Noncommunicable diseases (NCDs) present a significant public health challenge in the Eastern Mediterranean Region (EMR), where premature mortality due to NCDs remains higher than in any other WHO region. Countries in the EMR face numerous obstacles affecting the implementation of evidence-based programs designed to address NCD risk factors. These challenges are exacerbated by complex issues such as weak health systems, limited local capacity, and the added strain of conflict and displacement. Vulnerable populations, particularly those in humanitarian settings, are disproportionately affected, with barriers to accessing appropriate interventions and gaps in the continuity of care.

In response to these challenges, EMPHNET’s NCD Research and Prevention Center (NCDsRC) launched the EMR Operational and Implementation Research Studies Mini-Grants initiative. Co-funded by EMPHNET and TEPHINET, with technical support from WHO-EMRO and the US CDC, the initiative aims to accelerate the use of scientific evidence in addressing NCD-related challenges. The mini-grants initiative focused on identifying barriers to the implementation of NCD programs, leveraging local knowledge to inform policy and strategy, and addressing the unique needs of vulnerable populations in conflict and displacement situations. By promoting context-specific solutions and evidence-based interventions, the initiative has supported countries in strengthening their NCD response.

Funded Projects Overview: Tackling NCDs Across the EMR

Through this mini-grants initiative, several projects were funded across priority countries, each designed to address critical NCD challenges and drive meaningful change through implementation research. Here we summarize several selected projects, highlighting their objectives, methods, and key findings.

Project One

Enhancing the Awareness of Policymakers About the NCD Tsunami in Afghanistan

This project, implemented by the Afghanistan National Public Health Institute (ANPHI), was designed to raise awareness and strengthen the capacity of policymakers from 22 government ministries in Afghanistan to tackle the growing NCD burden. The initiative promoted a multisectoral approach, emphasizing collaboration between ministries, including the ministries of health, education, and agriculture, to address key NCD risk factors. The study focused on tailored capacity building, with evaluations revealing a significant increase in NCD understanding among policymakers. The project also identified challenges in infrastructure, economics, and management, and it proposed solutions through a collaborative dialogue. This initiative successfully established focal points for future NCD interventions across ministries, strengthening Afghanistan's capacity to respond to its NCD challenges.

Project Two

Drug Adherence Among Patients with Hypertension and Diabetes in Bangladesh

This study sought to analyze medication adherence among patients with hypertension and diabetes attending NCD corners at sub-district hospitals in Bangladesh, and assess risk factors for nonadherence. Conducted in four upazila health complexes in Gopalganj, the research used the Morisky Medication Adherence Scale-8 (MMAS-8) to assess adherence levels. Among 301 respondents, 57% exhibited low medication adherence, with housewives particularly affected. Key factors contributing to low adherence included drug unavailability and incomplete prescription fulfillment. The study recommended improving drug availability, providing full prescription doses, and offering targeted health education for housewives to enhance adherence and healthcare outcomes in the region.

Project Three

Assessment of Lifestyle and Physical Activity Among University Students in Babylon Province, Iraq

This cross-sectional study, conducted at Babylon University, aimed to assess the prevalence of healthy lifestyle behaviors (HLBs) among students and to identify the factors contributing to unhealthy habits. With a sample of 590 students, the study focused on physical activity levels, fast food consumption, and tobacco use. The results revealed that only 45.1% of students engaged in regular physical activity, with males significantly more active than females, and dormitory students less active than non-dormitory residents. Barriers to physical activity were largely related to college life, such as lack of time and academic workload, as well as a lack of interest. Fast food consumption was also prevalent, with 70% of students eating fast food at least once per week, and 11.7% consuming it more than three times per week. Additionally, over 30% of male students were smokers, compared to less than 2% of females. Based on the study findings, universities should promote physical activity, especially among females and dormitory residents, by offering inclusive programs and facilities. Anti-smoking campaigns and cessation support should target males, as they have significantly higher smoking rates. Additionally, initiatives to promote healthier eating habits, better sleep hygiene, and responsible alcohol consumption should be implemented. Tailored health programs based on college type and individual needs can further enhance student well-being.

Project Four

Cigarette Smoking and Its Associated Factors Among Students at Babylon University, Iraq

This project examined the prevalence and factors contributing to smoking behaviors among 629 students at Babylon University. The study found that 18.8% of students were smokers, with (80.7%), using cigarettes (56%) using hookah, and (65.1%) using electronic cigarettes The mean age of smoking initiation was 16.9 years, with significant associations found between smoking behavior and age, sex, campus residency, and family smoking history. Knowledge about smoking risks was also significantly associated with smoking behavior. The study highlights the significant prevalence of smoking among university students and the critical role of knowledge in influencing smoking behavior. Demographic factors and family influence were significantly associated with smoking. To effectively reduce smoking among university students, the study recommends implementing comprehensive educational programs to raise awareness about the health risks of smoking, particularly targeting younger students and adolescents to prevent smoking initiation.

