Institute for Global Health and Development Harnessing AKU

Institute for Global Health and Development

Harnessing AKU’s Capacities Insights 2020

“Almost everything now seems to “flow” globally – people and images, money and credit, goods and services, microbes and viruses, pollution and armaments, crime and

terror. But let us remember, too, that constructive impulses can also flow more readily, as they do when international organization join hands across dividing lines.”

His Highness the Aga Khan

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2 Harnessing AKU’s Capacities

Contents Acknowledgements ........................................................................................................................ 2

About the Institute for Global Health and Development ............................................................... 3

The First Step: Understanding AKU’s Capacities ............................................................................ 4

Methodology .................................................................................................................................. 6

Key Findings ................................................................................................................................... 8

Insights Derived from this Assessment of Capacities ................................................................... 16

The Second Step: Harnessing AKU’s Capacities ........................................................................... 19

Conclusion .................................................................................................................................... 20

References ................................................................................................................................... 21

Acknowledgements This report was produced by Maryam Farooq and Diana MacKay. Dr. Zulfiqar Bhutta provided oversight and strategic direction. The report benefitted from contributions to the survey design and implementation by Asghar Ali and Shamsa Panjwani. Generous support from University Librarians Peter Gatiti and Khawaja Mustafa enabled access to hundreds of relevant publications. Much thanks goes to all those who gave generously of their time to fill out the survey and participate in consultations.

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About the Institute for Global Health and Development The Institute for Global Health and Development is a new research and policy action initiative of the Aga Khan University. Built on the vision of the Chancellor for the University to serve the developing world and Muslim societies in innovative and enduring ways, the Institute arose from a confluence of evolving factors influencing and shaping the today’s most pressing health and development issues. AKU is transitioning from an era of establishing roots to an exciting period of growth – and with this growth come capabilities for global engagement on a larger-scale. The idea to establish the Institute was championed by many. From the perspective of students, the rationale was clear. Anticipating careers that will require fluency with complex, societal interactions, environmental interdependencies, and geopolitical relations, today’s young people are justified in demanding that their institutions of higher learning provide them with the tools to navigate effectively and develop relevant leadership skills. Individual faculty members also showed interest in the creation of an academic unit that would drive interdisciplinary research, teaching and service. They frequently cited their desire for opportunities to expand collaboration across fields of expertise. The hope, they argued, was to reduce reliance on the reactive and infrequent chance of usually, small external calls of grant funding, and instead fuel strategic faculty alliances that could command competitive position – and proactive position – among major global agencies, even contributing to prominent international bodies establishing the frameworks for major global health and development initiatives. And at the University’s leadership, among AKU’s academic Deans and Directors, the University Executive, and the Board of Trustees, it was apparent that a major opportunity was afoot. Just as the University was deepening it resource base in cutting-edge fields such a stem cell and regenerative medicine, simulation technology in medical education, and innovations harnessing new digital technologies and creative entrepreneurship, there was an open space for coming together and organizing

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ambitious and enterprising approaches to address some of the world’s grandest health and development challenges, including the achievement of the Sustainable Development Goals. This is, at is core, the mandate of the Institute for Global Health and Development. The Institute, its work program now underway, champions interdisciplinary research and action on major global health and development challenges. It advances AKU’s health sciences leadership in Asia and Africa through partnerships with sister agencies in the Aga Khan Development Network and beyond, with a view towards developing cross-sectoral approaches to address problems that require large-scale, coordinated, intersectoral solutions.

The First Step: Understanding AKU’s Capacities In launching a new initiative, the first step is to determine a starting point and examine the immediate terrain. In the case of the Institute for Global Health and Development, Dr. Zulfiqar Bhutta’s central involvement in planning the Institute and his appointment as the Founding Director set the pace. Being among AKU’s longest-serving faculty members and having extensive experience in both the mechanics of large, grant-funded research centres at AKU and the international community of leaders in global health and development, his leadership ensured an advanced starting position. The Institute is geared up for engagement from the outset with the premier league of global players. Understanding the terrain required a concerted effort to connect with key stakeholders, enquire about strategic directions of mutual interest, assess capacity to engage, and secure good advice. To be effective in the Institute’s earliest undertakings, the core team needs to know, what resources are available at the outset? Who are the people most suited and best prepared to help kickstart activities and champion key opportunities? What level of interest do they have? How engaged are they willing to become? What areas of thematic focus will best leverage their talents? And importantly, how connected

