Non-communicable Diseases (NCDs) Working Group Chair Interview: Dr. Jeremiah Mutwalante Twa-Twa and Dr. Prajjwal Pyakurel

Few challenges in the dynamic world of public health are as daunting as preventing and managing non-communicable diseases (NCDs). We sat down with two remarkable leaders in this field: Dr. Jeremiah Mutwalante Twa-Twa from Uganda and Dr. Prajjwal Pyakurel from Nepal. They serve as the Working Group Co-Chairs for NCD Prevention and Health Promotion within the World Federation of Public Health Associations (WFPHA). 

NCDs, which include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, are responsible for a significant portion of global mortality. Unlike infectious diseases, NCDs are often driven by lifestyle factors such as poor diet, lack of exercise, tobacco use, and excessive alcohol consumption. Addressing these requires a comprehensive approach involving policy change, community engagement, and ongoing research.

Can you both introduce yourselves

Dr. Twa-Twa: I’m Dr. Jeremiah Mutwalante Twa-Twa from Uganda. I’m a medical doctor by training, with additional qualifications in public health, demography, and biostatistics. I’m a member of the Uganda National Association of Community and Occupational Health, which brought me into the World Federation of Public Health Associations (WFPHA). I am the Dean of the School of Health Sciences and lecturer at Kampala University. I’ve worked with the Ministry of Health since 1980, initially as a hospital manager and later as a district health manager. I served on the team that started the Uganda AIDS Control Program in the Ministry of Health. Later, I served as the Registrar of the Uganda Medical and Dental Practitioners Council and finally headed the Child Health Division of the Ministry of Health until 2010. After that, I ventured into politics, serving in the Parliament of Uganda for five years. In Parliament, I served as Vice Chairperson of the HIV/AIDS Standing Committee of Parliament for four years. I’m the Co-Chair of the WFPHA’s NCD Prevention and Health Promotion Working Group.

Dr. Pyakurel: I’m Dr. Prajjwal Pyakurel from Nepal. I am the General Secretary of the Nepalese Society of Community Medicine. We have over 200 members dedicated to public health in Nepal. I have a deep passion for NCD prevention globally. I was a visiting Lown Scholar at Harvard T.H. Chan School of Public Health, Boston, MA, USA, 2016 and a fellow of the International Society of Cardiovascular Epidemiology and Prevention, Nadi, Fiji. I’ve been working in NCD prevention since 2011, starting as a resident in Community Medicine. This journey led me to the WFPHA, where I was honored to be nominated as co-chair of the NCD Working Group in April 2024.

What motivated you to pursue a career in the public health sector?

Dr. Pyakurel: Serving humanity has always been my primary motivation. As an academician, service is paramount. My journey into public health began in 2011 during my residency in Community Medicine and Tropical diseases at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. I researched Cardiovascular risk factors among industrial workers in Eastern Nepal. Working with these underserved populations fueled my passion for public health. They often have low education levels and face numerous challenges, making it vital for public health professionals to advocate for and support them. My goal is to conduct research that informs policy and practice changes, ultimately contributing to NCD prevention on a global scale.

Dr. Twa-Twa: My interest in public health was sparked during my medical training in the 1970s by a professor who taught preventive medicine at Makerere Medical School when I was still an undergraduate student. My career in public health began in earnest in 1980, during a period of political turmoil in Uganda. Many healthcare workers had left the country, and I was deployed to a remote hospital, quickly moving into a management role. This experience necessitated further training in public health, which the Ministry of Health facilitated. Over time, I held various administrative roles, including being part of the team that started the Uganda AIDS Control Programme in the mid-1980s and heading the Child Health Division of the Ministry of Health. These experiences solidified my commitment to public health, although I am still interested in clinical work.

How long have you been associated with the World Federation of Public Health Associations?

Dr. Pyakurel: I officially joined the WFPHA on September 29, 2022, as a working group member. I became a Chair of the NCD Working Group on April 3, 2024, alongside Dr. Twa-Twa. We’ve been actively contributing as co-chairs for the past three months.

Dr. Twa-Twa: My association with the WFPHA extends back through my involvement with the Uganda National Association of Community and Occupational Health, a member organization of the WFPHA. Our former Executive Director and founder member of UNACOH, Dr. Deogratius Kaheru Sekimpi, has been on the WFPHA board for some time. Through this connection, I was nominated to join the WFPHA, leading to my current role as co-chair of the NCD Prevention and Health Promotion Working Group.

