<reporting-org ref="NP-IRD-201252183" type="40" secondary-reporter="0"> <narrative>B. P. Koirala Institute of Health Sciences</narrative> </reporting-org>

The COHESION - I project had two objectives: (i) The implementation and evaluation of the context specific co-created interventions in three countries – Mozambique, Nepal and Peru (Component 1). (ii) Explore the possibilities to translate the experience and the lessons learnt to other countries (India) for adaptation of the project in a different context (Component 2) Component 1 We propose to work in six communities in Mozambique, Nepal and Peru. Two communities (A&B) where we worked between 20017 - 2019 as part of the formative work will receive the co-created/co-designed intervention encompassing activities with the community’s health service users and health providers. Two other communities (C&D) will receive a co-designed only intervention of the same duration, the idea being evaluate if interventions that were co-created in other communities will work in new communities with similar characteristics. Finally, two different communities (E&F) will receive no intervention (“usual care arm”) to enable meaningful comparisons between intervention arms and usual care. The current project will enable us to evaluate the impact of a co-designed strategy in terms of (a) improved responsiveness of primary healthcare and patient satisfaction, and (b) improved health care provision for chronic conditions. We will compare the impacts of the co-designed intervention to those of the non-co designed intervention and usual care in terms of two major outcomes, responsiveness and patient satisfaction, as well as other health system-related outcomes. Component 2 In India, we will follow the approach taken in COHESION study and conduct a policy analysis, health system assessment and community perception study. A co-creation process will follow this to develop context-relevant interventions to improve the provision of care for people affected by non-communicable diseases and neglected tropical diseases. The co-created interventions will be pilot tested in the field for feasibility, acceptability, and preliminary effectiveness. If the COHESION approach proved to be locally adaptable in India, a protocol for the COHESION methodology will be developed that can be adapted to different settings.