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From Evidence to Equity Advancing Global Health Equity Through Integration Science

A Program at Brigham and Women’s Hospital

The Center for Integration Science in Global Health Equity develops integrated health care delivery models and nurtures integrated social movements to advance global health equity.

A Program at Brigham and Women’s Hospital

Contents From the Executive Director

Pathways to Global Health Equity

Advancing the Field Building a Foundation for Innovation

Integration Science in Action Supporting the NCDI Poverty Network

Unlocking the Broad Potential Incubating New Integration Science Models

The Center in Context By the Numbers, Leadership, Principal Partners, Selected Research Publications

CENTER FOR INTEGRATION SCIENCE IN GLOBAL HEALTH EQUITY

From the Executive Director

It has now been five years since we founded the Center for Integration Science in Global Health Equity. At the time, we had recently published the Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion to highlight the neglected diseases of the world’s most vulnerable people, especially children. We were eager for a platform to implement the Lancet Commission’s recommendations and to save lives. For years, we had worked across Partners In Health, the Department of Global and Social Medicine at Harvard Medical School, and the Brigham and Women’s Hospital Division of Global Health Equity. Our great friend and mentor, the late Paul Farmer, thought it was time to bring this work together under one roof. I wish Paul could read this report and see what the Center has accomplished. Paul showed us that global health had to be about opening our minds and hearts (and wallets) to respond to the great injustices of our time. The Center promotes the integration of health delivery models and social movements. Ultimately, though, our work is also part of the science of love.

GENE BUKHMAN, MD, PHD

Executive Director, Center for Integration Science in Global Health Equity Brigham and Women’s Hospital / Mass General Brigham Professor of Medicine, Harvard Medical School Co-Chair, NCDI Poverty Network

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Pathways to Global Health Equity

he Center for Integration Science in Global Health Equity develops integrated health care delivery models and nurtures integrated social movements to advance global health equity. To fulfill its mission, the Center pursues three interconnected pathways.

Building a Foundation for Innovation Advancing the Field

Conducting and catalyzing research to build the evidence, methods, and tools that harness the power and promise of integration science

RESEARCH ACROSS THE PATHWAYS Building and reinforcing the knowledge base connecting all three pathways

Unlocking the Broad Potential

Integration Science in Action

Incubating New Integration Science Models

Supporting the NCDI Poverty Network

Developing and testing new integration science applications to tackle other intractable global health challenges and to serve additional populations

Working with partners to generate evidence, strengthen national capacities, and translate integration science principles into effective frontline clinical practices and social movements

CENTER FOR INTEGRATION SCIENCE IN GLOBAL HEALTH EQUITY

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Building a Foundation for Innovation

Advancing the Field In the rapidly evolving landscape of global health funding, national governments and global health practitioners are increasingly looking beyond traditional disease boundaries to find and scale integrated solutions to ensure access to advanced care in resource-limited settings. The Center for Integration Science in Global Health Equity is leading in this effort, by producing rigorous evidence and methodologies that offer fresh perspectives on integrating health care services for some of the world’s most vulnerable people.

CENTER FOR INTEGRATION SCIENCE IN GLOBAL HEALTH EQUITY

Building a Foundation for Innovation

istorically, most progress in global health equity has focused on priority infectious diseases. Starting in the 2010s, though, global health movements for noncommunicable diseases began gaining momentum. With resources limited, these initiatives were built to reach as many people as possible, emphasizing interventions that protect people across their lifespans, from vaccines to education campaigns to hypertension drugs.

For all its reach, that approach left out treatment,

Bridging the Gap

especially for less common, yet more severe,

Integration science offers a systematic way to

conditions. As a result, severe noncommunicable

make limited health resources go further for the

diseases have become largely invisible on the

world’s most vulnerable people. Many low-

global stage, underfunded and underserved

income countries already combine services out of

by public health systems. In rural sub-Saharan

necessity, but these efforts are often fragmented

Africa and South Asia, home to up to 85 percent

and narrow. Global health still tends to fund and

of the world’s poorest people, most patients with

organize itself by disease, and that habit limits

these conditions must travel long distances for

the creative, responsive planning that patients

care—often past a district hospital that lacks

with complex conditions need.

the equipment to diagnose them. Many of these patients are children and adolescents, and most

