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The Ripple Effect of IMPACT: One Training Package, Wider Reach

What happens when a research tool designed for one programme proves valuable beyond it? Its impact begins to ripple outward.

A hypertension training package originally developed for the Centre for IMPACT’s community-based work is now supporting frontline health workers in new settings across Sindh. Adapted through a separate initiative, the same evidence-based resources have reached 60 Lady Health Workers and primary healthcare physicians across Jamshoro, Sujawal, and Karachi East, demonstrating how investment in strong research tools can continue creating value well beyond the programme that first developed them.

From one programme to another

The latest trainings were led by Dr Zeerak Jarrar, NIH Fogarty (D43) Fellow and research faculty in the Department of Surgery at Aga Khan University, through an intramural grant secured by Dr Zeerak as Principal Investigator and generously funded by the MBBS Class of 1988.

Rather than developing training resources from scratch, the initiative drew on the hypertension training package already developed and used through the Centre for IMPACT. This is where the ripple effect becomes visible: knowledge and tools generated through research do not have to remain within the boundaries of a single project. When they are practical, evidence-based, and designed for real-world use, they can be adapted and carried forward into new programmes, settings and audiences.

Reaching different parts of the health system

The sessions were conducted by Dr Zeerak Jarrar and Dr Farhala Baloch, who delivered the training across three districts. Through the initiative, hypertension management training reached 15 Lady Health Workers in Jamshoro, 25 Lady Health Workers in Sujawal, and 20 primary healthcare physicians in District Karachi East.

The settings and roles may differ, but the key goal remains: strengthening the capacity of frontline health workers to support high-quality hypertension prevention, identification, and management. From household-level screening in rural Sindh to clinic-based management in urban Karachi, the training demonstrates how a shared evidence-based approach can support hypertension care at different points across the health system.

Building partnerships for wider impact

The trainings were also strengthened by engagement with district health leadership. We were grateful for the support of the Deputy District Health Officers of Jamshoro and Sujawal, and Dr Anila, Deputy District Health Officer, Karachi East. Their participation reflects the importance of working alongside the public health system when translating research knowledge into practice.

At the physician training in Karachi East, Ms Safia Awan joined as guest of honour and distributed certificates to participating physicians, recognising their commitment to strengthening hypertension care.

When research keeps working

The story of this training package is ultimately bigger than a series of training sessions. It shows what can happen when research programmes invest not only in generating evidence, but also in creating practical, reusable tools that others can take forward. A resource developed for one programme can become part of another initiative; a training designed for one group can strengthen the skills of another; and knowledge generated through research can continue travelling through the health system.

Congratulations to Dr Zeerak Jarrar, Dr Farhala Baloch, and the wider team for taking this work forward.


The impact of a good research tool does not necessarily end when the project that created it ends.

Put into the right hands, it can keep moving and reaching new health workers, new settings and, ultimately, new communities.

Written by Dr Zeerak Jarrar.

 

When ‘We’re Not Alone’ Became the Biggest Learning Outcome

When we set out to deliver the PM+ training at SKBZ/CMH Muzaffarabad, our goal was straightforward: equip mental health professionals with evidence-based counselling skills. What we did not anticipate was that one of the most meaningful outcomes would have little to do with the training curriculum itself.

For many participants, this was the first opportunity to meet fellow mental health professionals from across Azad Jammu and Kashmir.

As introductions turned into conversations, a common realization emerged: we are not working alone.

Opportunities for specialized mental health training have historically been limited in Azad Jammu and Kashmir. Here, the PM+ programme has become more than a professional development workshop. It marks the beginning of a growing network of practitioners united by a shared commitment to improving mental health care in their communities.

Why This Training Mattered

Organizing the first PM+ training in Muzaffarabad required careful coordination and strong partnerships. 

Delivering this specialized mental health programme in a geographically remote region involved extensive planning, local collaboration, and close engagement with multiple stakeholders.

But behind every logistical challenge was a shared belief that professionals in Azad Jammu and Kashmir deserve equitable access to high-quality capacity-building opportunities.

