Opportunities and challenges to non-communicable disease (NCD) research and training in Pakistan: a qualitative study from Pakistan

Abstract

IntroductionMost of the global non-communicable disease (NCD)-related death burden is borne by low and middle-income countries (LMICs). In LMICs like Pakistan, however, a major gap in responding to NCDs is a lack of high-quality research leading to policy development and implementation of NCDs. To assess institutional opportunities and constraints to NCD research and training we conducted a situational analysis for NCD research and training at Aga Khan University Pakistan.MethodsWe conducted a descriptive exploratory study using grounded theory as a qualitative approach: semistructured interviews of 16 NCD stakeholders (three excluded) and two focus group discussions with postgraduate and undergraduate trainees were conducted. A simple thematic analysis was done where themes were identified, and then recurring ideas were critically placed in their specific themes and refined based on the consensus of the investigators.ResultsThe major themes derived were priority research areas in NCDs; methods to improve NCD research integration; barriers to NCD research in LMICs like Pakistan; design of NCD research programme and career paths; and NCD prevention at mass level, policy and link to the government. In general, participants opined that while there was an appetite for NCD research and training, but few high-quality research training programmes in NCDs existed, such programmes needed to be established. The ideal NCD research and training programmes would have in-built protected time, career guidance and dedicated mentorship. Most participants identified cardiovascular diseases as a priority thematic area and health information technology and data science as key methodological approaches to be introduced into research training.ConclusionWe conclude from this qualitative study on NCD research and training that high-quality research training programmes for NCDs are rare. Such programmes need to be established with in-built protected time, career guidance and mentorship for the trainees to improve their research capacity in Pakistan.

El análisis situacional de la teoría fundamentada en salud: una revisión integrativa de la variante postmoderna de la teoría fundamentada

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“…Si bien esta variante no se encuentra enmarcada en el paradigma positivista, en el cual se favorece el uso de la triangulación desde distintos ámbitos, es posible observar que los investigadores en el área de la salud triangulan y observan los fenómenos desde diferentes posiciones epistemológicas y ontológicas, reforzando de esta manera el rigor en la investigación cualitativa. (13)(14)(15)(16) En la categoría de gestión en salud, el análisis situacional destaca por su relevancia en la planificación efectiva, coordinación y comunicación en diferentes entornos de atención sanitaria, con el objetivo de salvaguardar la seguridad del paciente y la calidad de la atención. También se utiliza en el fortalecimiento de la práctica basada en evidencia, al abordar de manera crítica las diversas posturas de los profesionales de la salud en relación con su desempeño.…”

Palliative Care in Pakistan: Current Landscape, Challenges, Progress and the Way Forward

“…Pakistan's total expenditure on health in 2018 was reported to be 3.2% of it's GDP in 2018 as per the World Bank which in itself shows the government's inability to regard health as a priority. The country is currently facing a double burden of disease with NCD accounting for more than 50% of adult mortality with a projection of around 3.9 million deaths by 2025 as a result of NCD alone [10]. Cancer has also emerged as a major health issue which is reflected by the estimates for new cancer cases in the country standing at a staggering figure of 170,000 to 200,000 yearly with many presenting at an advanced stage requiring palliation from the beginning [11].…”