Initial work took the form of the design by Adam Coutts and Adel Daoud of a political economy audit of the Lebanese, Jordanian and Turkish health systems, using mental health and cancer care as case studies. Beginning in the second half of 2018, interviews were conducted with key stakeholders in the region including health ministries, private sector health providers, the UN and NGOs in partner countries. Working with other members of the R4HC Political Economy stream, team members completed extensive political economy reports on Lebanon and Jordan in the course of the summer of 2019. Simon Deakin has been working on a concept note discussing the contribution of institutional and behavioural approaches to the political economy of health.
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. Mona submitted a first draft of the political economy report for Gaza in August 2019. She made a number of presentations of her work and prepared abstracts for several conference presentations.
A further objective of the Political Economy stream has been to undertake a scoping exercise to establish how best to overcome obstacles to data collection, including ‘survey fatigue’ in the region. In the summer of 2019 Jesse Berns completed a preliminary report mapping data utilization inequities at patient and provider levels in the practice of aid agencies and NGOs active in the MENA region. The report shows that the heterogeneity of tools used to capture, store, transmit, clean and analyse healthcare data in the aid sector has implications for data insecurity.
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.
Since August 2018, the mental health stream of the R4HC project has made steady progress toward the project aims. Most of the day-to-day work has been led by our colleagues at the Global Mental Health Lab, who continue to train and supervise practitioners in the region working with refugees. As with previous reports, our primary role in that has been coordination between GMH and the R4HC group generally.
For the CBR-specific work, Kai Ruggeri and Tomas Folke have been working toward generating the necessary behavioural and mental health data from Lebanon. This will include both the Lebanese population as well as refugee populations of both Syrians and Palestinians in Lebanon. The entire 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.
The CBR has reached a tentative agreement with Ipsos in Beirut to collect data for the survey. As this comprises the largest contribution of the Cambridge team to the mental health stream, the largest update is likely to come in late September 2019. From that point, the team will translate insights to the capacity-building guidance for the MOPH, focusing on how behavioural insights are developed, translated to application/policy, and the long-term implications for mental health.
Kai Ruggeri and Tomas Folke have also submitted their earlier work on the use of nudging in mental health policy in Lebanon, which has now received a tentative acceptance in Evidence and Policy, pending one round of revisions.