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are they to each other and how integrated are they in networks of scholars and coalitions of policy influencers in global health and development? Another important element is unique to AKU. AKU is a multi-campus university, stretching across six countries on three continents. Further, the University is embedded in the larger Aga Khan Development Network, allowing even broader geographic scope, more extensive resources, and additional talent. The questions to probe include, are there established areas of close strategic alignment? How robust are the connection points? What are the mechanisms for coordination and collaboration with the Institute? AKU alumni are a remarkable source of expertise and commitment. They and their international networks can be tapped in the formation of research teams, program collaboration, grant applications, and awareness building. AKU also has many graduates in the community-based settings where many of the Institute’s programs will operate, and they can serve as champions in implementation support. Finally, there is great value in seeking out the guidance of trusted advisors. To this end, an external advisory group comprised of international experts in global health and development becomes another important source of insights on the lay of the land. What factors should drive decision-making? Where are the right initial opportunities? How should the Institute set out to achieve its goals? These and other questions formed the basis for early assessment of the Institute’s objectives and roadmap. The assessment took various forms, including: a survey of relevant faculty, a literature review of AKU-affiliated publications, consultations with AKU’s senior academic leadership team, and discussions with the Institute’s international advisory committee. This first step to understand AKU’s capacities taken, the second step becomes one of harnessing the identified capacities and determining the initial work program.

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Methodology The findings presented in this report are derived from multiple sources.

1. Consultations Over the past two years, at various AKU fora, and particularly at the meetings of the University’s Senior Academic Leadership Team (SALT), faculty members have discussed the rationale for the Institute’s creation and its strategic objectives. More recently, additional online consultations have invited more detailed input to help shape plans. These meetings have included AKU’s London-based faculty at the Institute for the Study of Islamic Civilizations (ISMC), Pakistan-based faculty (MC, SONAM, IED, and Exam Board) and East Africa-based faculty (MC, SONAM, IED, and GSMC). In addition, discussions have included a variety of AKU’s major research centres and institutes, including the East Africa Institute, the Institute for Human Development, the Brain and Mind Institute, the Cancer Institute and the Center of Excellence in Women and Child Health. In outreach to the agencies and entities of the AKDN, consultations took place with the University of Central Asia, Aga Khan Health Services, and the Aga Khan Foundation. Discussions also took place with senior leadership officials within the AKDN in light of increasing focus on climate change and environmental health.

2. Survey of Selected AKU Faculty To better understand the expertise and engagement of selected AKU faculty working in disciplines closely related to global health and development, a survey was conducted to probe for insights on ongoing projects and collaborations. The survey was targeted to those individuals and departments where related activities are known to be common or emerging.

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The survey was designed around the themes identified in consultations as areas of AKU’s strength or fields of major interest to faculty, including:

• Climate Change and Health (including energy resources, energy use, water quality and water ecosystems, clean air, indoor air quality, food security, secure shelter, etc.)

• Urban development and health (including water usage, treatment, and water system management, urban air quality, urban planning, etc.)

• Food insecurity, food systems and nutrition (including availability, access, utilization, stability, etc.)

• Gender issues and health (including women and child health, women’s employment, conflict and violence, gender inequality, gender norms, etc.)

• Society, culture, religion and health (including migration, beliefs about disease, spirituality, health-related preferences, historical influences on health, etc.)

• Broad social determinants of health and disease (including relevant areas not covered above)

On this last point, universal health coverage is a topic of huge global significance and a topic of focus, particularly for the Departments of Community Health Sciences and Population Health in AKU’s Medical Colleges in Pakistan and Kenya, respectively. Almost 70 LMICs are striving towards achievement of UHC and it is integral to the achievement of the Sustainable Development Goals. The survey asked questions pertaining to research collaborations, capacity for supporting local education programs, experience with providing advice to planners or policymakers in government, and involvement with monitoring and evaluation work. The survey also asked participants to rank the importance of:

• Data science

• Health economics

• Advanced biostatistics

• Epidemiological methods

• Monitoring and evaluation

• Grant writing

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The survey invited participants to rank their interest areas as well as identify the deliverables of the Institute during its first year of operation that would define its success.

