Integration Science Can Help Heal Global Health Inequities

PEN-Plus clinicians undertake echocardiography training in preparation for offering cardiac services to people living with rheumatic or congenital heart disease in Rwanda. The PEN-Plus model—an internationally implemented example of integration science—was first developed by clinicians in Rwanda.

Integration science can do more than deliver quality healthcare; it can also deliver global health equity solutions.

That’s the central premise of “From Local Innovation to National Scale to Global Impact: Integration Science as an Engine of Change and an Agenda for Action,” the second annual symposium of the Center for Integration Science in Global Health Equity.

The symposium will be held March 14 from 9 am to 1:30 pm EDT at Harvard Medical School’s Joseph B. Martin Conference Center in Boston. Registration is required for the free event, which will also be livestreamed and recorded to accommodate a global audience.

Based at Brigham and Women’s Hospital, the Center for Integration Science works toward global health equity by identifying gaps in groups of related health services, using integration science principles to bridge those gaps, and building multi-disease coalitions to help bring those services to rural sub-Saharan Africa and South Asia, where 90 percent of the world’s poorest people live.

Together with the Universidade Eduardo Mondlane in Mozambique, the center also serves as a co-secretariat of the NCDI Poverty Network, a partnership of health leaders in low- and lower-middle-income countries as well as their advocacy, policy, funding, and technical partners from around the world. At the core of their work is the implementation of PEN-Plus, an integrated care-delivery model that provides services to people living in extreme poverty with severe noncommunicable diseases, such as type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease.

“PEN-Plus, which is already saving lives in 14 countries, is the most advanced application of integration science,” said Gene Bukhman, MD, PhD, executive director of the Center for Integration Science and a co-chair of the NCDI Poverty Network. “But the field has tremendous potential for the development of other, equally effective models. So, in addition to continuing to refine PEN-Plus and support NCDI Poverty Network countries, our center is expanding the scientific basis for integrating health service delivery models and social movements to solve some of the world’s greatest health challenges.”

In 2023, the World Health Organization recognized the Center for Integration Science for its leadership in integration science by naming it a WHO collaborating center.

At the March 14 symposium, Bente Mikkelsen, MD, director of noncommunicable diseases in the World Health Organization’s Division of UHC/Communicable and Noncommunicable Diseases, will provide recorded remarks to celebrate the Center for Integration Science’s official role as the WHO Center for Integration Science and Service Delivery. Dr. Mikkelsen’s message will follow opening remarks by Dr. Bukhman and a welcome address by Bruce Levy, MD, chair of the Department of Medicine at Brigham and Women’s Hospital. Clinicians, researchers, academics, and program, policy, and advocacy specialists will then explore the many facets of integration science in a series of panel discussions.

In the first of those discussions, “Integration Science and the NCDI Poverty Network, Global Health Delivery Partnership, and Partners In Health Theories of Change,” panelists will examine integration science as a framework for mobilizing policies, programs, resources, and a movement of solidarity to advance global health equity. Dr. Bukhman will moderate the session, which will feature:

• Ana Mocumbi, MD, PhD, co-chair of the NCDI Poverty Network and an associate professor of cardiology, Universidade Eduardo Mondlane;

• Joseph Rhatigan, MD, chief of the Division of Global Health Equity at Brigham and Women’s Hospital, and chair of the Global Health Delivery Partnership;

• Salmaan Keshavjee, MD, PhD, director of the Center for Global Health Delivery, Harvard Medical School; and

• Cate Oswald, principal chief program officer at Partners In Health. 

In “Biocitizenship: Meaningful Engagement for People Living with Disease in Settings of Extreme Poverty,” panelists will discuss integrated service delivery models aimed at addressing the needs of people living with disease in resource-poor settings. The panelists will also explore ideas for building and leading national and global movements that demand access to health care as a fundamental human right. Apoorva Gomber, MD, MPH, associate director of advocacy at the Center for Integration Science, will lead a discussion with several panelists:

• Ruth Ngwaro, Voices for PEN-Plus advocate and person living with congenital heart disease;

• Maia Olsen, MPH, technical and implementation consultant for the World Health Organization’s Global Coordination Mechanism on NCDs;

• Jonathan Shaffer, PhD, an assistant professor of sociology at the University of Vermont; and

• Yogesh Jain, MD, founder of Sangwari, the implementing partner of the PEN-Plus clinic in Chhattisgarh, India.

The next panel will offer “Malawi Case Study: PEN-Plus as a Fulcrum for Progressive Decentralization and Integration of Services for Severe NCDs.” Emily Wroe, MD, MPH, programs director at the Center for Integration Science, will lead a conversation with:

• Luckson Dullie, MD, PhD, chief leadership development and engagement officer at Partners In Health and former executive director of Abwenzi Pa Za Umoyo/Partners In Health Malawi;

• Bright Mailosi, teaching fellow at the Harvard T.H. Chan School of Public Health and a former PEN-Plus clinical officer at Abwenzi Pa Za Umoyo/Partners In Health Malawi;

• Neil Gupta, MD, MPH, policy director at the Center for Integration Science; and

• Jones Masiye, MD, MPH, deputy director of noncommunicable diseases and mental health clinical services at Malawi’s Ministry of Health and an NCDI Poverty Network Steering Committee member.

Chantelle Boudreaux, ScD, associate director of integration research at the Center for Integration Science, will moderate “Integration Science and the Future of Facility Assessments” with:

• Ryan McBain, ScD, health economist at the Center for Integration Science;

• Kjell Arne Johansson, MD, director of the Bergen Centre for Ethics and Priority Setting at the University of Bergen, Norway;

• Solomon Tessema, MD, PhD, director of the Addis Center for Ethics and Priority Setting, Ethiopia; and

• Barkhá Vijendra, MD, coordinator of the Time-Driven Activity-Based Costing Study, Universidade Eduardo Mondlane, Mozambique.

Dr. Bukhman will moderate the final panel, “Integration Science as an Engine for Global Health Equity,” which will feature four panelists from the Center for Integration Science: Alma Adler, PhD, research and monitoring and evaluation director, and Drs. Wroe, Gomber, and Gupta.

“This symposium will provide a platform for clinicians, researchers, public health experts, and advocates to collaborate across disciplines and across borders to tackle some of today’s most intractable global health challenges,” said Dr. Bukhman. “Some of what we’re discussing—methodological advances in assessing health systems, opportunities for service-delivery integration—may at times sound wonky. But we’re really talking about something more fundamental: ensuring the world’s most vulnerable children and young adults can receive lifesaving care.”