tools of research methodology. Medical University Mohammed Bin Rashid SIDRA SHADAN Health System Strengthening of Public Health and Paternal Alcohol Consumption: to Examine Biopsy Device Access, to Build Climate Resilience Study: Health System A Case-Control Study Utilization, and Market United Arab Emirates Medical University Mohammed Bin in Least Developed Countries Performance for Diabetes Syria Rashid University in the Asia-Pacific Region Students also worked alongside Center and Hypertension in India SANDEEP NANWANI TIANHANG ZHOU GHADAH AL-SHARIF Canada staff to support research projects conducted Mohammed Bin Rashid ANDREW LINDEBORG JAFET ARRIETA Harvard Medical School Harvard Medical School RAMON GUINTO through the Center’s Cooperative Research Medical University George Washington THANNON THANNON Harvard T.H. Chan School Study: State Care for Vagrants Study: Exploring the Impacts of Harvard T.H. Chan School with Psychosocial Disability Parents with Severe Mental Illness Award Program and completed the online Yemen University Mohammed Bin of Public Health of Public Health in Yogyakarta, Indonesia on their Children: A Pilot Study United States Rashid University Assessing the Feasibility module, “SW25X — Global Health Case Study: Study: Protecting Human Health in FAHEEMA ALSHEHABI Iraq of User and Effectiveness of a Studies from a Biosocial Perspective.” in a World Above Two Degrees: CAMERON NUTT Gulf Medical University ANAN MAHMOUD Depression Care Delivery Value Smart Pathways Toward Climate- Harvard Medical School The one-month internship concluded with a Mohammed Bin GARRETT WILKINSON Chain in Low-Resource Settings: Smart Healthcare Delivery in Bahrain A Mixed Methods Study the Philippines Study: Undiagnosed Cases of journal club in which each intern presented Rashid University Kansas State University Symptomatic and Asymptomatic VAIBHAV AHUJA Egypt United States Ebola Virus Infection in Liberia: a critical appraisal of a scientific publication. Gulf Medical A Biosocial Analysis University Ajman TWINKLE OCHANI HELEN ZARWI India Chandka Medical Boston College College Lebanon MEHMET ILKER ARAZ Pakistan Acibadem University, Istanbul Turkey

42 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 43 Our Center seeks to promote systems of care delivery through which we can share the fruits of modern medicine — across diseases and across geographies.

We have set in motion a process of accompaniment: working in close partnership with researchers and practitioners to create new knowledge, and translating this knowledge into policies OUR PROGRESS that can directly improve health care delivery. Our mission is both intellectual and moral, and will require both the creation of better systems of care delivery, and a commitment from LOOKING people, communities and governments.

TO THE FUTURE We hope you will work with us to foster this change.

44 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 45 OUR PROGRESS

Our Global Footprint HARVARD UNIVERSITY This map represents the worldwide reach of our collaborators since the inception of the Center.

UNITED ARAB EMIRATES 50 Number of Workshops, Symposia, and Courses 2,685 Total Number of Attendees