Project Five

The Digital Landscape of Non-Communicable Disease Management in Jordan

This study explored the barriers and opportunities related to enhancing digital health solutions for managing NCDs in Jordan. While Jordan has made progress with digital platforms like the electronic health system "HAKEEM", which digitizes patient records, there are still significant challenges in expanding telemedicine and mobile health applications. This research, which combined surveys, focus group discussions, and key informant interviews, revealed that only 15% of participants were aware of available digital tools, with only 4% actively using them. Barriers to adoption included limited digital literacy, inadequate infrastructure, and socioeconomic constraints, particularly among older populations and refugees. Despite these challenges, digital platforms offer promising advantages for NCD management, such as real-time symptom tracking, medication reminders, and health data analytics. Among those using digital tools, 89% rated them as effective in managing their conditions. The study recommends improving access to digital health tools, expanding digital literacy programs, and addressing socioeconomic barriers to ensure that digital health innovations reach all segments of the population.

Project Six

Using Consolidated Framework for Implementation Research to identify and address barriers to the implementation of NCD programs in Somalia: an exploratory qualitative and desk review report

This study aimed to identify barriers to the implementation of NCD interventions within Somalia’s Essential Package of Health Services and to develop context-specific strategies to address these challenges. Through a combination of in-depth interviews with healthcare providers, government advisors, and international organizations, alongside a thorough desk review of relevant policy documents, the study uncovered several key barriers. These included limited adaptability of interventions, resource constraints, political instability, and sociocultural beliefs, which hindered the successful integration of NCD care into routine health services. Using the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendation for Implementation Change (ERIC) Matching tool, the research proposed context-specific strategies such as localizing NCD interventions and engaging local communities in their design and implementation. The study emphasized that by addressing these barriers, Somalia can improve the integration of NCD services into the health system and reduce the overall NCD burden.

Project Seven

Improving Hypertension Management in Afghanistan: A Small-Scale Intervention Using WhatsApp for Hypertension Education and Follow-up

The study, conducted in Kabul, Afghanistan, aimed to evaluate the effectiveness of using WhatsApp to deliver hypertension management education. A total of 102 hypertensive patients received educational content via WhatsApp for five weeks, focusing on blood pressure management, sodium reduction, and medication adherence. The intervention led to significant reductions in both systolic (from 153 mmHg to 140 mmHg) and diastolic blood pressure (from 94 mmHg to 86.9 mmHg). Participants also reported improvements in sodium intake reduction and medication adherence. Sociodemographic factors such as prior hypertension diagnosis and family history were linked to better outcomes, while the presence of comorbidities predicted improved medication adherence. The study concludes that WhatsApp is a promising, low-cost tool for health education in low-resource settings and recommends further research on mobile health (mHealth) interventions for managing chronic diseases.

Project Eight

Strengthening Post-Partum Mental Health: Integration of Mental Health Assessment Screening Tool in Routine Post-Natal Care

The study aimed to integrate a mental health assessment into postnatal care (PNC) in Bangladesh, for early identification and referral of women with postpartum depression (PPD). A cross-sectional study was conducted with 540 postnatal women across different healthcare levels in Bangladesh. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD, with results showing that 47.78% of participants had PPD, including 29.07% with major depression. Key risk factors for PPD included age (≥30 years), a history of depression, irregular menstruation, multiparity, abortion, pregnancy complications, and negative perceptions of pregnancy or delivery. The study found that only 36.05% of participants with PPD attended psychiatric consultations after referral, with higher attendance rates at tertiary hospitals. This highlights the need for better mental health services integration, particularly at the primary care level. The authors recommend incorporating the EPDS into routine PNC to ensure early detection and treatment of PPD, improving maternal health outcomes in Bangladesh. They also call for policies that enhance mental health services accessibility and awareness among healthcare providers and postpartum women.

The Projects’ Impact

By addressing the barriers identified through the mini-grants initiative, significant progress was achieved in advancing NCD management across the Eastern Mediterranean Region. The initiative fostered significant improvements in the understanding and implementation of NCD prevention strategies, empowering policymakers, healthcare providers, and communities alike. The initiatives led to enhanced medication adherence, greater engagement in healthy lifestyle behaviors, and the successful integration of digital tools for NCD management. These efforts have had a profound impact on diverse populations demonstrating tangible progress in building more resilient health systems capable of addressing the growing NCD burden.

"The Global Week for Action on NCDs 2024 emphasizes the urgent need to address the structural and contextual barriers hindering the implementation of evidence-based NCD programs in the Eastern Mediterranean Region. As we confront the highest premature mortality rate from NCDs worldwide, compounded by fragile health systems and the displacement of vulnerable populations, it is clear that innovative, context-specific solutions are paramount. Through collaborative efforts, such as EMPHNET's mini-grants initiative, we are not only accelerating the use of scientific evidence but also empowering local communities to take ownership of their health. This initiative demonstrates that by leveraging local knowledge and fostering multisectoral approaches, we can bridge gaps in care and create sustainable, impactful NCD interventions across the region."

– Dr Randa Saad, Senior Technical Specialist – NCD Mini Grant Lead

Next Steps: Expanding Evidence-Based Research and Implementation

Moving forward, the next steps must focus on scaling up successful evidence-based interventions and addressing the systemic challenges that persist in NCD prevention and control across the Eastern Mediterranean Region. This includes strengthening health systems through enhanced capacity building, improving access to essential medicines and services, and fostering stronger multisectoral collaboration to tackle the root causes of NCDs. Furthermore, prioritizing the integration of digital health solutions, expanding research on the social determinants of health, and ensuring that vulnerable populations, such as those in conflict and displacement settings, have access to continuity of care, will be critical. By investing in these areas and fostering community engagement, we can build more resilient and adaptive health systems capable of reducing the NCD burden and achieving long-term health gains.