One of the team’s proudest achievements was successfully delivering the entire four-day training with just two lead trainers: Rabeya and Maham. Together, they managed every aspect of the programme, from facilitating interactive learning sessions and conducting competency assessments to overseeing on-site coordination and logistics for all 21 participants. Balancing these responsibilities was demanding, yet it demonstrated the team’s dedication and adaptability.

The programme also highlighted the remarkable contribution of the team’s newest members: Asma and Hassan. While participating in the training themselves as future Master Trainers, they simultaneously supported the logistical management of the event. Their ability to balance learning with operational responsibilities reflected both their commitment and professionalism.

A Shared Vision for Mental Health

The opening session reinforced that this initiative represented something much larger than a single training programme.

Senior clinicians and institutional leaders described the training as an investment in the future of mental health services in Azad Jammu and Kashmir.

The programme itself was made possible through the dedication of Dr Anum (Consultant Psychiatrist, SKBZ/CMH Muzaffarabad), whose leadership was instrumental in bringing the initiative to the region. She coordinated with key stakeholders across institutions, fostered the collaborations necessary to organize the training, and reached out to mental health professionals from diverse organizations to ensure broad representation. Her efforts laid the foundation for a truly collaborative learning experience.

Dr Khawaja Hamid Rasheed acknowledged the considerable effort required to bring the programme to the region and appreciated the commitment of the Institute of Psychiatry team in ensuring that local professionals could benefit from this opportunity.

Discussions throughout the programme also focused on a broader vision for mental health care in Pakistan. Participants emphasized the importance of extending evidence-based training to underserved regions and building strong regional mental health teams capable of sustaining future initiatives locally. Rather than depending solely on centralized training programmes, stakeholders envisioned a system where professionals have equal opportunities to develop their skills, regardless of geographical location.

A Powerful Trifecta: Training, Mentorship, and Networking

For many participants, this vision resonated deeply. Working in a region with a limited mental health workforce often means fewer opportunities for advanced training, mentorship, and professional networking. The Centre for IMPACT PM+ strand addresses all three by providing practical clinical skills while creating valuable professional connections that many participants have never experienced before.

The urgency of strengthening the local workforce was further highlighted by Prof. Brigadier Shakir Sharif, who spoke about the growing burden of mental health challenges in the region, including increasing suicide rates. He emphasized that:

investing in local capacity is no longer optional it is essential.

He also expressed hope that the knowledge gained through this programme would extend beyond the participants themselves, creating a multiplier effect as they go on to train others and expand access to quality psychological care across Azad Jammu and Kashmir.

Looking Ahead

Participants will remember the first PM+ training in Muzaffarabad for more than the counselling skills it introduced.

It brought together professionals who had never before shared the same learning space. It revealed a community of mental health practitioners who, despite working toward the same goals, had rarely had the opportunity to connect. Most importantly, it demonstrated the impact that can be achieved when institutions collaborate to strengthen local capacity.

Throughout the four days, one message remained consistent: this should not be a one-time initiative.

Participants, institutional leaders, and partners shared a common aspiration to build a sustainable culture of mental health capacity-building across Azad Jammu and Kashmir.

By equipping local professionals with evidence-based psychological interventions while fostering a supportive professional network, the programme has laid an important foundation for a stronger, more connected, and more accessible mental health system in the region.

Sometimes, the most lasting outcome of a training is not only the knowledge participants gain, but the community they build together, which is what we are aiming to achieve through PM+ in the future.

Written by Rabeya Tariq, Research Assistant (IoP) PM+ Pakistan.

EMCR Spotlight! From Participants to Partners: Why Adolescents Belong at the Heart of Research

In the next of our EMCR Spotlight posts, we hear from Ali Hussaini, one of our pre-Doctoral Fellows, and Director of ORIC at Ziauddin University, Pakistan.

Can you tell us a little about yourself and your involvement in the Centre for IMPACT?

I am Ali Hussaini, Director of ORIC at Ziauddin University, Pakistan. Until recently I was involved with the Centre for IMPACT through the Community Engagement and Involvement (CEI) theme, and I am currently a pre-Doctoral Fellowship recipient from the Centre. My work sits at the intersection of research management, public health, community engagement, and capacity strengthening.