3. Literature Reviews of AKU-Affiliated Publications While the survey focused on selected faculty, two separate literature reviews adopted a wider scope to assess the depth and reach of faculty research. The first literature review retrieved publications having titles incorporating keywords closely aligned with the faculty survey. A second search identified all publications since the University’s inception having at least one AKU-affiliated author. These literature reviews added to the consultations and survey a richness of insights, some of which are distilled below.

Key Findings

1. Consultations A summary of consultations which took place throughout 2019 was presented in a paper entitled, “AKU Institute for Global Health and Development” (Ref. 1). This paper was discussed by the University’s academic leadership, Executive Committee and Academic and Student Affairs Committee of the Board of Trustees in November and December 2019. The report concluded, “a clear goal of the initiative is to better organize our AKU-wide and AKDN-wide capacities for attracting large grants and for being more competitive in our alignment as a viable partner for major international development projects.” During early 2020, just as the Institute’s secretariat was formed and the organization of initial launch-related activities were taking shape, the COVID-19 crisis forced a reconsideration of the Institute’s objectives and plans. The ensuing round of consultations via online conferences resulted in two key conclusions: (1) that the resolve of the Institute to tackle the major global health and development themes previously identified should not be swayed by the ground-shifting new realities brought on by the

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pandemic, while the Institute should also be nimble in taking up COVID-19 and the associated challenges and opportunities as part of its thematic agenda; and (2) that COVID-19 might serve as a catalyst for the Institute’s emergence, presenting new opportunities for funding and heightened resolve among stakeholders to act in unison, across disciplines and geographies, towards addressing the underlying determinants of global health and development challenges. The Institute’s International Advisory Committee was struck, chaired by Dr. Michael Merson, Professor of Global Health at Duke University and the founding director of the SingHealth Duke-NUS Global Health Institute. This Committee helped:

• Lay out the current global context and position the Institute within the AKDN and larger systems;

• Set the strategic directions for the Institute, its scope of work, and approach to partnerships;

• Offer guidance on how best to calibrate the ambitions and pace of the Institute;

• Determine what could set the Institute apart from other similar initiatives; and

• Imagine the Institute’s character and placement on the research-policy-advocacy spectrum.

2. Survey of Selected AKU Faculty

The survey of selected AKU faculty gathered information from 62 respondents, including a small number of staff members and academic leaders from the University of Central Asia and other AKDN agencies. (Ref #2.) The survey participants have primary appointments in the groups listed in Image 1. While the number of respondents is small in comparison to the total number of AKU faculty, the intention of the survey was not to canvas all faculty, but rather to enquire for detailed information about interests and activities from those faculty members known to be active in global health and development issues and research. The sample is considered a decent reflection of the diversity of viewpoints, although there is a general recognition that many additional

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faculty members are active in relevant fields and involved in conducting relevant research. Faculty Interest in Research Areas In accordance with the Institute’s areas of thematic interest as identified through the consultation process, the survey invited faculty members to report in significant detail on their related research activities and interests. The survey asked participants to rank thematic areas of greatest interest. The top three selections were “Broad Social Determinants of Health”, “Gender Issues and Health” and “Climate Change and Health”. (See Graph 1.) The areas of “Urban Development and Health” and “Society, Culture, Religion and Health” were only slightly lower in rank. “Food Insecurity, Food Systems and Nutrition” completed the ranking, and with one out of two faculty members showing an interest, it is a fair conclusion that there is widespread interest among faculty for all the identified thematic areas. Upon recommendation of the International Advisory Committee and acknowledgement of the limited capacity of the Institute’s core team to advance a work program in all areas, a decision was taken to initiate activities in four areas:

1. Broad Social Determinants of Health (as defined by the Sustainable Development Goals)

2. Gender Equity and Empowerment 3. Climate Change, Urban Development, and Health 4. Agriculture, Food Security and Nutrition

Image 1: Survey participants by primary appointment.

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Collaborative and Interdisciplinary Research The survey asked participants to assess the extent to which their work utilizes collaborative methods. (See Graph 2.) On average, 27% of survey respondents use collaborative methods in their work.

