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Pakistan at 79: A Promise for a Healthier Future

Every generation inherits a country shaped by the choices of those before it and leaves behind one shaped by its own.

In this blog, we hear from Syeda Nadia Bokhari (AKU) on the choices we can make towards a healthier Pakistan.

As Pakistan approaches 80 years of independence, the question is not only how far we have come, but what we want the next generation to inherit. A healthier Pakistan will not happen by chance. It will take a commitment to make health a priority, prevent disease earlier, and ensure that more people have the opportunity to live well.

For those of us working in health, that commitment means looking beyond treatment to the conditions that shape people’s health, the systems that support them, and the opportunities we create for prevention. It also means asking what each of us, in our own role, can contribute to a healthier future for Pakistan.

Our health system faces its own pressures

Pakistan’s health challenges are not just about the diseases we face, but whether people can access the care they need and afford it. Persistent gaps in healthcare access and high out-of-pocket costs make this even more challenging. Meanwhile, the country’s disease burden is evolving. Infectious diseases and maternal and child health remain pressing concerns, while non-communicable diseases (NCDs) are claiming an increasing share of lives. According to WHO estimates, NCDs accounted for 52% of deaths in Pakistan in 2021. Cardiovascular disease is a leading cause of death, with an estimated 46% of adults living with hypertension. This makes it critical to look beyond treating illness towards identifying risks earlier, strengthening prevention, and ensuring access to quality care without financial hardship.

Our promise to Pakistan

A healthier Pakistan will not be built through one decision or one intervention. It will take people making different commitments, in their homes, communities, healthcare facilities and workplaces, and working together to turn them into lasting change.

As Pakistan approaches its 80th year of independence, we asked people working across cardiovascular health and research what they hope to contribute to the country’s future. Their answers reflect a shared priority, that is, preventing illness earlier, bringing healthcare closer to people and making healthier lives possible for more families.

For Dr Imran Naeem, Lead of the Cardiovascular Disease Theme at Centre for IMPACT, the priority is to make hypertension prevention and treatment a routine part of primary healthcare:

“I pledge to work towards making blood pressure screening and treatment a routine part of primary care, helping prevent avoidable heart attacks and strokes.”

For Shakeel Ahmed Memon, Incharge of a Basic Health Unit in Hala participating in the MCHI trial, the commitment comes from two decades of serving rural communities:

“I will continue serving rural communities where access to healthcare remains limited. I hope for a Pakistan where people in our villages can access the care they need and our children can grow up healthier.”

For Rani Bhutto, Research Coordinator with the Department of Medicine at Aga Khan University, the focus is on making prevention accessible beyond healthcare facilities:

“I want to take hypertension awareness, screening and prevention to people’s doorsteps, especially to those who struggle to access healthcare. My hope is for more families across Pakistan to know their blood pressure, understand their risk and seek care earlier.”

For Soomal, a Lady Health Worker in Hala working as part of the MCHI trial, the commitment is to continue supporting families through trusted, community-based care:

“I will continue supporting the families who trust me, helping them understand their health, manage high blood pressure and seek care when they need it. I want to see healthier mothers, children and families in my community.”

My own pledge is both personal and professional; to make healthier choices in my life and use my work in health research communications to make health information easier to understand and act on, helping people make informed decisions for themselves and their families.

From individual promises to collective change

Individual commitments matter, but their impact grows when they are supported by systems that make healthier choices and better healthcare possible. For the Centre for IMPACT, this means bringing researchers, communities, healthcare providers, educators and other stakeholders together to generate locally relevant evidence, translate research into practice, and strengthen approaches to cardiovascular health that can be sustained and scaled:

  • Healthcare institutions can embed prevention into routine services
  • Research organisations can make evidence accessible and actionable
  • Schools and workplaces can help create environments that support healthier choices.

Each of us also has a part to play; knowing our blood pressure, making informed health choices, encouraging our families to seek preventive care, and supporting healthier communities. These commitments may differ in scale, but they share a common purpose: a Pakistan where prevention begins earlier, quality healthcare is within reach, and everyone has a greater opportunity to live a healthier life.

As we mark 80 years of independence, our promise must go beyond imagining a healthier Pakistan. It must be reflected in what we do every day, in the care we provide, the evidence we put into practice, the choices we make, and the change we create together.

