Multi-disciplinary partnerships for systemic change in health care provision and promotion

Synergos Senior Fellow, Dr. Mary Amuyunzu-Nyamongo, is the Executive Director and co-founder of the African Institute for Health and Development (AIHD), based in Nairobi, Kenya. The AIHD is a non-governmental organization founded in 2004 to empower communities to address health issues and implement solutions through research, training, and advocacy.

In 2008, the same year Mary became a Synergos Senior Fellow, AIHD co-facilitated an advocacy meeting in Tanzania focused on non-communicable disease (NCD) prevention and control and health promotion in response to the rise of NCDs in sub-Saharan Africa. Over 55 NCD experts and stakeholders from various countries attended. The meeting resulted in the formation of an expert group, made up of professionals working on different NCDs as well as tobacco control and nutrition promotion, and a partnership group of multi-lateral agencies invested in healthcare. The two groups re-convened in Uganda the following year to form the Consortium for Non-Communicable Diseases Control and Prevention in sub-Saharan Africa (CNCD-Africa), a multi-disciplinary, multi-country coalition. Mary was appointed the coordinator of CNCD-Africa, and the consortium remains housed at AIHD.

“As a consortium, you can do a lot more in terms of networking, building coherence, interventions, and setting standards,” explains Mary. The four major risk factors contributing to NCDs in Africa are poor diets, lack of physical activity, tobacco consumption, and harmful use of alcohol. CNCD-Africa engages partners across multiple disciplines to address NCD prevention, control, and management, recognizing the inextricable link between socio-economic conditions and health outcomes. In Mary’s own words, “tackling a single condition or risk factor is unlikely to achieve broad-based results that would lead to population level changes.” CNCD-Africa uses partnerships across countries and sectors to create systemic change, enabling stakeholders to focus on multiple components of a complex, multi-dimensional problem.

AIHD and CNCD-Africa represent a unique partnership to leverage international networks to effect local policy. The next item for AIHD and CNCD-Africa, a study on salt consumption in sub-Saharan Africa, exemplifies this relationship. CNCD-Africa provides the regional and global network to complete a multi-country study, while AIHD will conduct the Kenya-specific research and inform national policy based on the results.

While AIHD and CNCD-Africa have similar missions, the objectives of CNCD-Africa are wider. The consortium has the potential to expand across Africa, which is the ultimate goal. The objective of the consortium is to bring together a range of actors working on NCD related issues to coordinate, network, share knowledge, create standards, and advocate at the local, regional, and international level.

On the other hand, AIHD has the capacity to implement and take action, as part of CNCD-Africa, at the national level. The mission of AIHD is to “work with communities for better lives through evidenced-based programming.” CNCD-Africa aims to do exactly this. In order to create lasting change in a society, it is essential to engage actors at the community level, while simultaneously advocating for policy at the macro level. As Mary states, “transcending these two very different but connected levels, working upstream and downstream, is paramount to making a difference in working communities for a better life.”

In August 2011, Mary completed a Synergos peer exchange in Chile with Senior Fellows Bharati Chaturvedi and host Lake Sagaris. Mary’s role was to provide insight on how to intertwine health promotion and prevention activities into Lake’s work with living cities. Not only was Mary able to provide suggestions on how to create this link, given her work engaging multiple partners across sectors around health issues, but she also gained insight into community transformation. In response, Mary was able to use her experience to write a concept note to pilot a living city in Kenya. The goal is to create a culture of healthy living to help prevent NCDs - a creative solution in line with both AIHD and CNCD-Africa’s missions.

Mary came back to the Americas in September 2011, this time to New York for a UN forum to adopt a Political Declaration on NCDs. In the spirit of collaboration, Mary partnered with Senior Fellow Dr. Richard Deckelbaum, the Director of the Institute of Human Nutrition at Columbia University and Director of the Columbia and Gurion University collaboration - University Medical School for International Health (MSIH), based in Israel. Mary and Richard worked together to organize a side meeting during the UN forum titled, “Integrative Approaches to the Global Double Burden: Under and Over-nutrition and the NCDs.” The meeting aimed to provide recommendations for innovation within current systems to address the “Double Burden” and NCDs through integrative health and social approaches. The session brought together a range of stakeholders from civil society, the private sector, academia, research institutions and government. The outcomes of this session are currently being packaged to be published in a peer-review journal. This is yet another example of how Mary is using the wider Synergos network to promote systemic changes to address her mission, NCD prevention and solutions.