Bridging a Critical Gap in Care for the World’s Poorest Billion

Center named a WHO Collaborating Centre for its work in integrated care for people living in extreme poverty with severe noncommunicable diseases

By PAULA BYRON | Center for Integration Science in Global Health Equity Research Care Delivery

3 min read

Photographed from above, 24 people stand in the center of a sunlit room smiling up at the camera.
Center faculty and staff gathered at HMS in July 2022. Director Gene Bukhman is center front. Image: Stu Rosner

At a glance:

  • WHO taps HMS/BWH/PIH collaboration to help stop preventable deaths from complications of untreated noncommunicable disease among world’s poorest billion.
  • Integrated health systems can bring lifesaving care to millions who currently live — and die — without it.
  • Center is helping to share innovations that could prevent a half million children and young adults a year from dying avoidable deaths.

Childhood heart disease, type 1 diabetes, and sickle cell disease customarily fall into disparate clinical specialties. Even so, those conditions share certain disheartening characteristics: They’re all severe, chronic noncommunicable diseases that cannot be prevented. Their treatment protocols are complex. And, when left untreated, they kill the world’s children and young adults living in extreme poverty at devastating rates.

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The Center for Integration Science in Global Health Equity has been working with an international network to build systems and solutions that integrate expertise and resources across these diseases to save young lives in rural sub-Saharan Africa and South Asia, where 90 percent of the world’s people living in dire poverty are located.

For its leadership work in integration science, a relatively new discipline that seeks to align medical, scientific, and social resources across complex systems to better address population health care needs, the center was recently named the WHO Collaborating Centre on Integration Science and Service Delivery. With this designation from both the World Health Organization and the Pan American Health Organization, the center joins a global network of organizations supporting WHO initiatives.

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“We’re honored that both the World Health Organization and the Pan American Health Organization are recognizing our work,” said the center’s executive director, Gene Bukhman. “We also appreciate the value they’re placing on integration science, a relatively new field that has tremendous potential for delivering care to the people who need it most, which is an essential ingredient in achieving global health equity.”

Bukhman is also director of the program in global noncommunicable diseases and social change in the Department of Global Health and Social Medicine in the Blavatnik Institute at Harvard Medical School and a cardiologist at Brigham and Women’s Hospital.

Bringing care where it’s needed

In many low- and lower-middle income countries, care for severe, chronic noncommunicable diseases is available only at referral hospitals in major cities, making treatment both inaccessible and unaffordable for the rural poor. As a result, many children and young adults die prematurely — and preventably. The model that the Center for Integration Science principally uses, PEN-Plus, addresses this gap by bringing lifesaving care to first-level rural hospitals.

To optimize the use of health care resources, PEN-Plus trains providers such as nurses and clinical officers to provide crucial services across these diseases. Last summer, all 47 member states of the WHO Regional Office for Africa adopted PEN-Plus as their official strategy for providing care for people with severe noncommunicable diseases.

Training and technical support to scale up solutions

As part of its WHO Collaborating Centre mandate, the center will provide technical support to WHO’s work in characterizing and classifying existing models of integrated care for noncommunicable diseases, collaborate with WHO in the integrated care of these diseases in selected countries, and share best practices and lessons learned in the implementation of integrated care of these diseases. The WHO Collaborating Centre designation is slated to continue through April 2027.

The Center for Integration Science is a joint initiative of Brigham and Women’s, HMS, and Partners In Health. In addition to pursuing an ambitious research agenda, the center serves as the Boston co-secretariat of the NCDI Poverty Network, a global partnership that seeks to bridge the gap in universal health coverage for the world’s poorest billion.

The only other current Harvard-affiliated WHO Collaborating Centre — the Program in Global Surgery and Social Change — is also based at both HMS and Brigham and Women’s. Past Harvard-affiliated WHO Collaborating Centres included three at the Harvard T.H. Chan School of Public Health (one on the biostatistical evaluation of cancers from 1981 to 1994, one on health legislation from 1987 to 2004, and one on nutritional epidemiology and advanced training in public health nutrition from 1993 to 1999); one at Brigham and Women’s (on surveillance of antimicrobial resistance from 1985 to 2021); and one at HMS (on research and training in mental health from 1987 to 1994).

This story is adapted from a Center for Integration Science in Global Health Equity news story.