Why lived experience matters: bridging the evidence gap in mental health research

How people with lived experience are shaping research in Afghanistan

In a widely cited 2010 paper, researchers highlighted a striking imbalance: 96% of participants in studies published in leading journals across six areas of psychology came from Western industrialised countries, representing just 12% of the world’s population at the time. Drawing on Jeffrey Arnett’s earlier analysis, they questioned how confidently findings from such a narrow population could explain human experiences worldwide.

This concern became known as the WEIRD problem: the heavy reliance on people from Western, Educated, Industrialised, Rich and Democratic societies in psychological research. For mental health researchers, it raises a practical question:

How can we involve people with lived experience in making mental health support understandable and relevant to their everyday lives?

For World Mental Health Day, our PM+ Afghanistan team shares how lived experience and community involvement have helped us address that question, from reviewing the words we use, to influencing research and partnership decisions.

Starting with the people receiving support

Problem Management Plus (PM+) is a brief psychological intervention developed by the World Health Organization. Its evidence base includes studies in Pakistan and Kenya. Bringing this evidence into practice in Afghanistan also requires understanding how the approach fits local language, circumstances, and everyday life.

People who have experienced mental health difficulties and received PM+ bring knowledge that is essential to this process. They can explain how they understood the sessions, which explanations needed clarification, and how the suggested approaches fitted their lives.

Within the NIHR Centre for IMPACT’s PM+ implementation research, we created complementary opportunities to learn from these perspectives. Qualitative interviews explored the experiences of people who received PM+, and Community Advisory Panels (CAPs) provided an ongoing forum for people with lived experience and other community members to discuss the research and influence its direction.

Creating a continuing space for involvement

Separate female and male CAPs were established to support culturally appropriate participation. At establishment, they included 27 members: 13 women and 14 men. People with lived experience joined community health workers, teachers, religious leaders, social workers, psychologists, youth representatives, and PM+ trainers.

These panels brought together knowledge of receiving support, delivering it, and understanding the communities where the research took place. Through regular discussions, members identified priorities, reviewed study materials and helped refine mental health messages and visual resources.

Members also identified areas where they wanted further information and learning. This made capacity strengthening part of the engagement process, alongside opportunities to contribute their own knowledge. Electing their Chair and Vice Chair gave members a direct role in how the panels operated.

Listening closely to how support was understood

One practical issue concerned something researchers use every day: words.

If a term is clear in a professional manual, can we assume it will be clear in a community conversation?

In qualitative interviews, some people who received PM+ described needing simpler explanations, clarification, or repetition. Others described understanding the sessions with the help of everyday explanations. These accounts drew attention to how much the way an idea is explained can matter.

Community discussions also provided opportunities to review whether messages and visual materials were understandable and appropriate. Together with provider feedback and other implementation findings, these contributions encouraged the team to examine wording, explanations, and examples more closely.

Turning insights into adaptation

These insights helped inform three days of adaptation and contextualisation workshops. Mental health specialists, PM+ trainers, community health workers and supervisors, Dari and Pashto language experts, and community representatives brought their knowledge together.

Participants reviewed wording, explanations and examples in PM+ materials. The aim was to make them more understandable and relevant to local communities while preserving their intended therapeutic meaning and the intervention’s core components.

This required different kinds of expertise. Language specialists could examine an expression’s meaning; practitioners could consider how they would explain it during a session; community perspectives could help assess whether it was familiar and understandable in everyday life.

The process gave the team a practical way to respond to concerns raised through the research. It also reinforced a lesson: translating a sentence is one step; examining how people understand and use it requires further work.

The workshops generated recommendations for adapting the materials. Assessing how the resulting changes affect understanding and delivery remains an important part of the work.

Extending influence to shared decisions

Community contributions also shaped the partnership itself.

When a wider stakeholder group was proposed under the name “Coalition”, community feedback led to its renaming as the “Collaborative Initiative for Mental Health” to improve local acceptability. Community representatives and implementation partners also helped identify stakeholders whose involvement would matter for continued implementation. This connected community priorities with wider discussions involving implementers and decision-makers.

The panels therefore provided a foundation for broader engagement: a place to identify concerns, develop recommendations, and contribute to decisions that extended beyond individual meetings. These activities are building relationships that may support future implementation, although sustainability beyond the study will require continued commitment and resources.

