NIHR Global Health Resesarch Centre for Improving Mental and Physical Health Together

Non-communicable diseases (NCDs), such as heart disease, depression, and diabetes, are rapidly increasing, and are now responsible for most deaths and disabilities globally. In Afghanistan and Pakistan, countries with limited resources and affectedby recent conflicts, NCDs risk crippling fragile health systems and economies. In response, health systems and policies are evolving and diversifying, e.g., non-specialist healthcare workers are sharing tasks usually delivered by specialists; and non-state and private-sector organisations are increasingly providing health coverage. There is a knowledge gap, however, on interventions that are effective and can be delivered at scale in low-resource, conflict-affected settings. This provides timely opportunities to develop, test and embed evidence-based approaches to address NCDs. In preparing this proposal, we consulted with practitioners, affected communities and policymakers in the two countries, who identified a time-critical need to strengthen capacity in discovering and implementing affordable effective solutions to address NCDs. We were also guided by the recent research prioritisation process undertaken by the Higher Education Commission, Pakistan.Our long-term aim is to promote mental and physical health in Afghanistan and Pakistan by reducing premature deaths and disabilities caused by NCDs. In this proposal, we focus on three of the four key NCDs: common mental disorders (depression and anxiety), heart conditions, and diabetes. We will evaluate approaches to prevent and treat these, targeting those most at risk, and –uniquely– giving mental health parity alongside physical health.