Health and Wellbeing

Our work here aims to improve and contribute to the evidence base for effective intervention strategies and policies to promote the health and well-being of all people in Africa. The theme has five programs of work (Units): Nutrition and Food Systems; Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health (SRMNCAH); Chronic Diseases Management (CDM); Emerging and Re-emerging Infectious Diseases (ERID) to respond to the COVID-19 and Antimicrobial Resistance (AMR) challenges; and Health Systems Strengthening. 

Nutrition and Food Systems (NFS) – Aims to generate evidence, build capability and influence policy and practice to promote positive food systems transformation for optimal nutrition and health in Africa. The unit has three focus areas:  Maternal, Child and Adolescent Nutrition; Nutritional epidemiology; and food systems. 

• The maternal, child and adolescent nutrition program aims to inform policies, strategies and actions to optimize the health of mothers, children under five years, school going children and adolescents, with a special focus on nutrition in the first 1000 days including breastfeeding and complementary feeding. 
• The nutritional epidemiology program aims to improve the understanding of the role of diet in the etiology of health outcomes such as malnutrition including obesity in the African context, and identifying the determinants that influence diet. This area also focuses on evaluating interventions to improve dietary patterns, and translating nutritional epidemiology evidence into guidelines, policies and actions. 
• The food systems program aims to inform policies, strategies and actions on food systems transformation towards healthy, nourishing, inclusive, human-centered, resilient and sustainable food systems. We focus on sustainable production, access to and consumption of sustainable healthy foods, to promote health and wellbeing, while promoting a healthy environment and mitigating and adapting to climate change challenges. We apply a human-rights based approach to food systems transformation, with a special focus on food sovereignty; and freedom from hunger and the right to adequate food especially for the most vulnerable. We build capability and agency of grassroots organizations including women and youth groups as a pathway to effective food systems transformation in communities. 

Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health (SRMNCAH) – The SRMNCAH Unit generates rigorous evidence that informs programs and policies to improve sexual, reproductive, maternal, newborn, child and adolescent health in Africa. The SRMNCAH Unit has five focus areas:

• Maternal, newborn and child health: We seek to enhance access to safe, high-quality, and affordable maternal, newborn, and child health (MNCH) care within the framework of Universal Health Coverage (UHC). Our work takes a multifaceted approach, including generating evidence, adopting, testing, and adapting interventions to suit specific contexts. By pursuing this area of work, we aim to address one of the core challenges in MNCH—ensuring that mothers, newborns, and children have equitable access to essential healthcare services, regardless of their socio-economic status or geographical location.
• Maternal and adolescent mental health: We generate evidence related to the prevalence, underlying contexts, and dynamics of common maternal and adolescent mental health problems. We also seek to develop and test effective interventions to address prevailing mental health challenges among these demographics. Our work on maternal and adolescent mental health acknowledges the critical connection between maternal (perinatal) mental health and MNCH outcomes. Our work also aims to provide valuable insights into the multifaceted landscape of maternal (perinatal) and adolescent mental health, contributing to better policies, practices, and support systems.
• Young people’s sexual and reproductive health and rights (SRHR): We recognize the importance of investing in young people’s SRHR as a critical lever to harness the demographic dividend in Africa. We advance this agenda by undertaking research to understand the drivers of young people’s SRHR with a focus on early adolescents (10-14 years), those from marginalized communities and those most-at-risk of being left behind as the world focuses on the achievement of the 2030 development agenda such as pregnant and parenting adolescents. Through strategic partnerships with program implementers working on young people’s SRHR, the Unit also generates evidence about what works to reach youth with safe, respectful and comprehensive SRHR information and services. Recognizing that education is an important social determinant of young people’s SRHR, we work with colleagues in the Human Development Theme to understand how to make education systems more inclusive (e.g., promoting school re-entry for pregnant and parenting adolescents).
• Abortion and family planning: We implement studies focused on understanding the contexts and dynamics of unsafe abortion, family planning, contraceptive attitudes and behaviors, and fertility, deepening our understanding of the mortality and morbidity associated with unsafe abortion and unintended pregnancy, strengthening the measurement of unsafe abortion and unintended pregnancy; and assessing the impact of unsafe abortion prevention programs and barriers to quality post-abortion care. 
• Gender and sexuality-related vulnerabilities Our research examines the drivers of sexual- and gender-based violence (SGBV) and interventions to address SGBV among different populations, including refugee populations. Our work also examines the lived experiences of sexual and gender minorities (lesbian, gay, bisexual, trans, intersex, and other gender non-conforming persons—LGBTQI+ people), including the interlinkages between their lived experiences and health outcomes.

