NIHR Global Health Research Unit on Neurodevelopment and Autism in South Asia: NAMASTE Global Health Research Unit: Neurodevelopment and AutisM in South ASia Treatment and Evidence (NAMASTE) is an ambitious programme which aims to develop a flexible evidenced pathway towards universal health coverage for young children with Autism, focused on four regions in South Asia. Autism a severe neurodevelopmental disability has a significant impact on a child’s developmental trajectory into adulthood with profound long-term consequences on the individual and their families. About five million families in India alone live with a young autistic child, the great majority with no access to services. Over a 10-year collaboration, Sangath, an Indian public health research not-for-profit, and the University of Manchester have carefully adapted an early intervention, tested in the UK with evidence for improving long-term autism outcomes for non-specialist delivery in South Asia. The resulting 'Parent-mediated Autism Social Communication Intervention for Non-Specialists Plus (PASS Plus)’, is the first of its kind having shown real-world effectiveness in low resource settings. Sangath has in parallel, also developed an extensive digital training and supervision platform for health workers to support non-specialist delivery of a range of psychosocial interventions. 

NAMASTE will extend this work, with additional collaboration with the World Health Organization’s group-delivered 'Caregiver Skills Training' (CST) for more general neuro-disability, into a comprehensive detection care pathway, which will include a novel, flexible digitally enabled, two-level screening protocol (for young children with neurodevelopmental difficulty); combined with a complimentary evidenced intervention protocol embedded in the health system where possible. NAMASTE will develop a training, research and capacity building hub across India, Sri Lanka and Nepal over 5 years. Initial workforce development will build clinical and research capacity across each country; including masters, doctoral, and post-doctoral training from the UK for future health leadership. In each region and at each stage, community partners, self-advocates and co-applicants will help co-design awareness materials and advise on tool and protocol development. Evaluation of this program will be disseminated in international scientific and policy forums. This NIHR Global Health Research Unit will generate a hub for high quality research in autism and other developmental disorders in South Asia. 1. To develop and evaluate a stepped detection pathway for a broad range of Neurodevelopmental Disorders (NDDs) including autism. This will include a system of universal screening and surveillance for developmental delays as well as autism risk, for young children. Outcome:  A community administered questionnaire which is sensitive and specific in identifying young children with neurodevelopmental disabilities including autism. 400 Public health midwives (PHM) in Sri Lanka; 155 frontline workers in India and 14 Female Community Health Volunteers (FCHV) sensitized to neurodevelopmental disorders and to administer the questionnaire.
2. To digitize the training for non-specialist to deliver two evidenced interventions, including the World Health Organization Caregiver Skills Training (WHO-CST); and the Parent-mediated Autism Social Communication Intervention for non-Specialists Plus (PASS Plus), a developmental intervention supporting social communication for autism. The programme will develop linked competency assessments for each intervention, ensuring a scalable certification process. Outcome: 10 PHMs in Sri Lanka, 8 frontline workers in India and 4 non-specialist in Nepal trained to competency to deliver the two intervention packages. 
3. To digitize a supervision platform for the PASS Plus intervention. This digital platform will allow remote access to non-specialist delivered sessions to allow supervision and quality checks and facilitate peer supervision in groups. Outcome:  A digital platform which will be evaluated for use in building and supporting peer supervision skills of non-specialist health workers in delivering the PASS Plus intervention. 
4. To develop and capacity build a training and supervision cascade to deliver both interventions. Outcome: A minimum of four Master trainers for both interventions will be established within each country team.
5. To evaluate the effectiveness of the data pipeline from detection to intervention across the sites, using process indicators, elucidating the accuracy of the detection pathway, the engagement with the interventions being delivered and the acceptability, feasibility and quality of non-specialist delivery of the two interventions. Outcome:  A scalable model for a district level service provision for young children with neurodevelopmental disorders
6. To evaluate service use and organisational costs in the implementation areas; and developing relevant health economic quality of life outcomes. Outcome Development of joint policy briefs with government partners for dissemination and scale up of services.
7. To develop research and clinical capacity in partnership regions coupled with an extensive postgraduate training and supervision programme. This will include four PhD students registered at the University of Manchester, and embedded within local site activity. These individuals will develop capacity in key areas of need and supported to act as a nucleus to lead future clinical research within South Asia. Additionally, six Masters courses and bespoke training and professional development activities to further build capacity within local teams. Outcome Research and clinical capacity to deliver NAMASTE objectives and to develop and sustain a South Asia Neurodevelopmental Disabilities Research Hub extending beyond the project timelines 
8. To develop a public engagement campaign through participatory and collaborative methods, to help increase the awareness of neurodevelopmental disorders and autism in the implementation communities. Outcome:  A customised toolkit for each site for advocacy and awareness raising.