Initial work scoping a political economy audit (‘PEA’) of the Lebanese, Jordanian and Turkish health systems was carried out and interviews were conducted from 2018 with key stakeholders in the region including health ministries, private sector health providers, the UN and NGOs in partner countries. Extensive drafts of the political economy reports on Lebanon and Jordan were completed in the course of the summer of 2019. Work continued on these reports in 2020 and they were largely completed by the end of September 2020.
Following her appointment in the autumn of 2018, Mona Jebril conducted a critical literature review on the political economy of health in Gaza and analysed it using MAXQDA software. After her submission of the PEA draft report in August 2019, Mona started preparing for fieldwork in the Gaza Strip via Skype and telephone from Cambridge. Mona used a snowballing method to reach participants. She conducted a number of in-depth interviews with policy makers, and health officials from different health sectors in Gaza including the Ministry, UNRWA, NGOs, and private institutions. She also conducted interviews with carers of patients in the Gaza Strip. Mona developed a journal of personal reflections on the interviews using Scrivener software. She then transcribed all interviews by herself. Mona coded the interviews using the MAXQDA software. The report was published in November 2021. Mona made numerous presentations of her work in a variety of forms (blogs, podcasts, animations and a play which was staged at the Cambridge Junction in July 2021).
The Political Economy workstream produced a parallel report on the political economy of health in Lebanon, How Politics Made a Nation Sick. The Political Economy of Health in Lebanon, published by Conflict and Health Research Group at King’s College, London. The lead author was Professor Fouad Fouad of the American University of Beirut, and contributing CBR researchers included Adam Coutts, Adel Douad and Simon Deakin. The research draws on extensive interviews and data analysis. The report dissects the causes of the weak political response to a series of health crises in Lebanon and calls for a shift away from the current reliance on the private sector to deliver public health, arguing for a new model that better balances private and public provision.
Bothaina Attal joined the CBR as a CARA Visiting Fellow in 2020. She is a medical health professional and researcher previously based in Yemen. Bothaina carried out research on the governance of public health in Yemen, using the methodology developed for the R4HC project, and published a number of papers relating to the health situation in Yemen.
During 2020 and 2021 Simon Deakin worked on a paper exploring governments’ response to Covid-19 using a theoretical framework which explores the role of the state in delivering public health and related collective good (see the report on the Research in the Theory and Practice of Governance project for further details).
To meet R4HC aims for year one (2017-2018), the CBR’s partners in the Global Mental Health Lab (Teachers College, Columbia University) trained mental health providers in Lebanon to meet competency criteria in Interpersonal Psychotherapy (IPT) as supervisors and providers; systematically collected outcomes of patients who accessed individual IPT treatment; piloted integration of the IMPACT collaborative care platform in a primary healthcare center in Lebanon; and have been engaging with stakeholders expand treatment in primary and specialty clinics serving host and refugee communities.
In 2018-19, the mental health stream of the R4HC project made steady progress toward the project aims, and continued to support the work of our partners at Columbia. Kai Ruggeri and Tomas Folke worked towards generating the necessary behavioural and mental health data from Lebanon. The survey was completed in the summer of 2019 following several rounds of feedback including from local partners and Lebanese academics at the American University of Beirut, with whom the CBR team interacted at the Lancet Palestinian Health Alliance Conference 27-28/03/2019, and with whom they have approval from the Lebanese Ministry of Public Health to collect the data. The survey was translated into Modern Standard Arabic by a professional translator.
In 2019-20 Hannes Jarke joined the team and worked with Kai and Tomas, on a survey of mental health, trust, and decision-making in refugees and the general population in Lebanon. The survey was subsequently completed with the help of IPSOS in Lebanon. In 2021 Federica Stablum joined the team to contribute generally to the work of the mental health stream.
In 2020-21 many aspects of the work had to be adapted due to lingering political instability, worsened by the pandemic, and the continued fallout from the August 2020 explosion in Beirut. Multiple initiatives were started and halted for various reasons, but the team still ended up with several critical outputs. Their primary empirical study on decision-making/risk-taking and mental health in Lebanon was published in May 2021, with a second paper forthcoming most likely in late 2021. Once regular travel resumes, the aim is to get more visibility for this work, though team members were able to present in-person to the Max Planck Institute for Human Development in Berlin. The first paper was also converted into a policy brief that was provided to participants in subsequent training and partnership programs.
Several initiatives were developed as adaptations to the original evidence-based policy training, planned initially to offer remote engagement for colleagues in and from Lebanon working in mental health policy. The aim of this programme is to strengthen the bridge between research and policy in the field of public health and mental health. Delivered in collaboration with the Cambridge Centre for Science and Policy (CSaP) during 2021, the R4HC – Cambridge Knowledge Exchange Programme (KEP) consisted of one-to-one meetings between five ECRs and policymakers (‘Partners’) from Lebanon and experts from the University of Cambridge selected on the relevance of their work. After the meetings the Partners of the KEP and a wider network of roughly 20 ECRs from the MENA region were invited to two workshops, one led by the PRG on ‘Evidence-based behavioural policy’ and one led by Dr Iris Elliott (external) on ‘Communicating research evidence’.
In late August 2021, we completed the final wave of training for the Knowledge Exchange Programme, which focused on training courses in evidence-based behavioral policy as well as research communication. In completing the R4HC project in 2022, the primary final output from the mental health team was a publication in which we validated one of the behaviour/risk metric frameworks that we used in Lebanon. This article was published somewhat out of order as it had been run during the period that data collection was not possible in Lebanon (data were from Italy), but we paused writing it once we could focus on the Lebanon materials and partnerships (covered in the 2021 report). The published work included three CBR affiliates (Folke, Stablum, Ruggeri).