Center for Integration Science in Global Health Equity Celebrates Inaugural Symposium

The Center for Integration Science in Global Health Equity (CIS) hosted its inaugural symposium on Thursday, 10 November 2022 at the Joseph B. Martin Conference Center at Harvard Medical School (HMS).

The Center is a joint initiative of the Division of Global Health Equity at Brigham and Women’s Hospital, the Program in Global NCDs and Social Change at Harvard Medical School, and the NCD Synergies project at Partners In Health. The event introduced the Center as a platform for clinicians, researchers, and academics to collaborate in applying integration science to design, implement, evaluate, and bring to scale models for decentralizing services progressively and integrating those services to optimize both health system resources and patient outcomes and well-being.

“The mission of the Center for Integration Science is to accelerate the just redistribution of resources in the interest of global health equity by identifying integrated units of operational effectiveness in health care delivery and scaling their implementation through collective action.”

CIS Executive Director Dr. Gene Bukhman

Together with the Universidade Eduardo Mondale in Mozambique, the Center also serves as the co-secretariat for the NCDI Poverty Network, a group of 22 low- and lower-middle-income countries (and growing) that was formed in December 2020 to implement the recommendations of the Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion.

Towards a Science of Integration for Global Health Equity

The symposium began with opening remarks from CIS Executive Director Dr. Gene Bukhman and brief introductions from the CIS leadership team.

BWH President Dr. Robert Higgins, BWH Department of Medicine Interim Chair Dr. Bruce Levy, and Partners in Health Co-Founder Todd McCormack also delivered opening addresses at the event.

CIS Executive Director Dr. Gene Bukhman

Dr. Bukhman, who is also Co-Chair of the NCDI Poverty Network, then presented the background of decades of innovation in clinical care, research, and analysis that led to the establishment of CIS. Starting in the 2000s, Bukhman and colleagues at Partners In Health worked with the Ministry of Health in Rwanda to develop a strategy for progressive decentralization and integration of chronic care services at first-level hospitals for multiple non-communicable conditions that were endemic causes of preventable death and suffering among children and young adults.

The Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion, which Bukhman co-chaired with Dr. Ana Mocumbi from Universidade Eduardo Mondlane, identified lack of access to care for severe NCDs as the biggest gap in universal health coverage in low-income countries and proposed a strategy to address it by building integrated care teams of mid-level providers, auxiliaries, and physicians at lower levels of the health system to deliver packages of interventions that require related skills and benefit from shared space and information systems.

Following publication of the Lancet Commission report in 2020, 15 lower-income countries that had conducted parallel analyses through national NCDI Poverty Commissions came together to forge the NCDI Poverty Network as a platform for implementing the Commission’s recommendations. The Network has since grown to include 22 countries, 14 of which are implementing or scaling-up PEN-Plus, a proven integrated delivery model that decentralizes integrated chronic care services for severe chronic NCDs like type 1 diabetes, rheumatic heart disease, and sickle cell disease. In August 2022, the 47 member states of WHO’s African region adopted PEN-Plus as a regional strategy to address severe NCDs.

Dr. Emilio Tostão, Scientific Director, Universidade Eduardo Mondlane

The Center for Integration Science will build on these successes to support further expansion and national scale-up of PEN-Plus and to develop, test, evaluate, and implement other integrated service delivery models

Following Dr. Bukhman’s presentation, Universidade Eduardo Mondlane Scientific Director Dr. Emilio Tostāo provided an overview of the partnership between CIS and Universidade Eduardo Mondlane as the co-secretariat of the NCDI Poverty Network, which works to mobilize resources to support health sector interventions that reduce suffering and prevent death from non-communicable diseases among the world’s poorest children and young adults.


Panelists highlight the power of integration science in advancing global health equity

The Inaugural Symposium featured three panel discussions with leading global health policy makers, patient advocates, researchers, implementers, and academics who discussed how integration science can be (and has been) used to inform the design, implementation, evaluation, and scale-up of integrated service delivery models for interventions prioritized based on equity.

From left to right: Alma Adler, Emilio Tostão, Ryan McBain, and Chantelle Boudreaux

The first panel featured a discussion on integration science as the study of delivery model design, including optimal clustering of tasks among providers and interfaces within and outside of the health system. Panelists included Dr. Tostāo, NCDI Poverty Network East Africa Regional Lead Dr. Wubaye Walelgne Dagnaw, CIS Lead Investigator Dr. Ryan McBain, and CIS Associate Director for Integration Research Dr. Chantelle Boudreaux. CIS Research and Monitoring and Evaluation Director Alma Adler moderated the discussion, which focused on developing techniques for studying the distribution of tasks within health systems, as well as techniques for modelling optimal clustering of these tasks.

From left to right: Maia Olsen, Moses Echodu, Apoorva Gomber, and Jon Shaffer. Gregg Gonsalves and Ana Gomanju pictured on screen.

The second group of panelists consisting of global health advocates and community organizers discussed how to build a multi-disease social movement in support of integrated care delivery strategies like PEN-Plus. The panelists included Associate Professor of Epidemiology at Yale School of Public Health Dr. Gregg Gonsalves, CIS Type 1 Diabetes and Global Health Equity Research Fellow Dr.  Apoorva Gomber, Postdoctoral Fellow of Sociology at Johns Hopkins University Dr. Jon Shaffer, and Voices of NCDI Poverty Fellows Anu Gomanju from Nepal and Moses Echodu from Uganda. The panel was moderated by CIS Advocacy Director Maia Olsen.


From left to right: Vikram Patel, Gedeon Ngoga, Emily Wroe, and Robert Riviello

In the final panel, Pershing Square Professor of Global Health at Harvard Medical School Dr. Vikram Patel led a discussion about experiences with implementation of integrated delivery models in the areas of chronic care for severe NCDs, acute/critical care, and breast and gynecological care. CIS Training Director Gedeon Ngoga, CIS Director of Programs Dr. Emily Wroe, Associate Professor of Surgery and of Global Health and Social Medicine at Harvard Medical School (HMS) Dr. Robert Riviello, and World Health Organization Regional Office for Africa Cervical Cancer Technical Officer Sharon Kapambwe shared their perspectives and insights during the discussion.

You can read more about CIS and its work here and watch a recording of the event below.