Could you detail your working group’s current activities and share your vision and plans for the future

Dr. Pyakurel: Despite being only three months old as co-chairs of the World Federation of Public Health Associations (WFPHA) NCD Prevention and Health Promotion Working Group, we’ve hit the ground running. We’re launching monthly webinars starting July 18, 2024, and planning policy brief trainings beginning October 2024. Regular meetings are set for the third week of each month, and we’ve drafted an action plan for 2024-2026, which includes a one-year plan to be implemented from July to December 2024.

We are also seeking collaborations and funding opportunities to conduct global capacity-building programs for NCD prevention. Our vision aligns with WFPHA’s seven goals: advancing public health knowledge and promoting systematic change. For instance, we plan to conduct mass awareness campaigns, develop health promotion materials, and offer research and capacity-building training for young public health professionals worldwide. Our three-year action plan is set to be endorsed on July 25, 2024, after which we’ll begin implementing our activities.

Dr. Twa-Twa: We’re developing an inclusive action plan incorporating member feedback to address NCDs over the next three years. Our vision aligns with WFPHA’s goals and mission. I envision a vibrant working group that supports national public health associations at the grassroots level, providing guidance and coordination. Effective advocacy and addressing NCD problems through coordinated efforts will be our focus. We wish for the NCD prevention and control initiatives to take a first-line position on the health agenda at all levels globally.

How do your activities align with supporting and implementing WFPHA’s strategic plan?

Dr. Twa-Twa: Our activities are structured to address all aspects of NCDs along the WFPHA’s mission and goals. For instance, under Goal 1, we aim to develop policy briefs on issues like alcohol, drugs, and diet. Goal 2: we plan to advocate for systematic change and sustainable funding for NCDs. We’re working on strengthening the prevention and control of NCDs through robust mechanisms under Goal 3. For Goal 4, we plan to advance public health knowledge through education and research initiatives. We’re also focused on building partnerships, working closely with national Public Health Associations, and ensuring regular communication and coordination to achieve our WFPHA goals. Above all, we shall work closely with sister WFPHA-WGs to form a solid, formidable, and vibrant WFPHA team. 

How has being part of WFPHA and its network enhanced your working group’s activities and expanded its reach?

Dr. Pyakurel: WFPHA’s extensive network of over 5 million colleagues globally offers immense opportunities for collaboration and learning. Our working group benefits from this diverse pool of expertise, fostering partnerships and collaboration that enhance our efforts. Leading this group from an LMIC setup, like Nepal, is a privilege and provides us with unique perspectives to address global public health issues. This network enables us to leverage international knowledge and best practices, which can be adapted and applied to our local contexts.

Dr. Twa-Twa: We value the experience of those who have previously contributed to WFPHA-NCD-WG. In this respect, we have recently discussed with Prof Miguel Angel Royo, former Chair NCD-WG, and Professor Iidefonso Hermandez Aquado, currently Chair Policy Committee WFPHA, who have offered valuable insights. Collaboration with experienced individuals and organizations at national and international levels shall strengthen our efforts. This collective wisdom and support will help us to advocate for NCD control and prevention effectively. 

How does being part of WFPHA support your group’s efforts to promote healthy nutrition policies worldwide?

Dr. Pyakurel: Our group’s mission extends beyond nutritional policies to a broader NCD prevention and health promotion context. While we focus on food policies and healthy diets, we also aim to address other risk factors for NCDs. We plan to design vital policy documents on five major risk factors for NCDs to be advocated at the Fourth High-Level Meeting of the UN General Assembly on preventing and controlling NCDs in 2025. Raising mass awareness, especially among younger generations, about the dangers of junk food and the benefits of nutritious diets is crucial. Implementing nutritional labeling and banning unhealthy food advertisements are part of our strategy to improve global health outcomes.

Dr. Twa-Twa: Our predecessors prepared policy briefs, which we plan to continue and expand. National public health associations are crucial in influencing food standards and policies at the country level. By developing solid nutritional policies and promoting healthy eating habits, we aim to impact global health significantly. Mass awareness campaigns and educational initiatives targeting children will be essential in shifting dietary behaviors and reducing the prevalence of NCDs.

How does your working group collaborate with governments and international bodies to influence NCD prevention policies?

Dr. Pyakurel: In line with Goal 5 of the World Federation of Public Health Associations (WFPHA), we focus on strengthening partnerships with groups that share our values. Our upcoming three-year action plan includes engaging national governments, parliamentarians, and UN agencies in collaborative dialogs to control NCDs and implement relevant protocols. We aim to prepare comprehensive engagement reports, follow-up actions, and policy briefs to present to the WFPHA leadership for further advocacy at the UN Assembly. This will help elevate NCD prevention on a global scale. We’re actively involving parliamentarians, UN agencies, and government officials in our discussions to create a collaboration network for impactful work across various regions.