Integration science starts from the other

have no affordable treatment options.

direction: it begins with what patients need, then matches those needs to what health workers can do and how patients move through the health system. The approach is practical, and it

Research Snapshot

is built to scale. It rests on two pillars—delivery model design and social movement design— that use data to make integration efforts both

A Critical Need: A 2022 assessment of 16 district

comprehensive and effective.

hospitals in nine lower-income countries found that only two had all the equipment needed to treat type 1 diabetes, and only two stocked both of the essential

Delivery Model Design

medicines for sickle cell disease. Led by the Center

Delivery model design reduces the fragmentation

in collaboration with research partners, the study—

that comes from organizing care disease by

published in PLOS Global Public Health—mapped

disease, especially for conditions that are less

service delivery readiness gaps for facilities with a

common, yet more severe. The result is a smarter

combined catchment of nearly 5.3 million people.

map of care: conditions that need similar kinds of care are treated together in a single, more accessible

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An Official World Health Organization Collaborating Center

n 2023, the World Health Organization

identify and classify existing models of integrated

recognized the value and potential of integration

care for severe noncommunicable diseases, studies

science by designating the Center the official

how effective and sustainable those models are,

WHO Collaborating Center on Integration

develops proposals for joint research, supports

Science and Service Delivery. In this role, the Center

integrated care in selected countries, and shares

works with the World Heatlh Organization to

lessons learned in a range of settings.

Social Medicine

Management Science

Health Systems Science

CONNECTING THE DOTS

Economics

Integration science applies expertise and methodologies from a range of disciplines to bridge fundamental gaps in traditional, disease-specific approaches to global health

Clinical Design

Public Policy

Philanthropy Science

CENTER FOR INTEGRATION SCIENCE IN GLOBAL HEALTH EQUITY

Building a Foundation for Innovation

type 1 diabetes, sickle cell disease, and childhood

Research Snapshot

heart disease—now provide care close to home that was once available only at distant referral

Home Monitoring: The first qualitative study of continuous

hospitals, if at all.

glucose monitoring in a rural low-income setting followed 42 patients with type 1 diabetes in Malawi for three months. Conducted by the Center for Integration Science and its research partners, the study—published in BMJ Open—found continuous glucose monitoring to be feasible and acceptable despite relatively low numeric literacy, which complicated sensor changes and added clinic visits.

Social Movement Design The second pillar, social movement design, draws on the shared experiences of people living with severe, chronic illnesses to address the many challenges they face outside the clinic. This pillar includes peer support, community building, advocacy, and policy work.

facility, rather than scattered across separate

Center researchers study how different

specialty clinics that most patients can never reach.

conditions shape daily life, including physical pain, stigmatization, stress on caregivers, and

Integration scientists treat this fragmentation as

financial strain. In one study of continuous

a design problem, not an inevitability. Working

glucose monitors in rural Malawi, for example,

closely with clinicians, they model the best ways

participants said what troubled them was not

to group services for several conditions so that

the device itself but its alarms, which could draw

small, specific improvements can add up to

unwanted attention and stigmatization in public.

strong, lasting systems of care. The work begins with clinical realities: What level of care can a

The researchers also look for common ground

given facility deliver safely and well? Which tests,

that allows different patient groups to work

equipment, and supplies can be shared across

together. Those shared experiences become the

conditions? And how can training, mentoring,

basis for coalitions that can build, advocate for,

and referrals serve multiple conditions without

and sustain programs.

creating new bottlenecks? Center for Integration Science researchers refine

Bringing It All Together

their designs continuously, drawing on close

The delivery model pillar yields playbooks that

collaboration with frontline teams and careful

countries can adapt for their own clinical settings,

tracking of results. PEN-Plus, the most advanced

while the social movement pillar yields templates

example of integration science to date, shows this

for organizing participation around overlaps

approach at work. At district hospitals in a growing

in lived experience across diseases and for

number of countries, nurses and clinical officers

transforming one-off giving opportunities into a

trained to manage complex conditions—such as

social and philanthropic movement based on an

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enduring solidarity. Together, these approaches

Ultimately, evidence gathered under each pillar

form a growing, shared knowledge base, with

focuses on the drivers that can help achieve

methods, measures, and decision guidelines that

equity. As models are implemented, the Center

can help governments and philanthropic partners

assesses important strategies, such as how

be strategic about where to place limited resources

ministries of health and implementers can adopt

and understand how to sustain care programs.

those models at scale.