What this means for mental health research

WEIRD bias reminds us to examine whose experiences are represented in research. Our work in Afghanistan brings that question into everyday practice: whose language is reflected in materials, whose priorities enter discussions, and whose recommendations influence decisions?

Community involvement alone cannot resolve the imbalance in the global evidence base. It can, however, help researchers identify assumptions and give local knowledge a meaningful place in their work. Our approach shares several principles with the WHO framework for meaningful engagement, including recognising lived experience as expertise, supporting participation in decisions and adapting engagement to the local context. These principles are reflected in community contributions to materials, the election of panel leadership, and recommendations that influenced partnership decisions.

Our experience shows that meaningful involvement needs to continue throughout the research process. People need opportunities to understand the work, raise concerns, make recommendations and hear how their suggestions are used. Research teams also need to be willing to act on that input and explain where questions remain.

This World Mental Health Day, we recognise people with lived experience as contributors to mental health research.

In PM+ Afghanistan, their involvement has helped us reconsider familiar wording, review materials and shape partnership decisions. For our team, meaningful involvement means showing how people’s contributions influence the work.

Written by Abdul Ahad Sultani, HealthNet TPO Afghanistan, on behalf of the PM+ Afghanistan team.

The team will share further lessons from this community engagement pathway at the NIHR Community Engagement and Involvement Showcase on the 19th November 2026.

References:
Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33(2–3), 61–83. DOI: 10.1017/S0140525X0999152X.
Arnett, J. J. (2008). The neglected 95%: Why American psychology needs to become less American. American Psychologist, 63(7), 602–614. DOI: 10.1037/0003-066X.63.7.602.

 

 

Access Shouldn’t Wait for the Perfect Path: Inside the 9th PM+ Training of Trainers in Quetta

There are trainings you complete, and there are trainings you carry with you. The 9th cohort of the Problem Management Plus (PM+) Training of Trainers in Quetta, Balochistan belongs firmly in the second category.

A Region We Had Been Trying to Reach

Quetta had been on our list since last year. Every time we tried to plan a training there, the same question came up. How do we conduct this safely? Balochistan’s security sensitivity is not a small detail on a map; it is a lived reality that shapes almost every decision an organization makes before stepping into the region. So, the plans kept getting pushed. Not because the need wasn’t there, the need was one of the strongest across all our regional sites, but the path to meet that need was not simple.

This year, instead of waiting for the path to become easier, we decided to build a new one.

Choosing a Different Way In

The decision to adopt a hybrid model was not made lightly. It meant redesigning a training format that had worked reliably in fully in-person settings and trusting that it could still hold its depth and quality when split across physical presence and virtual delivery. It meant more planning meetings, more contingency thinking, and honestly, more uncertainty than we were used to.

Under the leadership of Prof. Dr Asad Tamizuddin Nizami, the plan took shape. The team would travel to Quetta to conduct an inception meeting in person at the Balochistan Institute of Psychiatry and Behavioural Sciences. We would meet all 46 participants face to face, understand the local context directly from stakeholders, and then hand off the core training to be delivered online from the Institute of Psychiatry, Rawalpindi Medical University.

What made this plan work was Prof. Asad taking the time out of his own busy schedule to travel with us all the way to Quetta. His presence was more than symbolic. It was genuinely encouraging for the whole team, and it made a lot of things go smoothly that could easily have gone wrong. His experience and calmness under pressure set the tone for how the entire visit unfolded.

The clearest lesson in leadership from that day was watching how a time-bound plan can be executed effectively when the person leading it is fully present and engaged.

Every part of our Quetta visit: the travel, the inception meeting, the stakeholder engagement, was completed in under 24 hours. That kind of execution does not happen by chance. It happens because someone at the front is willing to move at the pace the situation demands and bring the team along with him.

The Part That Stays with Me

Choosing to go to Quetta despite the known security concerns was not a small ask of the team. It would have been easy to justify staying back and running everything remotely from the start. Nobody would have questioned that decision. But the team chose otherwise. They chose to show up in person for the parts of the process that mattered most for building trust: the first meeting, the first handshake, the first real conversation with the people we would be training.