Dr. Twa-Twa: We’ve started this journey by engaging essential NCD control and prevention stakeholders. For example, I’ve connected with the Ministry of Health in Uganda and have been welcome to join the team developing the national NCD action plan. We’re exploring synergies at both national and international levels, seeking collaboration and partnerships with all key stakeholders to address NCDs effectively.

Dr. Pyakurel: In Nepal, I’ve worked with the Kathmandu Metropolitan City as a technical advisory group member for NCD prevention. We’re enforcing tobacco control laws and partnering with the WHO country office in Nepal for Anti-Tobacco Campaigns. Our efforts include mass school campaigns, reviewing tobacco laws, and ensuring legal coherence to counter tobacco industry challenges. 

How does the Association’s membership facilitate your group’s work with international bodies?

Dr. Pyakurel: While our focus extends beyond food labeling, we aim to engage with FAO and other bodies on broader NCD prevention policies. We plan to discuss food policies and nutritional labeling with FAO soon, ensuring our initiatives are incorporated globally.

Dr. Twa Twa: Building on past efforts, we plan to influence food policies and all NCD modifiable risk factor policy-related issues at national and international levels. This includes writing policy briefs, engaging national authorities, and ensuring the implementation of protocols for universal health coverage. NCDs and food-related issues like diet and marketing will be central to our activities.

Any last words?

Dr. Pyakurel: As part of the WFPHA’s NCD working group, our success relies heavily on team effort and leadership facilitation. We can offer technical expertise, communicate effectively, and draft proposals, but we need support from the leadership of WFPHA for collaborative initiatives and securing funding. Collaborative efforts are essential for global public health advancement.

Dr. Twa-Twa: The world must recognize that NCDs represent one of the most severe epidemics. Unlike infectious diseases, NCDs require long-term strategies to reverse their impact. International organizations, including UN agencies and the WFPHA, have a mandate and moral obligation to guide global efforts in NCD control. Immediate action is crucial, and our working group’s initiatives need the attention and support of those in positions to make a difference, not for personal gain but for the betterment of global health. Action is needed now rather than later.

In this enlightening interview, Dr. Twa-Twa and Dr. Pyakurel share their profound commitment to public health and their strategic vision for tackling NCDs. Their combined expertise and passion drive the global fight against these pervasive diseases, ensuring a healthier future for all.

Working Group Members:

Jeremiah M. Twa-Twa, Co-Chair of NCD Working Group, Member of Parliament of Uganda.

Prajjwal Pyakurel, Co-Chair of NCD Working Group, B. P. Koirala Institute of Health Sciences Nepal.

Aron Troen, member of The Hebrew University of Jerusalem, Israel.

Lidya Genene Abebe, Addis Ababa University | AAU · Department of Epidemiology and Public Health, Ethiopia.

Abigiya Wondimagegnehu Tilahun, Addis Ababa University, AAU · School of Public Health, Master of Public Health, PhD student at Martin Luther University, Ethiopia.

Abiot Mitiku Gosa, Ethiopian Red Cross Society, Addis Ababa, Ethiopia.

Sefonias Getachew, Chairperson of the research and community service committees of the public health department in Debre Berhan University (DBU), Ethiopia.

Muluken Gizaw, Addis Ababa University, AAU, Department of Preventive Medicine, School of Public Health, Ethiopia.

Zaccheous Achidi Asanga, BCH Africa.

Julienne Ngo Likeng, Governing Council of WFPHA and Executive Director of the Cameroon Public Health Association, Cameroon.

Prince T. Lamin-Boima, Njala University, Sierra Leone.

Rana Al Hamawi, Eastern Mediterranean Public Health Network, EMPHNET · Public health programs, Jordan.

Randa Saad, Eastern Mediterranean Public Health Network, EMPHNET, Center for Excellence in Applied Epidemiology BSc, MD, Lebanon.

Monika Brovč, Nacionalni inštitut za javno zdravje NIJZ, slovenia

Matthew Spiteri, (BFA) (Hons)(Melit.) in Digital Arts, University of Malta.

Nuha Fofana, Serrekunda, Kanifing Municipal Council, The Gambia Epidemiology and Disease Surveillance Officer,  Ministry of Health, The Gambia.

Ronan Payinda,  Young Health Programme (YHP) Impact Fellowship, New Zealand.

James Mckeown Amoah, national organizer for the Ghana Public Health Association.

Muhammad Aziz Rahman, a lecturer in the Institute of Health and Wellbeing at the Federation University Berwick Campus, Australia.

Sanghamitra Ghosh, Secretary General, Indian Public Health Association, India.

George Nonas, BistroMD, LLC, The Australian National University, Australia.