81 Total Number of Scholars

Total Number of Countries 102 Represented

46 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 47 ABOUT US

Faculty DAVID JONES, MD, PhD CRAIG McCLAIN, MD EDWARD NARDELL, MD SADATH SAYEED, MD, JD A. Bernard Ackerman Professor Assistant Professor Professor of Medicine Assistant Professor of Global of the Culture of Medicine of Anaesthesia Brigham and Women’s Hospital Health and Social Medicine Our sincere thanks to the Harvard University faculty who play Harvard Medical School Boston Children’s Hospital Harvard Medical School SCOTT PODOLSKY, MD a key role in building capacity in Dubai, the UAE, and the region. ROBERT KAPLAN, PhD ANDREW McDOWELL Professor of Global Health AJAY SINGH, MBBS, MBA, FRCP Marvin Bower Professor Post-Doctoral Fellow and Social Medicine Senior Associate Dean for Global NASREEN ADAMJEE, MBBS MYRON BELFER, MD PAUL FARMER, MD, PhD DAVID GOLAN, MD, PhD of Leadership Development Harvard Medical School Harvard Medical School Education and Continuing Education Lecturer on Global Health Professor of Psychiatry Kolokotrones University Dean for the Basic Science Harvard Business School Harvard Medical School JOHN MEARA, MD, DMD, MBA GIUSEPPE RAVIOLA, MD and Social Medicine Boston Children’s Hospital Professor of Global Health and Graduate Education ARLENE KATZ, EdD AMIL SHAH, MD Harvard Medical School and Social Medicine Harvard Medical School Steven C. and Carmella R. Assistant Professor ALLAN BRANDT, PhD Harvard Medical School Lecturer on Global Health Kletjian Professor of Global of Psychiatry Assistant Professor of Medicine PHILIP ANDERSON, MD Amalie Moses Kass Professor BYRON GOOD, PhD and Social Medicine Health and Social Medicine Boston Children’s Hospital Brigham and Women’s Hospital Assistant Professor of of the History of Medicine HAMED FAROOQI, MBBS Professor of Medical Anthropology Harvard Medical School Boston Children’s Hospital JOSEPH RHATIGAN, MD AARON SHAKOW, PhD Emergency Medicine Harvard University Lecturer on Global Health Harvard Medical School SALMAAN KESHAVJEE, MD, PhD ATEEV MEHROTRA, MD Brigham and Women’s Hospital and Social Medicine Associate Professor Research Associate MEREDITH BROOKS, MPH, PhD Harvard Medical School MARY-JO DELVECCHIO GOOD, PhD Professor of Global Health Associate Professor of Health of Medicine Harvard Medical School RIFAT ATUN, MBBS Research Fellow Professor of Global Health and Social Medicine Care Policy Brigham and Women’s Hospital Harvard Medical School Harvard Medical School DAVID SHAYE, MD Professor of Global Harvard Medical School WAFAIE FAWZI, MBBS, PhD and Social Medicine CHRISTINE RIEDY, MA, MPH, PhD Health Systems Richard Saltonstall Professor Harvard Medical School Instructor in Otolaryngology AAMIR KHAN, MBBS, PhD CAROLE MITNICK, ScD Harvard T.H. Chan School GENE BUKHMAN, MD, PhD of Population Sciences, Associate Professor of Oral Massachusetts Eye and Ear Infirmary of Public Health Assistant Professor Professor of Nutrition CAMILLA GRAHAM, MD Lecturer on Global Health Associate Professor of Global Health Policy and Epidemiology of Medicine Harvard T.H. Chan School Assistant Professor and Social Medicine Health and Social Medicine Harvard School of Dental Medicine MARK SHRIME, MD JANE BARROW, MS Harvard Medical School Harvard Medical School Brigham and Women’s Hospital of Public Health of Medicine Assistant Professor ROBERT RIVIELLO, MD Assistant Dean for Global Beth Israel Deaconess of Otolaryngology and Community Health SUBHASH CHANDIR, MBBS, PhD MOLLY FRANKE, ScD Medical Center ARTHUR KLEINMAN, MD SAMIA MORA, MD Assistant Professor of Surgery Massachusetts Eye and Ear Infirmary Harvard School of Dental Medicine Lecturer on Global Health Assistant Professor of Global Esther and Sydney Rabb Associate Professor of Medicine Brigham and Women’s Hospital and Social Medicine Health and Social Medicine NEIL GUPTA, MD Professor of Anthropology Brigham and Women’s Hospital CHRISTOPHER WALSH, MD, PhD MERCEDES BECERRA, ScD Harvard University EDGAR ROSS, MD Harvard Medical School Harvard Medical School Instructor in Medicine Bullard Professor of Pediatrics Professor of Global Health Brigham and Women’s Hospital JOIA MUKHERJEE, MD, MPH Associate Professor and Neurology and Social Medicine ANDREW ELLNER, MD SEHAMUDDIN GALADARI, PhD ERIC KRAKAUER, MD, PhD Associate Professor of Medicine of Anaesthesia Boston Children’s Hospital Harvard Medical School Assistant Professor Senior Lecturer on Global JOHANNA GUTLERNER, PhD Associate Professor of Medicine Brigham and Women’s Hospital Brigham and Women’s Hospital of Medicine Health and Social Medicine Interim Associate Dean Massachusetts General Hospital NORMA WARE, PhD ANNE BECKER, MD, PhD KERIM MUNIR, ScD, MBBS LUBNA SAMAD, MBBS Brigham and Women’s Hospital Harvard Medical School Harvard Medical School Associate Professor of Medicine Maude and Lillian Presley DUNCAN MARU, MD, PhD Associate Professor Lecturer on Global Health Harvard Medical School Professor of Global Health MAHA FARHAT, MD JEROME GALEA, MSW, PhD HESHAM HAMODA, MD Instructor in Medicine of Psychiatry and Social Medicine and Social Medicine Assistant Professor of Research Associate in Global Assistant Professor of Psychiatry Brigham and Women’s Hospital Boston Children’s Hospital Harvard Medical School COURTNEY YUEN, PhD Harvard Medical School Biomedical Informatics Health and Social Medicine Boston Children’s Hospital Instructor in Medicine Harvard Medical School Harvard Medical School Brigham and Women’s Hospital

It is an honor and a pleasure to work with Shehzad Noorani. You will find his photographs throughout our progress report and on display in our offices in Boston and Dubai. Shehzad has a deep interest in social issues that affect lives of millions of people in developing countries. He has covered major stories resulting from man-made and natural disasters in Afghanistan, Iraq, , Sudan, Sri Lanka, Syria, Turkey and Bangladesh. Other assignments for organizations like UNICEF, WFP, BRAC, UNAIDS, Johns Hopkins and Harvard University have taken him to over 60 countries in Europe, Asia, Central Asia, Africa and the Middle East.