Lancet Series on Integration Science

he Center is leading in the development of a four-part series in The Lancet that will showcase integration science as a tool for unlocking significant gains in global health equity. Written by 50 experts from nearly two dozen countries, the series will present both

the theory behind integration science and its real-world applications. Drawing on more than 5,000 patient observations from dozens of health facilities across sub-Saharan Africa and South Asia, it will also detail the clinical resources, skills, and care pathways on which integration science builds.

PAPER 1

PAPER 2

PAPER 3

PAPER 4

Lessons from Integration Science

Delivery Model Design

Integrated Social Movements

Applications for Global Health Equity

A compilation and analysis of lessons learned during the NCDI Poverty Network’s first six years of working with more than a dozen countries in implementing PEN-Plus, an integrated care delivery model designed for people living with severe noncommunicable diseases in resource-limited settings

An analysis of the four-phase delivery model design that helps health systems move from fragmented care to integrated approaches by assessing existing capacities, identifying integration opportunities, and reconfiguring care pathways for maximum efficiency

A discussion of a strategic shift away from traditional advocacy categories— whether disease-specific, demographic, or health system-focused—and toward integrated social movements based on the shared experiences of people living with severe noncommunicable diseases

Detailed case studies that illustrate how integration science advances global health equity by effectively aligning policy priorities, resource availability, and implementation strategies to expand access to care for people living with severe conditions in lowand lower-middle-income countries

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Supporting the NCDI Poverty Network

Integration Science in Action The Center for Integration Science helps convert integration science theory into action through its support of the NCDI Poverty Network, a coalition of governments, organizations, and advocates that are revolutionizing access to care for people living with severe, chronic noncommunicable diseases in low-resource settings. The Network’s primary focus is on PEN-Plus, an integrated care-delivery model that enables low- and lower-middle-income countries to deliver health care and hope to people living with severe, chronic noncommunicable diseases, such as type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease.

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Supporting the NCDI Poverty Network

n sub-Saharan Africa, children with type 1 diabetes often die within a year of diagnosis, and half of the nearly one thousand babies born with sickle cell disease each day will not live to see their fifth birthday. Yet the global health agenda largely overlooks young people living with these conditions. Across rural sub-Saharan Africa and South Asia, treatment is available only at a handful of urban hospitals, far beyond the geographic and financial reach of most families.

The Center was established to confront these

PEN-Plus across sub-Saharan Africa, South Asia,

disparities—not only by conducting research, but

and the Caribbean through clinical care, training

also by powering a global movement through its

programs, and monitoring and evaluation systems.

work as the U.S.-based co-secretariat of the NCDI Poverty Network. Center faculty and staff run

Answering a Critical Need

Network operations, managing grants, coordinating

PEN-Plus was born of necessity in rural Rwanda

partnerships, and helping countries implement

nearly two decades ago. Frustrated by the lack of

Patient Impact Mended Heart: When António Joaquim’s heart suddenly began racing, his parents were alarmed; they had already lost a young daughter to a heart condition. They enrolled António at a nearby PEN-Plus clinic in rural Mozambique, where he was diagnosed with rheumatic heart disease and received the logistical and financial support he needed for lifesaving heart surgery. The 15-year-old now visits the clinic regularly for ongoing care and peer support.

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proper equipment, medications, and staff training

NCDI Poverty Network

that would allow them to provide advanced care for people living with severe noncommunicable diseases, a handful of clinicians from the Ministry of Health and Inshuti Mu Buzima (Partners In Health– Rwanda)—including Dr. Gene Bukhman, a Brigham and Women’s Hospital cardiologist then working with Inshuti Mu Buzima—began developing a new, integrated care-delivery model. Their innovation was in the design. The clinicians realized they could train nurses and clinical officers to diagnose and treat a group of severe conditions—such as type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease—that belong to different medical

SHARED EXPERTISE: Health ministry representatives from Angola, Eswatini, and Lesotho participate in a study tour of Mozambique’s PEN-Plus clinic. The NCDI Poverty Network hosted the event to provide valuable insights into launching PEN-Plus programs.