That choice says something about the kind of commitment this work demands. It is one thing to believe in expanding mental health services on paper. It is another to walk into a region carrying that belief, knowing the risks, and doing it anyway because the people on the other side deserve access to quality care regardless of where they live.

That team included Ms Maham Abid (Project Manager), with Ms Noor Fatima, Ms Rabeya Tariq, Ms Asma Muzaffar, and myself, Hassan Raza Ali. Looking back, I do not think I fully appreciated in the moment what it meant to have this particular group of people on that trip. Each of them showed up fully, handled the uncertainty of the day with composure, and carried out their part of a tightly timed plan without losing sight of why we were there in the first place.

The People Who Made Us Feel Safe

One of the most meaningful parts of the Quetta visit was meeting the stakeholders at the Balochistan Institute of Psychiatry and Behavioral Sciences. Prof. Hazrat Ali, Director of the institute, and Prof. Ghulam Rasool, Founding Director of BIPBS, welcomed us with warmth. They took the time to sit with us, to put us at ease, and to encourage us in a way that gave the whole team a real sense of confidence and validation. In a region to which we had carried so much apprehension, their hospitality provided a safe and secure environment that made the inception meeting possible in the first place.

What stayed with me even more than their welcome was their story. In the short time we spent with them, we learned how they had started and built the mental health system in Balochistan, often from very little, in a context far more difficult than most of us have had to work in. Hearing that firsthand was humbling. It put our own hesitation about traveling to Quetta into perspective and left us genuinely inspired by what dedication over the long term can accomplish, even in the most under-resourced and challenging environments.

Learning to Train Differently

Back in Rawalpindi, the real experiment began. We needed to deliver a training online that we had only ever done in person, to a group we had only met once. There was no established playbook for this within our project. 

It required us to rethink our pacing. We needed to be more intentional about engagement. We could not read a room the same way virtually and needed to lean more heavily on structure to keep 46 participants connected and motivated across the sessions. It was uncomfortable at times.

But discomfort is often where the most useful learning happens.

This training taught us a great deal about how flexible our model can be when the situation demands it.

The Numbers That Mattered Most

At the end of the training, we conducted competency assessments through roleplays, the same rigorous standard we hold every cohort to regardless of format. The results were satisfactory, though not quite as strong as what we typically see from our fully in-person cohorts. That is not surprising given everything this cohort had to work around, and it is okay. It was part of the learning that came with trying something new and gives us something concrete to think about as we move forward. Specifically, how can we refine the hybrid model for future cohorts?

What Quetta Taught Us

Every training teaches you something about the intervention itself. This one taught us something about ourselves as a team. It taught us that access to mental health training should not be limited by geography or by the difficulty of reaching a place. It taught us that innovation in project delivery is sometimes born not out of convenience but out of necessity, when the usual way forward is simply not available.

Most of all, it reminded me that behind every cohort number and every completion report, there are people who made a deliberate choice to show up for this work under circumstances that asked more of them than usual. That is not something I want to reduce to a statistic.

Quetta is done now, but I won’t stop thinking about it anytime soon. It has quietly become one of the trainings of which I am most proud to have been part.

Written by Hassan Raza Ali (IoP).

From Motivation to Community Action: A Community-Led Step Towards Diabetes Prevention

Community ownership is at the heart of the EMPOWER-D intervention.

One inspiring example from Budhni Block, Rural Tehsil Chamkani, Peshawar, shows how community members can come together to take practical steps towards better health.

During the EMPOWER-D intervention sessions, Community Mobilizers encouraged community members to take an active role in the prevention and control of diabetes and its risk factors. They also shared experiences and success stories from other communities, motivating people to think about how they could support the health of their own community.

Community Comes Together to Support Health

Inspired by these discussions, the community members decided to take a collective step. They collected funds among themselves and purchased a glucometer and BP apparatus for regular health monitoring in their community.

The equipment was then given to a local dispensary owner and PLA group leader in Budhni Block, who agreed to take responsibility for conducting BP and blood sugar checks once a week within the community.

Community members contribute Rs. 50 per person for the checking, as agreed by the group, or they can bring their own glucose strips for blood sugar testing. This simple arrangement is helping community members regularly monitor their BP and blood sugar levels and become more aware of their health.