His personal in-depth documentary work has been extensively exhibited and featured in major international magazines and publications around the world. He received numerous awards including Mother Jones International Fund for Documentary Photography for Daughters of Darkness, a story about the lives of SHEHZAD NOORANI commercial sex workers in South Asia and honorable mention by National Geographic’s All Roads Photography Program in 2005 for Children of Black Dust. River Bleeds Black, his work on environmental degradation of the Burganga river in Bangladesh, was selected by the Open Society Institute for Moving Walls 15.

48 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI HEALING LIFE. DELIVERING CARE. 49 ABOUT US

Steering Committee Senior Advisors Leadership Team

ALLAN BRANDT, PhD PAUL FARMER, MD, PhD SALMAAN KESHAVJEE, MD, PhD JENNIFER PUCCETTI, MPP Amalie Moses Kass Kolokotrones University Professor of Director Executive Director Special Professor of the History Global Health and Social Medicine Harvard Medical School Center Harvard Medical School Department of Medicine Harvard University for Global Health Delivery—Dubai of Global Health and Social Medicine Thanks Harvard University Chair, Department of Global Health Professor of Global Health Executive Director and Social Medicine and Social Medicine Harvard Medical School Center We are grateful to those who Harvard Medical School Harvard Medical School for Global Health Delivery—Dubai have supported the ongoing Chief, Division of Global Health Equity work of the Center. Brigham and Women’s Hospital Co-Founder Al Jalila Foundation Partners In Health Advance Access & Delivery Beth Israel Deaconness Medical Center Staff Boston Children’s Hospital

Special thanks to the staff members who support all aspects of the Brigham and Women’s Hospital Center’s work in Boston, in Dubai and in the region from 2016–2018. Chandka Medical College Division of Global Health Equity at Brigham and Women’s Hospital DAVID GOLAN, MD, PhD SEHAMUDDIN GALADARI, PhD NASREEN ADAMJEE, MBBS SUCHITRA KULKARNI Harvard Global Dubai Harvard Foundation Dean for the Basic Science Senior Lecturer on Global Director of Research Senior Program KATE APOLLO and Programs Coordinator for Medical Research and Graduate Education Health and Social Medicine Finance Manager Harvard Medical School Harvard Medical School Dubai Health Authority CAROL BENOIT ANDREW LINDEBORG BELYNDA BADY Department Coordinator Research Assistant Dubai Healthcare City Authority AMER SHARIF, MBBS, MSc Associate Director Gulf Medical University CEO Education Sector SUBHASH CHANDIR, MBBS, PhD HELENA MARTINS of Operations Dubai Healthcare Epidemiologist Program Manager Harvard Business School City Authority PHYLLIS FROTHINGHAM Account Analyst Harvard Global Support Services Vice Chancellor RACHELE COX ELIZABETH NOYES Harvard School of Dental Medicine MBRU Research Assistant Research Assistant BLAGA OVCHAROVA Harvard T.H. Chan School IRAM HAQ JOE SAX Human Resources Manager of Public Health Research Assistant Research Assistant Interactive Research and Development JOSEPH O’REGAN, FCCA LIA TJAHJANA DEBRA KEANEY GARRETT WILKINSON Director International Projects Massachusetts Eye and Ear Infirmary Director of Finance Intern Harvard Global Support Services Administrator Massachusetts General Hospital DARA KELLEHER GILMER ZAMORA PARKER WELLINGTON Mohammed Bin Rashid University Manager of Operations Office Attendant AJAY SINGH, MBBS, Project Manager of Medicine and Health Sciences MBA, FRCP and Administration Partners In Health Senior Associate Dean Thumbay Group for Global Education and Continuing Education Harvard Medical School Harvard Medical School Executive Director Advisory Committee Dubai Harvard Foundation for Medical Research DAVID GOLAN Ex officio We are grateful to Its generous financial support has allowed the Center

JOHANNA GUTLERNER SALMAAN KESHAVJEE the Dubai Harvard to establish a presence in Dubai and make tangible Foundation for progress throughout the region. We are also grateful ARTHUR KLEINMAN JENNIFER PUCCETTI Medical Research. for the Foundation’s continued support of our mission AJAY SINGH ROBIN WHEATLEY to build capacity for change. MICHAEL WHITE JENNIFER HARDING (COUNSEL)

50 CENTER FOR GLOBAL HEALTH DELIVERY—DUBAI