specialties yet require a similar cadence of care. All need accurate diagnosis, symptom management, emotional and social support, and long-term monitoring. And all depend on medicines that must be carefully dosed, since too little—or too much— can prove fatal. Treating those conditions together also meant space, staff, and training could be shared. After receiving just three months of advanced training, nurses and clinical officers could manage patient cases themselves. Physicians supervised initial consultations, and specialists visited every month or two to confirm diagnoses and advise on more complex cases. The clinics also served as national training sites. By 2016, Rwanda had expanded the model to all 42 of its district hospitals. In 2019, the World Health Organization recognized

The NCDI Poverty Network works to expand lifesaving care for children, adolescents, and young adults facing the double burden of severe noncommunicable diseases and extreme poverty. Led by its co-secretariat—the Center for Integration Science and Universidade Eduardo Mondlane in Maputo, Mozambique—the Network helps countries launch, strengthen, and evaluate integrated care programs, particularly PEN-Plus. Since its founding in 2020, the Network has grown to include the governments of low- and lower-middle-income countries and hundreds of technical, policy, funding, and advocacy partners. Together, they form a coordinated effort to help countries care for people living with severe noncommunicable diseases. The Network’s primary mission is to deliver on the promise of PEN-Plus for everyone living with these conditions: quality care, close to home.

this approach as PEN-Plus—a complement to WHO PEN—the WHO Package of Essential Noncommunicable Disease Interventions for Primary CENTER FOR INTEGRATION SCIENCE IN GLOBAL HEALTH EQUITY

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Supporting the NCDI Poverty Network

Health Care, which targets more common conditions such as hypertension and type 2 diabetes.

The Research Underpinning By then, Dr. Bukhman and a fellow cardiologist, Dr. Ana Mocumbi from Universidade Eduardo Mondlane in Maputo, Mozambique, had begun co-chairing the Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion, which brought together nearly two dozen global health experts to build the scientific case for scaling PEN-Plus globally. In 2020, the commission published a landmark report finding that severe noncommunicable diseases cause more than 560,000 avoidable deaths every year among the world’s poorest children, adolescents, and young adults, with just four conditions—type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease—leading to nearly 100,000 of those deaths. Commission members estimated that progressive implementation of affordable, cost-effective, and equitable interventions could, by 2030, save the lives of 1.3 million of the world’s poorest people under the age of 40. The report ended with a call to action. Just

Patient Impact

two months later, Drs. Bukhman and Mocumbi answered that call themselves. In December 2020—during a Zoom call, at the height of the

Reclaimed Childhood: Before receiving treatment

COVID-19 pandemic—they joined representatives

for sickle cell disease at a PEN-Plus clinic in Tanzania,

from low- and lower-middle-income countries to

four-year-old Sesilia lived with constant pain, frequent

launch the NCDI Poverty Network. That modest

fevers, and a weakness so debilitating she could not

beginning belied the years of science, advocacy,

even sit up, much less walk. Now she runs.

and partnership behind the initiative, which Drs. Bukhman and Mocumbi continue to co-chair.

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Integration Science in Action: How PEN-Plus Works The PEN-Plus model integrates health systems, treatment protocols, and solidarity movements to ensure that people living with severe noncommunicable diseases can receive the lifesaving care they need close to home.

Health C (WHO enter First-Le P E F N ir s ) t -Le ve l v e l o s p ospit ital (PEN-PH (PEN-PH l u s lus) al R ) e f e r ral Hosp ital

First-L (WHO P er evel H EN) o s (PENReferrals Plus) pital Refe

DISTRICT HOSPITALS (PEN-PLUS)

REFERRAL HOSPITALS

First-Le vel os pit (PEN-PH lus) al Referrals Referra rral Ho l Hospit spital al

Referrals , trainin g, mentors hip

Referrals , ainin t r g, mentors hip

torship

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Referrals Referrals, training, , trainin g, mentorship men

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Referra l Hosp

HEALTH CENTERS Health C (WHO PEN) ent

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Referrals

Referrals , trainin g, mentors R e f e hip rratraining, Referrals, ls, train ing, mento mentorship rship

