Project Structure and Resources

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

In this strand, Scoping, Assessment and Design, researchers have appraised key challenges in the delivery of NCD and mental health interventions, within the contexts of Lebanon and Sierra Leone.

Research has focused on:

  • Identifying health systems and community factors that contribute to fragility of the health system delivery
  • Uptake of these interventions

This phase has featured:

  • 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
  • Consultation with policymakers, providers and service users



Protocols have been developed for a number of the proposed methodologies, to be used in the course of the fieldwork. These are used 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 (MoH). They are regarding health systems capacity, for support for persons with NCDs.

View the Clinic Ethnography protocol, for the assessment of patient experience and service provision culture:

A Guide to Clinic Ethnography (March 2019) - ( Available on request via IGHD Email Address)

View the Participatory Assessment Tool for Mapping Social Connections:

Social Connections Tool - A User's Guide - ( Available on request via IGHD Email Address)

Research briefs

The RUHF research teams at QMU, COMAHS and AUB are working together on a range of research studies. These are designed 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.

View the research briefs on NCDs:

Non-Communicable Diseases in Fragile Setting: The Case of Syrian Refugee in Lebanon ( Available on request via IGHD Email Address)

Addressing the silent apidemic in Sierra Leone:Preventing and managing non-communicable diseases ( Available on request via IGHD Email Address)

View the research briefs on mental health:

Mental Health and Psychosocial Support in Fragile Setting:The Case of Syrian Refugees in Lebanon ( Available on request via IGHD Email Address)

Improving understanding of and access to quality mental health care in Sierra Leone ( Available on request via IGHD Email Address)

Scoping studies

A rigorous review of literature was undergone, concerning mental health and psychosocial support (MHPSS) and non-communicable diseases (NCDs) in Sierra Leone.
QMU and COMAHS research teams have completed these open access scoping studies, providing insights into barriers and opportunities regarding the improvement of health service provision in this fragile setting.           

View the scoping studies:

A Scoping Study on Mental Health and Psychosocial Support (MHPSS) in Sierra Leone : ( Available on request via IGHD Email Address)

A Scoping Study no Non-Communicable Diseases (NCDs) in Sierra Leone - ( Available on request via IGHD Email Address)


‘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.

View the slides used in the presentation:

NCDs in El Salvador - ( Available on request via IGHD Email Address)


'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".

View the slides used in the webinar:

Health Systems in Situations of Fragility - ( Available on request via IGHD Email Address)

View Sophie Witter's staff profile:

Professor Sophie Witter 



View the newsletters from Strand 1:

The RUHF Newsletter- Issue 1- April 2018

The RUHF Newsletter- Issue 2- August 2018

The RUHF Newsletter- Issue 3- November 2018

In this strand, Strategic Intervention and Evaluation, we will analyse both the institutional and community factors that facilitate and constrain interventions. We will then use these to identify strategic actions, in order to increase service accessibility, accountability and quality.

Again deploying innovative methodologies, we will evaluate the impact of these strategic actions. Our focus will be on care delivery and uptake, at the interface between health systems and communities.


Policy briefs

View the NCD policy brief:

Dynamic of Non-Communicable Diseases:prevention,Diagnosis and Control in Lebanon -( Available on request via IGHD Email Address)

View the mental health policy brief:

Dynamics of Mental Health and Psycosocial Support Services in Lebanon:Access, Utilisation and Delivery - ( Available on request via IGHD Email Address)

Training material

NCD clinical deskguide

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

View the Sierra Leone NCD clinical desk guide:

Non-Communicable Diseases: Diagnosis and Treatment Deskguide - ( Available on request via IGHD Email Address)

View the facilitator course guide:

Facilitator Course Guide:Non-Communicable Disease Deskguide Training - ( Available on request via IGHD Email Address)


"Health systems research in fragile settings"

The work of RUHF featured in an editorial in the Bulletin of the World Health Organisation in June.
This editorial outlined the strategic approach of the unit, and the importance of considering the interface between the health system and community structures in contexts of fragility.

View the WHO bulletin editorial:

Health Systems Research in Fragile Settings


‘A Community–Based System Dynamics Approach for Understanding Factors Affecting Mental Health and Health Seeking Behaviors in Beirut and Beqaa Regions of Lebanon
Researchers from RUHF - Aya Noubani, Karin Diaconu, Lilian Ghandour, Maria El Koussa, Giulia Loffreda and Shadi Saleh - conducted research fieldwork in Lebanon, both in Beirut and Beqaa.
The findings were presented by Aya Noubani in October at QMU, Edinburgh and King's College London, as part of the "Research for Health in the Syrian Conflict" conference.

View the video recording of the discussion:

Aya Noubani’s seminar on Mental Health in Lebanon


View the newsletters from Strand 2:

The RUHF Newsletter- Issue 4- March 2019

The RUHF Newsletter- Issue 5- July 2019

In this strand, Generalisation and Dissemination, we will build on evidence from our work in Lebanon and Sierra Leone in the earlier phases, in order to formulate a health in fragility assessment framework.

This will be used to inform intervention planning and health system appraisal in LMICs globally.

We will test, refine and validate this health in fragility analytic framework, through intervention research both in different contexts.