Over the years, I have become increasingly interested in how we can make research more meaningful to the communities it is intended to serve. For me, research should not simply be something that is done to communities. It should be something that is developed with communities, where people have a genuine opportunity to influence the questions we ask, the solutions we design, and the way findings are translated into action.

Through this journey, I have developed a particular interest in the meaningful involvement of adolescents and young people in research, an area I hope to explore further through my Pre-Doctoral Fellowship.

What inspired your interest in involving adolescents in research?

Adolescents are often described as the “future,” but I believe they are also very much part of the present. They are already experiencing and responding to the health, social, educational, and environmental challenges that researchers are trying to understand.

Yet, when we conduct research, young people are frequently positioned as respondents or beneficiaries rather than as partners. We ask them questions, collect data from them, and then move on. We may consult them at the beginning of a project, but rarely give them a meaningful role in shaping what happens next.

I believe we need to rethink this.

  • If we are researching adolescent mental health, for example, who better to help us understand what mental wellbeing means in their everyday lives?
  • If we are designing school health interventions, why should young people not have a voice in deciding what activities are engaging, realistic, and relevant to them?

If we are exploring digital health, social media, climate change, or healthy lifestyles, young people can offer insights that adults may simply not see. My interest is therefore not only in researching adolescents, but in involving adolescents in the research process itself.

What does meaningful adolescent involvement in research look like to you?

Meaningful involvement goes beyond inviting young people to attend a meeting or asking them to complete a survey. It means creating opportunities for adolescents to contribute to different stages of the research process—from identifying problems and prioritising research questions to designing interventions, interpreting findings, and thinking about how research can be translated into action.

For me, the key word is meaningful.

We need to ask ourselves: Are young people genuinely influencing decisions, or are we simply creating the appearance of participation?

A young person should be able to see how their contribution made a difference. This could be as simple as helping researchers refine a questionnaire, redesigning an intervention to make it more relevant to their peers, contributing to communication materials, or helping interpret research findings from a young person’s perspective.

It also means creating safe and inclusive spaces where adolescents feel comfortable expressing views that may differ from those of adults.

Why is this particularly important in Pakistan and South Asia?

In Pakistan and across South Asia, adolescents represent a significant proportion of the population and are navigating a rapidly changing world. They are experiencing challenges related to education, employment, mental health, gender norms, technology, climate change, nutrition, and access to health services.

At the same time, many decisions affecting their lives are made by adults.

There is therefore a strong case for creating structured platforms where young people can participate in research and policy conversations. This is particularly important when working with communities where young people’s voices may be constrained by social, cultural, or family structures.

However, meaningful engagement requires sensitivity. We cannot simply import models of youth participation from other settings and expect them to work everywhere. We need to understand local contexts, respect cultural norms, consider safeguarding, and ensure that young people are supported to participate safely and confidently.

This is where community engagement becomes so important. Research partnerships need to be built on trust, respect, and mutual learning.

What have you learned from your experience of community engagement?

One of my biggest lessons is that communities are not simply recipients of knowledge—they are also producers of knowledge.

Through my work in community engagement, I have seen how creative approaches such as storytelling, puppet shows, poetry, health carnivals, and sports can create spaces for people to discuss health and wellbeing in ways that traditional research methods sometimes cannot.

These experiences have reinforced my belief that research communication and engagement should not be limited to academic papers and conferences. If our research is intended to improve people’s lives, we need to think about how knowledge travels beyond academic institutions.

With adolescents, this becomes even more important. Young people communicate differently, learn differently, and engage with information through different channels. We need to meet them where they are and create opportunities for them to express themselves in ways that feel natural to them.

What would you like to see change in the way researchers work with young people?

I would like to see a shift from researching adolescents to researching with adolescents.

This requires researchers to rethink power dynamics. We need to recognise that our academic expertise does not automatically make us experts in young people’s lived experiences.

I would like to see young people involved earlier in research projects—not simply after the research questions, methodology, and intervention have already been finalised.

