NIHR Global Health Research Centres 1: Centre for Improving Mental and Physical Health Together A UK and low- and middle-income country (LMIC) research partnership aiming to improve the lives of those experiencing noncommunicable diseases (NCDs) such as heart disease, depression and diabetes in Pakistan and Afghanistan, and the relevant systems available to those populations. The project will also develop the research capacity of related organisations working in these countries. NCDs are rapidly increasing and are now responsible for most deaths and disabilities globally. In Afghanistan and Pakistan, countries with limited resources and affected by 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 share tasks usually delivered by specialists; and private sector organisations are increasingly providing health coverage. There is a knowledge gap, however, on effective, scalable interventions in low-resource, conflict-affected settings. This provides timely opportunities to develop, test and embed evidence-based approaches to address NCDs. In preparing this project, we held consultations with practitioners, affected communities and policymakers in both countries, who identified a time-critical need to strengthen capacity in discovering and implementing affordable effective solutions to address NCDs. We also referred to a recent research prioritisation process undertaken by the Higher Education Commission in Pakistan. The 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 giving mental health parity alongside physical health. Firstly, we will identify the most practical, affordable solutions. A group of academics, practitioners and policymakers will prioritise a shortlist of solutions, including those offered to individuals and communities as well as those implemented at population level. Using various research methods, we will assess the health and economic impact of these solutions. Secondly, we will train researchers, particularly women scholars, to become tomorrow’s research leaders. The trainees will include 8 Masters, 16 Doctoral, 6 Post-doctoral scholars (at least 60% women) and 70 research and support staff (short-term courses). Participating institutions will create competitive faculty positions to retain these scholars beyond the funding period. We will enhance health research standards in our institutions whilst promoting an environment in the two countries that demands, understands and utilises research to inform policy and practice. We will use Community Advisory Panels to engage with patients and families. Following training, Panels will help design, conduct, and disseminate research, bringing practitioners and policymakers together to inform the research and share findings. Multiple channels–journal articles, policy briefs, print and social media– will be used to make findings accessible to academic and lay audiences. Over time, we will develop strong, diverse academic leadership bringing wider health, societal, and economic benefits to the region. Jointly led by Aga Khan University, and the University of York, this global project network brings together experts in diabetes, cardiovascular disease, mental health and global public health research from Pakistan (Aga Khan University; Khyber Medical University; The Institute of Psychiatry; Baqai Institute of Diabetology & Endocrinology at the Baqai Medical University; The Initiative), Afghanistan (HealthNet TPO; Kabul University of Medical Sciences) and the UK (University of York; University of Liverpool; University of Edinburgh). The project will start in October 2022 and run until September 2027. The research plan has ten objectives which are related to research and capacity strengthening activities. All objectives are in line with the overall Centre aims to i) develop and evaluate innovative and sustainable models to deliver individual and population-level interventions, in order to strengthen health systems and support policies for equitable roll-out of strategies for the prevention and treatment of non-communicable diseases (NCDs) and; ii) to strengthen capacity in applied health research and research governance, prioritising gender equality. The Centre objectives are as follows: • By the end of Year 1 of the project, we will complete a valueof-information analysis and stakeholder prioritisation exercise with policy makers, practitioners and community advisory panels. This will help us identify the most suitable interventions we could trial and to assess their feasibility in local contexts in Pakistan and Afghanistan. • By the end of Year 1 we will identify suitable data sources, refine/expand existing population cohorts, digitise data collection and prepare study sites. This will ensure the Centre is ready to carry out identified interventions from Year 2 onwards. • By the end of Year 1 we will assess the existing capacity within the project partner organisations and health, policy and community systems in Pakistan and Afghanistan, in order to develop a tailored action plan with a special emphasis on gender equity. • By the end of Year 1 we will develop a research training and mentorship programme for researchers, practitioners and policymakers. • By the end of Year 1 we will establish research governance functions, Community Engagement and Involvement and Policy Fora. This is in order to share best research governance practice, to receive advice from key stakeholders and to ensure communication between the project and stakeholders is effective. • By the end of Year 4 we will evaluate the (cost-)effectiveness, equity and implementation of selected interventions (Objective 1) for modifying NCD risk factors and/or improving NCD outcomes through randomised controlled trials and health economic approaches. • By the end of Year4 we will deliver a training programme to project members and key stakeholders, strengthen institutional capacity in data and financial management within partner organisations and strengthen applied health research courses/degrees in partner organisations. • By the end of Year 3 we will conduct a mid-term review of all training and capacity strengthening plans and activities. • By the end of Year 5 we will work with key stakeholder fora to translate our project findings into policy and practice and enact plans to sustain research and its impact. We will use our links to extend the Centre's impact across the World Health Organization Eastern Mediterranean Region. • By the end of Year 5 we will support project trainees to secure follow-on fellowships or extramural funding and conduct an end of project impact- assessment.