Referrals

Referr als, tr mento aining, rship

Referrals HEALTH SYSTEMS: Health treat more common, yet less severe, noncommunicable diseases, such as Refcenters err ls Referrals hypertension and type 2 diabetes, aby using tools and protocols from WHO PEN, the WHO Package of Essential Noncommunicable Disease Interventions for Primary Health Care. PEN-Plus complements WHO PEN by enabling district hospitals to treat less common, yet more severe, conditions. PEN-Plus further allows mid-level clinicians to receive training and mentorship from specialists at referral hospitals; to refer patients to those hospitals for acute specialty interventions, such as surgery; and to provide the ongoing follow-up care those interventions require.

Type 1 Diabetes

Congenital Heart Disease

Sickle Cell Disease

Rheumatic Heart Disease

TREATMENT PROTOCOLS:

SOLIDARITY MOVEMENTS:

PEN-Plus trains mid-level care

In collaboration with the ministries of

providers, such as nurses and clinical

health of PEN-Plus countries, clinical

officers, to provide services for

implementers, and advocacy, policy,

severe noncommunicable diseases—

funding, and technical partners from

such as type 1 diabetes, sickle cell

around the world, the NCDI Poverty

disease, rheumatic heart disease, and

Network co-secretariat—composed

congenital heart disease—through a

of the Center for Integration Science

single point of care. These advanced

and Universidade Eduardo Mondlane

services include echocardiography and

in Maputo, Mozambique—seeks to

the management of medications with

create synergies across disease

narrow therapeutic windows, such as

communities and to advocate for

insulin and anticoagulants.

funding for PEN-Plus internationally.

CENTER CENTERFOR FORINTEGRATION INTEGRATIONSCIENCE SCIENCEIN INGLOBAL GLOBALHEALTH HEALTHEQUITY EQUITY

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Supporting the NCDI Poverty Network HAITI

Patient Impact Hope for the Future: After receiving a type 1 diabetes

A Research Center The Network’s early momentum proved even greater

diagnosis as a teenager, Joyce Muimui felt overwhelmed,

than anticipated. So, to provide the Network with an

fell behind in school, and had to repeat a year. When

administrative home, in 2021, Dr. Bukhman launched

Zambia opened its first PEN-Plus clinic in 2023, though,

the Center at Brigham and Women’s Hospital, a

her life turned around. Her blood sugar spikes and

teaching affiliate of Harvard Medical School and a

body aches subsided, and she learned to manage her

founding member of Mass General Brigham.

condition. “I feel better,” said Muimui, now 20. “It’s like I

In creating the Center, Dr. Bukhman also gave

don’t even have diabetes.”

the integration science field a research base for further innovation.

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PA L

CHHATTISGARH

SOMALILAND

BURKINA FASO DEMOCRATIC REPUBLIC OF THE CONGO REPUBLIC OF THE CONGO

MAP KEY

ESWATINI

PEN-Plus Countries

PEN-Plus Countries To date, 29 countries have initiated PEN-Plus, including 14 that are already providing advanced care in dedicated clinics. A range of other countries are also actively preparing to adopt the model.

A year later, the success of PEN-Plus in expanding

follow: the Third International Conference on PEN-

access to lifesaving treatment led all 47 member

Plus in Africa, held in Dar es Salaam, Tanzania, in

states of the WHO African Region to adopt the

June 2026, drew keen participation from more than

model as their official strategy for caring for people

50 countries.

with severe noncommunicable diseases. What began as a local solution in rural Rwanda has To date, 29 countries have initiated PEN-Plus,

become a global force, bringing health care and

including 14 already providing care in dedicated

hope to a growing number of people living with

PEN-Plus clinics. More countries are preparing to

severe noncommunicable diseases. CENTER FOR INTEGRATION SCIENCE IN GLOBAL HEALTH EQUITY

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Incubating New Integration Science Models

Unlocking the Broad Potential Through its research and generative relationship with the policymakers and implementers that compose the NCDI Poverty Network, the Center for Integration Science has shown that integration science can close deadly gaps in global health care. Building on that success, the Center is now developing new models and applying integration science principles to other stubborn health challenges and to other populations.