35%32% 33%

31%

19%16%

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5%

10%

15%

20%

25%

30%

35%

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Broad SocialDeterminants of

Health

Climate Changeand Health

Gender Issues andHealth

Food insecurity,Food Systems and

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Society, Culture,Religion and

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UrbanDevelopment and

HealthPer

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age

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Col

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Topic Areas

Collaborations in Research

73%

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Broad Social Determinants of Health

Gender Issues and Health

Climate Change and Health

Society, Culture, Religion and Health

Urban Development and Health

Food insecurity, Food Systems and Nutrition

Percentage of Total Participants

Topi

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Faculty Interest Areas (n=62)

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Research Informing Policy Work The survey asked participants how their work informs policy. (See Graph 3.) On average, 19% of the respondents reported that the research they produce in the highlighted disciplines has influenced planners and policymakers.

Research Informing Educational Programs Research, program development, and policy impact are important pillars of the Institute’s mandate. But translating research results into educational programs for students and professionals is also an objective. The survey enquired whether research published by participants was translated into educational programs. (See Graph 4.) On average, 18% of respondents reported that their work informs educational programs.

26%23%

19%16% 16% 16%

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Gender Issues andHealth


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Urban Developmentand Health

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Focus Areas

Research Informing Policy

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Capacity Building As the Institute offers opportunities for the development and expansion of skills and capacities useful to the acquisition and execution of large-scale, interdisciplinary grants, the survey invited respondents to report on which areas deserve priority attention for capacity building. (See Graph 5.)

Capacity Area Participants Vote (%)

Grant Writing 46%

Data Science 37%

Monitoring and Evaluation 35%

Epidemiological Methods 27%

Advanced Biostatistics 15%

Working Across AKU/AKDN Entities In recognition that AKU and the AKDN offer unique opportunities for tackling global health and development challenges, the survey asked participants to share information on their activities involving collaboration across AKU entities and beyond to the agencies of the AKDN. Among survey respondents, 71% indicated that they had

31%

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16%14% 13% 12%

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Gender Issuesand Health

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Society, Culture,Religion and

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and Health

Food insecurity,Food Systemsand Nutrition

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Research Informing Educational Programs

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experience working in such collaborations and 29% reported they had no such experience. The survey allowed for open answers to this question, and several faculty members offered insights on the challenges of forming cross-entity research collaborations, and in particular, the absence of incentives.

3. Literature Reviews of AKU-Affiliated Publications The literature reviews were conducted by AKU’s library staff to augment the information collected in the faculty survey. (Ref 3.) Using keywords consistent with the survey’s six thematic areas, and retrieving publications with at least one AKU-affiliated author, the literature found total numbers of publications as follows:

• climate change and health (38)

• urban development and health (3)

• food insecurity, food systems, and nutrition (318)

• gender issues and maternal & child health (148)

• broad social determinants of health (1,022) The last category’s significantly higher number of results was due to the inclusion of many sub-topics, including health planning, health infrastructure, ethics, global health, nursing, society, beliefs and culture. The University’s work on gender has been scant in terms of issues pertaining to gender studies (e.g., gender equity) but the University has done substantial gender-focused health work (e.g., maternal and child health). An analysis of the publications in each category illustrates the tremendous academic partnerships in play among AKU faculty. For instance, among the 38 publications related to climate change and health, there were 43 unique AKU authors and 92 external collaborators engaged from 32 unique countries. Among the 3 publications related to urban development and health, each involved a unique AKU author and a total of 14 external partners representing 11 different countries. These networks are valuable, and the second literature review demonstrates the enormous span of these connections across a more expansive lens of research topics.

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This subsequent literature search – which removed any keywords, retrieving any publication over the past ten-year period having at least one AKU-affiliated author – resulted in a mammoth directory of 5,114 publications. It’s possible to see the University faculty intensifying research output year by year:

• 2010 (97)

• 2011 (410)

• 2012 (379)

• 2013 (416)

• 2014 (421)

• 2015 (519)

• 2016 (647)

• 2017 (684)

• 2018 (750)