I would also like to see more investment in building young people’s research capacity. Adolescents can be supported to understand research methods, ethics, data collection, storytelling, and knowledge translation. With the right support, they can become powerful advocates for evidence-informed change within their schools, families, and communities.

Most importantly, we need to close the feedback loop. If young people contribute to research, they deserve to know what happened as a result of their contribution.

What does a “day in the life” look like for you?

No two days are quite the same. My work involves a combination of research management, grants, programme development, teaching, capacity building, and community engagement.

I may spend part of the day working with researchers on funding opportunities or research projects, and another part thinking about how research findings can be translated into meaningful community action.

What I particularly enjoy is working across different spaces—bringing together researchers, practitioners, communities, and volunteers. These interactions constantly remind me that the most valuable insights often emerge when people from different backgrounds come together.

My work with the Centre for IMPACT strengthened this perspective. It encouraged me to think more deeply about how we can build stronger bridges between research and communities and how engagement can become an integral part of the research process rather than an activity that happens alongside it.

What is next for you?

Looking ahead, I would like to contribute to developing stronger models of adolescent and youth engagement in research, particularly in Pakistan and other low- and middle-income settings.

I am interested in exploring how adolescents can be involved not only as research participants but as co-designers, advisors, communicators, and advocates for research.

I also hope to see more opportunities for young people to develop research and leadership skills. If we can give adolescents the confidence and platforms to engage with research today, we may be helping to develop the researchers, health professionals, community leaders, and changemakers of tomorrow.

For me, the ultimate goal is simple: young people should not only be the subjects of research about their lives—they should have a voice in shaping the research that seeks to improve those lives.

That is the kind of research culture I hope we can build: one where communities are partners, where young people are heard, and where evidence is shaped together with the people it is meant to serve.

Where Trust Already Lives: Taking Mental Health Conversations To Community Spaces and Religious Sites of Karachi

A mosque courtyard after Friday prayers, the quiet interior of a church hall, an imambargah during a community gathering,  a madrassa classroom, a busy clinic waiting area with patients still holding their token numbers… these are not the settings typically associated with a clinical trial.

But under the SPiRiT-D project, they became exactly that: the frontline of a mental health intervention, built person by person.

A research trial, built for the real world

SPiRiT-D is a hybrid type-II effectiveness-implementation trial,  a research design that asks two questions at once: does this mental health intervention work clinically, and can it actually be delivered in the real world? Hybrid designs like this are increasingly favoured in global mental health research precisely because they shorten the long, often frustrating gap between “evidence” and “everyday practice” (Curran et al., 2012).

Implemented under the Centre for IMPACT in partnership with SINA Health, Education and Welfare Trust, the SPiRiT-D trial integrates mental health care for depression and anxiety directly into primary healthcare clinics serving underserved urban populations across Karachi. However, integrating a clinical intervention into a health system is only half the equation.

The other half,  arguably the harder half, is getting people to walk through the door in the first place.

This is where community engagement comes in. Not as an add-on, not as a footnote to the “real” trial activities; but as a deliberate, structured implementation strategy, designed from the outset to increase the reach, acceptability, uptake, and long-term sustainability of mental health services implemented as part of the trial.

Borrowing trust instead of building it from scratch

In communities where mental health is rarely spoken about openly, you don’t win trust by giving a diagnosis. You win it by reaching out to where trust already exists.

This is where social capital theory became more than an academic framework, it became our field strategy. Rather than treating clinics as the only entry point, we deliberately engaged the relationships, networks, and respected figures that communities already lean on: imams at mosques, priests at churches, religious scholars at madrassas, and elders leading imambargahs and community gatherings.

These aren’t just alternative venues. They’re repositories of accumulated trust and social capital that took years, sometimes generations, to build. By working with faith leaders rather than around them, we weren’t asking communities to trust something new. We were asking trusted voices to open a door that was already familiar to them.

The reach by numbers

Across mosques, churches, imambargahs, madrassas, and open community spaces, the sessions added up to:

The sessions

Each session used narrative-based storytelling including real life stories that let people recognize their own experiences without ever being handed a diagnosis. Sessions ran as short talks, open discussions, and Q&A, conducted in Urdu or the locally spoken regional language including Balochi, Sindhi, Punjabi, and Pashto; using everyday, non-clinical language and culturally grounded examples standing in for medical terminology.