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Incubating New Integration Science Models

ntegration science points toward a broader vision for health systems—one in which the way care is delivered goes hand in hand with the social movements that demand and sustain that care. Emerging work suggests ways in which these two pillars can come together to build health systems that are coherent, patient centered, and sustainable.

In delivery model design, one promising application

are beginning to explore how existing networks

is helping health systems adapt as donor

of people living with HIV might grow to include

funding shrinks. In Tanzania, for example, where

people with other chronic conditions, thus

international HIV funding is expected to decline,

creating broader patient movements that can

researchers are rethinking how to protect hard-won

build demand for integrated care.

gains in care. Rather than keeping HIV services as a stand-alone program, this work explores how HIV

PEN-Plus camps, organized by the NCDI Poverty

clinics can become hubs for broader chronic care

Network and its partners through a grant to

that also treats conditions such as hypertension and

the Center, offer another example of work in

type 2 diabetes. By convening national discussions,

intentional social movement design. The camps

the effort aims to help the country design its own

bring together children, adolescents, and young

care models that are more efficient and better serve

adults living with type 1 diabetes, sickle cell

a wider range of patients.

disease, and childhood heart disease to build confidence and community.

Integration science also applies to how health systems identify people who need care. In

Easy to replicate, the camps extend support

Nepal, for instance, researchers are exploring

beyond the clinic and create opportunities to

how to integrate newborn screening and active

deliver care, conduct research, and build the

outpatient screening for pediatric conditions into

shared experiences that keep people engaged.

routine health services. This work extends beyond

Over time, networks that are formed through this

PEN-Plus care delivery to examine how earlier

shared experience deepen, providing a platform

detection can connect children to continuous,

for information sharing, advocacy, and action.

coordinated care, and whether these pathways are effective, feasible, and affordable.

Together, these applications reflect a future in which health systems are not only better

Social movement design opens new possibilities

designed, but also more deeply rooted in the

for collective action. In Tanzania, researchers

communities they serve.

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Emerging Priorities As the Center continues to deepen its collaborations and body of research, it is positioning itself to respond to the rapidly shifting global health landscape through emerging applications of integration science across multiple disciplines and diagnoses. These include: ◗ Establishing a theory of change to bring global health interventions to scale effectively and sustainably, as countries establish national operational plans for PEN-Plus and the program matures across multiple partners and countries. This work includes codifying elements and best practices in planning and policy, defining levers for domestic and external resource mobilization, and exploring the role of social movements in supporting all these elements at scale. ◗ Leveraging clinical and scientific expertise across Mass General Brigham to create additional research, treatment, and training opportunities in global health, enabling the development of integration science models in such fields as pediatrics, women’s health, cardiac care, and oncology. ◗ Building a body of work that examines the intersection of global health and philanthropy science, particularly in a time of declining public sector commitments toward global health, burgeoning private wealth, and growing income inequality. ◗ E xploring the potential roles of artificial intelligence, music, and art in integration science, and how they might affect and inform individuals’ political action, philanthropic giving, and biological citizenship, including concepts of identity, disease, and health.

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The Center by the Numbers*

2021

Faculty and staff

Year the Center launched

100 30k >

Research collaborators

Research studies published since 2021

*As of October 2026

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Estimated number of patients already receiving care at Center-supported PEN-Plus clinics

600

Clinicians who have received PEN-Plus training

The Center in Context

Years the Center’s founder spent developing and testing integration science in the field with collaborators before launching the Center

2023

Year the World Health Organization designated the Center its official collaborating center for integration science

PEN-Plus clinics receiving direct support from the Center

29 countries collaborating with the Center + Additional country collaborations in development

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Leadership Gene Bukhman, MD, PhD

Neil Gupta, MD, MPH

Executive Director

Senior Director of Policy

Professor of Medicine, Harvard Medical School

Assistant Professor of Medicine, Harvard Medical School

Alma Adler, PhD, MSc, MA Director of Research

Marta Patiño Rodriguez, MD

Assistant Professor of Medicine,

Associate Director of Education and Training

Harvard Medical School Colin Pfaff, MBBCh, M Med (Fam), MPH Chantelle Boudreaux, ScD, MA