• 2019 (791) The findings of these reviews are yet to be fully understood. But some generalizations are clear. The vast majority of these publications involved multiple authors from a wide variety of universities. To what extent these collaborations are different from other universities is yet to be studied. But there is no doubt, AKU’s faculty members are involved in a wide array of global research collaborations at the faculty-to-faculty level. Furthermore, it is evident from perusing the results that the range of research investigations is extremely wide, and the bulk of the research is very narrow in scope, contained within the field of expertise. In other words, AKU’s research gravity tends towards intradisciplinary research. Although there are instances of interdisciplinary research, it is largely conducted by only a few notable researchers who are exceptionally productive in championing this work. Type of research aside, an important finding is in the recognition of these vast global networks among AKU’s research community. Interestingly, these networks do not seem to be clustered among predominantly Muslim countries, instead spreading widely

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around the world, with impressive penetration in all continents except South America. The aspect of AKU’s research output is not the focus of the University’s attention. Even the occasional opportunities to spotlight collaborations of note are rare. More study is needed, as harnessing these networks and knowledge resources could be catalytic for the University as a whole.

Insights Derived from this Assessment of Capacities Beyond the findings above, additional insights can be derived from the consultations, survey and literature reviews regarding AKU’s capacities to leverage the Institute for Global Health and Development. These insights are subjective, open to debate, and intended as fodder for further consideration as the Institute’s leadership, associated faculty, and emerging collaborators begin to advance a work program. Among many possibilities, here is a sampling of pertinent observations:

1. AKU has depth and breadth of expertise that may not be fully appreciated and needs to better cross-fertilize. For a variety of important reasons, AKU’s academic entities have established themselves, to a considerable extent, in silos. Within each entity, and within the geography of each campus, faculty do tend to know each other and the general terrain of each other’s research work. But familiarity with the expertise and research work of colleagues in other schools and campuses is low. Even as more opportunities emerge for collaborative, interdisciplinary teams, institutional norms do not actively support the construction of diverse teams taking up interdisciplinary research activities or positioning themselves for leadership on complex, multisectoral issues. AKU’s institutional resources to support cross-fertilization of expertise are building, and this may help expose the depth and breadth of expertise so that more cross-entity coordination and interdisciplinary research collaborations can become the new norm.

2. AKU’s faculty members who are engaged in global health and development work are stretched thin, not high in numbers, and sometimes insufficiently backstopped by mentees who are being prepared to follow them into leadership roles. Faculty members at AKU with experience in global health and development

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are most suited to leading involvement with the Institute. Yet, they are evidently pressed to their limits. The challenges presented by the unparalleled events of 2020 may be inflating this sense. But launching a new Institute for Global Health and Development in the midst of a global health pandemic that is redefining the foundations of development outcomes requires “all hands on deck” – a hard order when all hands are already at full power.

3. Faculty appetite for more opportunity is enormous. The survey sampled only a small percentage of AKU’s faculty, and a highly aligned sample at that. Yet, respondents overwhelmingly indicated a thirst for kind of research opportunities to be targeted by the Institute – large in scale, involving longitudinal cohort studies, enabling comparative research across geographies, and arriving at opportunities for policy influence and societal impact. This is the promise of an AKU education and an AKU career. The challenge will not be in motivating faculty engagement; instead, the call is for putting in place the conditions that support faculty in realizing these opportunities. It is worth noting that student appetite is largely unknown, but it can be safely surmised that if a similar exercise were conducted to understand the demand among students for more interdisciplinary learning and research opportunities providing experience in ambitious programs to address issues such as climate change and human health, the response would be highly favourable. This leads to the next point.

4. Student engagement could be enhanced. The Institute’s vision and mandate embed the important conviction that its activities should include avenues connecting with the interests of students. For undergraduate students, these may be curricular components. Or they may be experiential learning opportunities. For graduate students, including PhDs and post-docs, the Institute can open doors to advanced research opportunities, avenues for presenting research findings to global audiences, and cultivation of know-how in creating, attracting, and implementing large-scale grants with leading global funders.

5. AKU’s faculty members are extremely well networked – particularly within their own disciplines globally. The literature reviews revealed remarkable global academic networks of AKU’s faculty members. If the connections between authors were mapped, it would be apparent that AKU’s faculty have long been

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collaborating with other scholars from all around the world. There may be a few clusters of intensity, in cities such as London, but for the most part, the map would show a wonderful array of interconnectivity throughout the world. These networks, if analyzed more closely, would likely demonstrate the deepest connections are tied to narrowly defined fields of research. However, they do represent value, especially in terms of building awareness regarding AKU’s research interests, research facilities, and caliber of research execution.