Chronic Diseases Management (CDM) Unit – The Center’s focus here is on the generation of evidence on chronic diseases management as a systematic approach to coordinating health care interventions across levels (individual, organizational, local and national). The focus on “management” signals a shift away from the dominant notion of treatment, and the intended outcome from “cure” to stewardship. The unit has three focus areas:

• Non-communicable diseases (NCD) aetiological research,  generating evidence on the burden, epidemiological and genetic risk factors for NCDs. 
• Chronic diseases interventions research, entailing the co-design of new interventions or  new ways of delivering known interventions in various African populations for prevention or care of people with chronic diseases such as hypertension, diabetes, cancers, mental illness and chronic lung diseases. Examples of intervention projects include use of digital technology for improving self-management, decision support for primary care workers, task-shifting to community health promoters and self-help patient support groups for improving the financing of care among vulnerable population.
• Implementation research, using systematic approach to understanding, and addressing health system and implementation bottlenecks. Here we use a demand-driven approach where research questions are framed based on needs identified by implementers in the health system. Examples of our implementation research  projects include; review of NCD policies and implementation gaps, developing and implementing NCD prevention policies  examining barriers and facilitators to policy implementation, evaluation of policy implementation with a major focus on measuring implementation outcomes such as acceptability, adoption, appropriateness, cost, fidelity, coverage and sustainability.

Health Systems Strengthening (HSS) – Our Africa-led agenda to strengthen and build more resilient systems for improved health is addressing knowledge gaps related to chronic disease management, epidemiology and identifying mitigation strategies for the rising burden of injury.

Emerging and Re-emerging Infectious Diseases (ERID) – The Center will produce research on the emerging re-emerging infectious diseases across Africa in terms of epidemiology, understanding coverage of intervention and their impact as well developing and testing and innovations aimed at overcoming identified barriers. The areas of work are summarized below: 

• To contribute to the understanding of the levels, distribution, drivers, and impact of major emerging and re-emerging infectious diseases in sub-Saharan Africa.

Clarifying the epidemiology of emerging and re-emerging infectious diseases is at the center of their prevention and control. We aim to design and conduct epidemiologic studies to improve our understanding of the levels, distribution, risk factors, and impact of emerging and re-emerging infectious diseases. COVID-19 has demonstrated, to a new level, the value of countries being able to use data to understand the dynamics of the epidemics. Surveillance should be part of enhancing our understanding of the epidemiology of new and old epidemics.

Using existing surveillance systems and data sources, we will aim to deepen our epidemiological understanding of various infectious diseases and thus inform programming. Surveillance to monitor existing epidemics and detection of new ones is limited and the systems, including laboratory capacity, are weak. Detection of the emergence of drug-resistant strains is also a function of active surveillance. We will focus on supporting the implementation of antimicrobial stewardship in priority countries in East and Southern Africa (ESA) and West and Central Africa (WCA).

• To describe and identify gaps in the coverage of interventions against major emerging and re-emerging infectious diseases

The Sustainable Development Goals (SDG) dispensation aims to ensure that no one is left behind. However, continued delivery of health interventions as usual might achieve this. We aim to not only measure coverage of interventions but also identify barriers, and inequities, which often go undetected. We will focus on vaccine-preventable diseases, current epidemics such as COVID-19, and HIV and malaria.

• To assess the impact of large-scale public health interventions against major emerging and re-emerging infectious diseases

Investment in the health sector as a proportion of a country’s GDP, while inadequate, is still substantial. As such, it is important to understand whether interventions in the sector are effective. While vaccines are available for some of the emerging (COVID-19) and re-emerging diseases (tuberculosis), uptake of the respective vaccine in some areas remains low. Over the years, we have built the capacity to conduct large-scale impact evaluations to help inform public health decisions.

• Test health systems innovations to increase access, uptake, and use of interventions with a focus on addressing inequities, reaching traditionally excluded sub-populations, addressing vaccine hesitancy, and proposing evidence-informed solutions to addressing barriers to accessing services

Delivery of interventions often reaches a saturation point to the effect that more of the same does not lead to better health impact. Hard-to-reach sub-populations may remain uncovered/unreached by interventions and as such serve as the source of outbreaks and possibly development of resistance due to irrational use of antimicrobials. We aim to promote innovation to advance and improve access to critical public health interventions to ensure reduced inequality and inequity in disease burden. We will focus on harnessing community resources, the use of digital technology, and tweaking the healthcare system to serve hard-to-reach populations better.