Associate Director of Programs

Associate Director for Integration Research Collin Whelley, MA Paula Byron, MA

Associate Director of Data Systems and

Director of Communications

Monitoring and Evaluation

Rylie Garrison, MEd

Emily Wroe, MD, MPH

Director of Finance and Operations

Senior Director of Programs Assistant Professor of Medicine,

Rachel Gasana, MBA

Harvard Medical School

Senior Director of Advancement

Principal Partners The Center for Integration Science works with a range of partners that provide global perspectives, disease-specific expertise, and resources to advance the work of the NCDI Poverty Network, accelerate the expansion of PEN-Plus, and provide a continuous feedback cycle for the Center’s work in integration science. Africa Centres for Disease Control (Africa CDC)

Muhimbili University of Health and Allied Sciences

American Heart Association

Partners In Health

American Society of Hematology

Sonia Nabeta Foundation

Breakthrough T1D

St. Jude Children’s Research Hospital

Clinton Health Access Initiative

UNICEF

Foundation for Cardiovascular Care in Africa

Universidade Eduardo Mondlane

Government of Scotland

World Health Organization (Geneva)

Leona M. and Harry B. Helmsley Charitable Trust

World Health Organization Regional Office for Africa

PHOTOGRAPHS: IVAN SIMONE CONGOLO (PAGES 12, 13); COURTESY OF THE WORLD HEALTH ORGANIZATION (PAGES 14, 16); ILLUSTRATIONS: BRIAN STAUFFER/THEISPOT (COVER, PAGES 1, 4, 10, 18, 21); COMPLEX STORIES (PAGE 25); INFOGRAPHICS: COMPLEX STORIES (PAGES 3, 7); GRAPHIC DESIGN AND ART DIRECTION: LAURA MCFADDEN DESIGN, INC.

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Selected Center Research Publications 2026 Fulai E, Boudreaux C, Drown L, et al. Patient and provider experiences with PEN-Plus in rural Mozambique: cohort characteristics at baseline. Glob Health Action 2026;19(1):2623347. Puetz W, Noble C, Drown L, et al. Decentralized chronic care service delivery for people living with type 1 diabetes in low- and lower-middle income countries: a scoping review. Endocr Pract 2026;32(7):1156–1169. Klassen S, Sandeepa K, Adler A, et al. Implementing a national acute rheumatic fever case-finding program and registry in Nepal: protocol for a multi-site implementation study. Front Cardiovasc Med 2026;13. Boudreaux C, Mansoor M, Aron MB, et al. Pathways to Care for Patients with Severe Chronic NCDs: A Cross-Sectional Survey of Inpatients in Neno, Malawi. Trop Med Int Health 2026.

2025 Ferrari G, Davies J, Thapa A, et al. Prospective cohort study evaluating feasibility, acceptability, and clinical impact of diabetes self-management education in a PEN-Plus program in Southeastern Liberia. PLOS Glob Public Health 2025;5(12):e0005657. Eltigany M, Drown L, Akala O, et al. Models of care for noncommunicable diseases in primary care: key elements and design in low- and middle-income countries—a scoping review. Glob Health Action 2025;18(1):2543604. Drown L, Adler AJ, Salvi D, et al. Facility readiness for decentralized Package of Essential Noncommunicable Disease Interventions–Plus (PEN-Plus) care in nine lower-income countries. PLOS Glob Public Health 2025;5(4):e0004398. Boudreaux C, Wroe EB, Thapa A, et al. Organization of services for severe chronic noncommunicable diseases at first-level hospitals in nine lowerincome countries: results from a baseline assessment of PEN-Plus initiation. PLOS Glob Public Health 2025;5(5):e0004552.

2024 Thapa A, Chibvunde S, Schwartz L, et al. Appropriateness and acceptability of continuous glucose monitoring in people with type 1 diabetes at rural first-level hospitals in Malawi: a qualitative study. BMJ Open 2024;14(5):e075559. Ndumwa HP, Mori AT, Ruhago GM, et al. Cost analysis for initiating an integrated package of essential non-communicable disease interventions (PEN-Plus) in Kondoa District

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Symposium Series on Integration Science To spark new ideas and research in integration science, every two years the Center hosts a symposium at Harvard Medical School. The series brings together researchers, clinicians, and implementation, policy, and advocacy specialists to learn from experts and collaborate across disciplines on some of global health’s toughest challenges.

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