6. Juxtaposed to these global networks, AKU faculty members are not well connected within the AKDN. This is the promise of the Institute, to change this and leverage the tremendous opportunities inherent in aligning AKU’s research strengths in health sciences and related areas with the health and development capacities of the AKDN.

7. The interests of AKU faculty and key collaborators are highly consistent with the Institute’s identified thematic areas. There has been little to no disagreement regarding the 3-4 priority themes. In fact, resounding enthusiasm has signaled additional readiness to proceed. The Institute’s activities may smooth the way for climate change, gender equity, food and nutrition and the broad social determinants of health (especially the SDG goals) to become identified as AKU’s pinnacle areas of strength.

8. Yet to be studied is the extent of funder and donor willingness to support selected initiatives. A vital element of understanding AKU’s capacities would be an assessment of donor and funder readiness to support and invest. The context of 2020 has radically reshaped the positions of major funders, including international, bilateral and national development agencies. Major foundations are also reeling and readjusting. AKU’s tremendous donor community can also be anticipated to regroup. In all instances, the Institute will need to be ready to make the case for financial and other supports with a strong value proposition.

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The Second Step: Harnessing AKU’s Capacities Having understood AKU’s capacities, the next step is to harness them in service of the Institute’s mandate. This work is underway, guided by Dr. Bhutta and with the support of a small secretariat. A landscape analysis will help situate the Institute within the context of many other organizations operating in this space – including global agencies, funders, competitors and potential collaborators. This work will help define the Institute’s value proposition in light of the broader global arena, offering both an assessment of priority opportunities for engagement as well as a document that can help market the Institute’s capacities among these key stakeholders. A series of inaugural webinars are announcing the Institute’s interest in engaging in the initial priority thematic areas. The first webinar, held on September 14, 2020, exceeded 300 registrations for a discussion on climate change, health and development involving speakers and panelists from around the world. A second webinar on October 28, 2020, focused on agriculture, nutrition and food systems. A third webinar, on November 25, 2020, takes up the thematic area of gender, health and development. And more webinars are planned for early 2021. Each of these events is bringing together high-profile leaders from AKU, the AKDN, and other prominent organizations, occasionally tapping into AKU’s impressive ranks of graduates, many of whom are well-placed for strategic involvement in the agenda. One key objective of the webinars is to start identifying the individual faculty members, students, and supporters who will form working groups in each thematic area. A new website has been launching that serves as a communications hub. The Institute’s resources are showcased, research and newsletters are available here, and event announcements and recorded webinars are posted. The website also welcomes expressions of interest in collaboration.

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White papers that articulate the health and development challenges associated with each thematic area will help showcase AKU’s capacities to potential funders and partners. These papers will also help cultivate a short list of priority grant applications. Work is also underway to establish the Institute’s research teams and form key partnerships in anticipation of grant applications and other activities. Cross-appointment of associate faculty is one means for this growth of the Institute’s capacities, and invitations are being extended within AKU and to selected external scholars. More opportunities are envisioned for visiting faculty and collaborative work involving various global consortia.

Conclusion The Institute for Global Health and Development is launching at a time of upheaval, presenting both challenges and opportunities. But the signals, as evidenced by extensive consultations, the faculty survey, and the literature reviews, underscore that that AKU is ready to rise to the occasion. All stakeholders have consistently and energetically advocated for the Institute’s work to begin, starting with selected areas of AKU’s high performance (e.g., climate, nutrition, and gender), and gradually building out through strategic collaborations and partnership. Building more capacity will be essential. The feedback has been clear that more coordinated resources are required in areas such as grant-writing, and that the Institute can help add critical skills to AKU’s capacities in areas such as health economics, data analytics and monitoring and evaluation. The initial strategy is one of partnership. Especially given the current global environment, in which priorities and resource allocations are shifting, there are important opportunities that the Institute can leverage. This is the focus of the months ahead.

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References

1. AKU Institute for Global Health and Development, December 2019. 2. The survey was administered between MONTH and MONTH. It was shared

directly with selected faculty members, circulated to Deans and Directors for further distribution, and invited participation from a small number of AKDN colleagues working in global health and development.

3. PubMed Literature Searches, June and August, 2020

Documents

Institute for Global Health and Development Harnessing AKU