Just as important as what we said was how we said it: every session was entirely voluntary. No incentives, no obligations. People could engage, simply observe, or step away at any point because trust that’s coerced isn’t trust at all.

What changed?

The results were tangible, and they showed up in ways that mattered both for individuals and for the SPiRiT-D trial itself:

  • Improved recognition of depression and anxiety symptoms among clinic attendees
  • Increased openness to mental health screening as part of the routine care delivery
  • Enhanced trust in SINA’s primary care services
  • A strengthened link between community awareness and the trial’s enrolment pipeline
  • Strong acceptability of a voluntary, culturally sensitive engagement format
  • Direct support to trial recruitment, helping the study meet its target sample size

That last point matters more than it might first appear. Recruitment is often the quiet bottleneck of trials. For us, the community trust did not just improve wellbeing conversations; it moved the trial itself forward.

What approaches are key for the future?

  • Fold awareness work into clinical delivery; not beside it, inside it.
  • Go further into community and faith-based spaces that already hold trust.
  • Treat religious and community leaders as partners in the trial, not hosts for a one-time visit.
  • Build structured feedback loops, so we’re not just counting attendees,  we are hearing them.
  • Test repeat sessions over one-off visits, because trust is built in returns, not appearances.

None of this was without friction.  Clinic sessions competed with limited time and patient loads. Community turnout varied by timing and location. Stigma does not dissolve in a single conversation, and language diversity across Karachi’s neighborhoods meant messaging had to be adapted, not just translated.

Measuring the longer-term impact of a single session remains an open challenge we are still working through.

Written by Kinza Zeeshan, Research Fellow/Trial coordinator-SPiRiT-D.

Curran, G.M., Bauer, M., Mittman, B., Pyne, J.M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care.

From Learning to Leading

During the EMPOWER-D intervention sessions, community members were encouraged to learn more about blood pressure (BP), diabetes, and how to check BP and blood sugar levels. One female community member showed a strong interest in learning how to check blood pressure and blood sugar levels. Our Community Mobilizer trained her on how to use a BP apparatus and glucometer.

What started as a simple learning opportunity soon became a meaningful step towards community leadership.

From Participant to Community Leader

After receiving the training, she became the leader of one of the PLA groups in Garhi Faizullah 1, Block 33, Chamkini. She decided to make herself available one day every week so that women in her community could check their blood pressure and blood sugar levels without having to travel to a hospital or local dispensary.

To support this initiative, she bought her own BP apparatus and glucometer. She provides these checks free of cost, only asking community members to bring their own glucometer strips.

A Community Initiative Led by a Woman

This initiative has made BP and blood sugar checks easier and more accessible for women in the area. Many women shared that weekly visits to hospitals or local dispensaries for checks was difficult for them.

Now, having someone from their own community who can provide these basic checks has given them greater convenience, confidence, and motivation to take care of their health.

Visiting the Community and Seeing the Change

After learning about this inspiring initiative, Gul Ghutai from the research team visited the field on the same day. She met the women involved, observed the activity, and recorded their experiences and the positive response from the community.

The Community Mobilizers were also very happy to see how their efforts had encouraged a community member to take responsibility and support others.

The visit ended with a joyful moment as the women came together for a photograph, proudly showing their victory signs.

For the EMPOWER-D team, this was more than just a photograph. It represented confidence, community ownership, women’s leadership, and the power of small actions to create meaningful change.

A Proud Moment for the EMPOWER-D Team

This is a great example of how community engagement can go beyond awareness sessions. A woman who initially joined as a community member is now helping others in her community.

The EMPOWER-D team is especially proud to see this kind of community-led change in rural areas, where simple and locally driven initiatives can make health services more accessible.

From learning to leading, this woman has shown that when communities are given the right knowledge and support, they can become powerful agents of change.

Written by Gul Ghutai (KMU EMPOWER-D team).

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