The initiative is a good example of how communities can use their own resources to support health activities. Rather than depending entirely on external support, community members came together, contributed financially, purchased the necessary equipment, and decided how it could be used for the benefit of others.

A Visit to the Community Session

During one of these weekly sessions, Dr Wali Muhammad, District Coordinator Peshawar, visited the community session and observed the activity. He also had his BP and blood sugar checked, paying Rs. 50 according to the arrangement agreed by the group.

Dr Wali Muhammad appreciated the efforts of the community members and the PLA group leader for taking ownership of the activity. He also encouraged the community to continue supporting such initiatives for better health.

 

 

Turning Participation into Ownership

This initiative demonstrates how the EMPOWER-D intervention can help community members move from simply participating in activities to taking ownership of their health.

The community’s decision to collect funds, purchase a glucometer and BP apparatus, and entrust the equipment to a local PLA group leader shows how small, community-led actions can create sustainable health activities.

It also highlights the important role of Community Mobilizers and PLA groups in encouraging people to learn from one another, share success stories, and take practical action within their own communities.

Through the continued efforts of motivated community members and local leaders, we are hopeful that communities like Budhni Block will become increasingly empowered to prevent and control diabetes and promote healthier lives.

When communities come together, small actions can lead to meaningful and lasting change.

Written by Gul Ghutai.

EMCR Spotlight: Building Research Skills with the Centre for IMPACT

In the next of our EMCR Spotlight posts, we hear from Hasina Zeb, one of our Bursary Recipients, and Research Assitant on one of our affiliated projects: Global Equity in Research: A Gender-Inclusive Approach (read more about the project here).

Can you tell us a little about yourself?

My name is Hasina Zeb, and I work as a Research Assistant on the Gender Equity in Global Health Research project, which builds on the work of the Centre for IMPACT. My work focuses on developing a practical toolkit to promote gender equity in global health research through evidence-informed and actionable approaches. I also serve as a Research Coordinator at The Initiative on the Quit4TB project (RESPIRE NIHR132826), where I oversee data management and coordinate with field teams to support study implementation.

How did you end up in this field? Was there a specific moment or interest that led you to the Centre for IMPACT and to apply for the bursary opportunity?

I have always admired the Centre for IMPACT’s commitment to supporting early- and mid-career researchers (EMCRs), particularly through its strong focus on capacity building.

Joining a Centre for IMPACT project has been one of the most rewarding milestones in my professional journey.

It has given me the opportunity to contribute to the development of a gender equity toolkit that I hope will help bring meaningful and lasting change to global health research.

I was looking for an opportunity to develop my expertise in mixed methods research. The Centre for IMPACT bursary provided exactly that opportunity. When the bursary call was announced, I applied with the intention of using it to attend the Mixed Methods Research course offered online by the University of Oxford, as it aligned closely with my learning goals. Receiving the bursary made this possible and has been instrumental in strengthening my methodological knowledge and research skills.

What does a typical day look like for you?

A typical day for me is largely desk-based. I spend most of my time working on my laptop, working on documents, conducting data quality checks and validation, managing research datasets, and carrying out data analysis. Depending on the project, my day may also include coordinating with field teams, contributing to reports and research outputs, and collaborating with colleagues to ensure studies are progressing smoothly.

What has been the greatest value in your bursary activity so far?

Through the Centre for IMPACT bursary, I was able to attend the Mixed Methods Research course offered by the University of Oxford. The course has significantly strengthened my research skills and deepened my understanding of mixed methods research. One of the most valuable aspects for me was gaining a much clearer understanding of how to meaningfully integrate quantitative and qualitative methods within a single study. This was an area I had always wanted to explore in greater depth, and the course has given me the knowledge and confidence to apply these approaches more effectively in my own research.

What are you most excited about working on in the coming year?

Over the coming year, I am most excited about developing my PhD proposal and taking the next step in my academic journey. My goal is to secure a PhD position while continuing to grow professionally as a researcher. I look forward to building on the skills and experience I have gained through my current projects and applying them to research that can contribute to meaningful improvements in global health.

What do you do to switch off when you aren’t doing research?

When I’m not doing research, I like to stay active to unwind. These days, I’m aiming for more than 10,000 steps a day and enjoy going for walks and working out. I also like watching movies, which is a great way for me to relax and switch off after a busy day.

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