Our work is structured over an initial four-year period in three phases of development:

  • Phase 1
  • Phase 2
  • Phase 3

In Phase 1 (2017-2018) Scoping, Assessment and Design, researchers will appraise key challenges in delivery of the NCD and mental health interventions in the contexts of Lebanon and Sierra Leone. Research will focus on identifying health systems and community factors contributing to fragility of the integrated ‘system for health’ relevant to delivery and uptake of these interventions. This phase will feature structured reviews of relevant published and grey literatures; preliminary field research mapping challenges related to fragility utilizing a range of cutting-edge quantitative and qualitative methodologies; synthesis of findings; and consultation with policymakers, providers and service users.




Protocols have been, or are in the course of being, developed for a number of the proposed methodologies to be used in the course of the fieldwork, to facilitate research team training and research ethics submissions. Versions of these protocols were piloted in supplementary fieldwork in El Salvador (April to June 2018), conducted at the request of the Ministry of Health with respect to health systems capacity for support for persons with NCDs.

 You can view the Clinic Ethnography protocol, for the assessment of patient experience and service provision culture: A Guide to Clinic Ethnography (March 2019)

 You can view the Participatory Assessment Tool for Mapping Social Connections: Social Connections Tool - A Users’ Guide


Research Briefs on NCDs and MHPSS in Lebanon and Sierra Leone. The RUHF research teams at QMU, COMAHS and AUB are working together on a range of research studies to prevent and manage NCDs, and improve access to quality mental health care in fragile settings. These briefs offer a summary of key findings and recommendations for policy makers, health practitioners, NGOs and academics.


You can download the Research Briefs:

"Non-Communicable Diseases in Fragile Settings: The Case of Syrian Refugees in Lebanon"

"Mental Health and Psychosocial Support in Fragile Settings: The Case of Syrian Refugees in Lebanon"

"Addressing the silent epidemic in Sierra Leone: preventing and managing non-communicable diseases"

"Improving understanding of and access to quality mental health care in Sierra Leone"


Scoping Studies on MHPSS and NCDs in Sierra Leone. After a rigorous review of the literature on mental health and psychosocial support (MHPSS) and non-communicable diseases (NCDs) in Sierra Leone, QMU and COMAHS research teams completed these open access Scoping Studies which provide insights into barriers and opportunities to improve health service provision in this fragile setting.


You can view and download the Scoping Studies here:


"A Scoping Study on Mental Health and Psychosocial Support (MHPSS) in Sierra Leone"

"A Scoping Study on Non-Communicable Diseases (NCDs) in Sierra Leone"


Presentation  Analysing NCDs care in public health services in El Salvador. Is stronger community engagement part of the solution?’. Researchers from RUHF, Marta Jimenez and Montse Leon, conducted research fieldwork in El Salvador between March and June 2018, in collaboration with QMU researcher, Nicole Vidal. The preliminary findings were presented at QMU, Edinburgh in May and El Salvador and Madrid (Spain) in June.


You can view and download the slides used in the presentations here

Find out how patients with chronic diseases live in El Salvador. Watch the video here


Webinar 'Health Systems in Situations of Fragility'. This presentation was given by Professor Sophie Witter on 17th May 2018 for the American University of Beirut - Global Health Institute's Webinar series: "Global Health and Conflict".

You can view and download the slides used in the webinar here




In Phase 2 (2019-2020) Strategic Intervention and Evaluation, we will use our analyses of institutional and community factors facilitating and constraining interventions to identify strategic actions to increase service accessibility, accountability and quality. Again deploying innovative methodologies, we will evaluate the impact of these strategic actions, focusing on care delivery and uptake at the interface of health systems and communities.




Training material NCD clinical deskguide. RUHF researchers, the Ministry of Health and other relevant stakeholders have finalised a desk guide fo uncomplicated non-communicable diseases (NCDs) and mental health (MH) cases for qualified clinicians, such as doctors, community health officers (CHO) and mental health nurses in Sierra Leone. The deskguide is a concise 'quick reference' to identify, diagnose and treat NCDs, such as hypertension and diabetes, and MH issues, such as depression, and it has been adapted to Sierra Leone population and context. The deskguide is complemented with a Facilitator Course Guide.


You can download the Sierra Leone NCD clinical desk guide and facilitator course guide:

 "Non-Communicable Diseases: Diagnosis and Treatment Deskguide"

 "Facilitator Course Guide: Non-Communicable Diseases Deskguide Training"


In Phase 3 (2020-2021) Generalisation and Dissemination, we will build on evidence from our work in Lebanon and Sierra Leone in the earlier phases to formulate a health in fragility assessment framework to inform intervention planning and health system appraisal and strengthening in LMICs globally. We will test, refine and validate this health in fragility analytic framework through intervention research both in different contexts.

NIHR Research Unit on Health in Fragility (RUHF)

Please contact us to find out more about our work.

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NIHR Research Unit on Health in Fragility (RUHF)

NIHR Research Unit on Health in Fragility (RUHF)
0131 474 0000