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Tackling the NCD Crisis: Key Lessons andApproaches for Global Health Practitioners

Katie Kowalski, Senior Program Officer, Project HOPE USA

Razana Allie, NCD Technical Lead, Project HOPE South Africa

Jenny Xu, Program Director, Project HOPE China

Cheena Malhotra, Program Manager, Project HOPE India

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The HOPE Centre:A community-based approach to preventing and treating Diabetes and Hypertension in South Africa

A public-private partnership between Project HOPE, Eli Lilly, the SouthAfrican government, and academia

Erushka Pillay: Country DirectorRazana Allie: NCD Technical Lead

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Improved Clinical Outcomes for Diabetes

Mean HbA1c among HOPE Centre Patients, September 2012 to August 2015

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7

First Visit Recent Visit

N=202 N=250

Well-controlled

HbA1c = 7

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Improved Clinical Outcomes for Hypertension

168

127

87 83

SBP DBP

First Visit Recent Visit Linear (First Visit) Linear (Recent Visit)

Mean Blood Pressure among HOPE Centre Patients, September 2012 to August2015

N=1,503 N=1,127 N=1,503 N=1,127

Well-controlled SBP = 140;Well-controlled DBP=90

After 4 clinical visits, the trend line shows that approximately 72% of patients had blood pressure readings that were controlled.

The HOPE Centre: An Integrated Approach

A community-based approach to the prevention and treatment of NCDs that aims to improve the total wellbeing of those who are at risk for developing or are living with diabetes and hypertension.

Raising Awareness

• CommunityEducation & Screenings

Improving Access to Quality Care

• Comprehensivecare for Diabetes & Hypertension

Empowering Patients

• PatientEducation & Facilitated Patient Support Programs

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Raising Awareness & Empowering Patients

5 steps to Self Care

Nutrition and Cooking classes

Exercise program

Gardening

Village Savings and Loans

Community Outreach and Screenings

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Improved Access to Integrated, Quality Care

Acute PHC

Pap Smears, PSA,

Family Planning,

TB and HIV Screening

Point of Care

Monitoring:

HbA1c, Urine Albumin,

Creatinine Ratio,

Lipogram

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What Works from a Patient Perspective

“The difference I notice between the HOPE Centre and other health facilities is that Project HOPE staff care for people. There are no long

queues that you find at other clinics. They don’t just give

medication but they educate patients as well …”

Tshuma, HOPE Centre Patient8

Lessons Learned

Weekly doctor visits to PHC sites to enable intensificationof treatment for both DM as well as HT patients

Include Insulin on Essential Drugs List in PHC and upskill nurses toeffectively manage patients on these drugs

Government-lead surveillance and monitoring involving all partnerscan help us better understand the scale of the problem and design/implement appropriate interventions

Integrated models need to include effective approaches for mentalhealth and cancer

Integrated, patient-centered model of care is effective!9

Recommendations

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Replicate monitoring/surveillance strategies for NCDs more

broadly in South Africa. Support government by implementing

health promotion/prevention activities at the community level

Integrate, TB & HIV, mental health, epilepsy, and respiratory diseases

into our model in South Africa

Provide the opportunity to initiate and titrate patients onto insulin

therapy outside of tertiary institutions

An Effective Alliance to Tackle

Respiratory Disease

Supported by:

11 Jenny Xu: Program Director, Respiratory Health

CARD Program Elements

Supported by:

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Policy andeconomicanalysis

Improve HCP Capacity

ImproveHospitalFacility

Increase patients/publ ic awareness

• Social media promotion

• Asthma day• COPD campaign• Screening events

• Standard respiratory clinics

• Nebulizer rooms

• CME (continual medical education)

• Lung function training

• SMiLE project

• White Paper• Economic Burden

of Disease Paper

• Shanghai asthma project

• Cost effectivenessof early lung function screen

Research

Targeting 1,000 hospitals & 54,000 HCW

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Economic Analysis to Inform Policy and Action

Supported by:

% of China’s 2013 Total Health Expenditure

35% of COPD Patients currently treated If 100% of COPD Patients are treated

1.42% GDP 4.04% GDP

COPD direct medical cost =

COPD total economic cost =

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351.6 billion Yuan

1072.3 billion Yuan

1.7% China GDP

Improving Provider Capacity (at 8 months)

Supported by:

Health Care Providers trained with improvedpost-test scores

1143 on Respiratory Disease Diagnosis and Treatment

2550 on Lung Function Testing

35 on Pediatric Asthma

10,000 Online Trainings for Lung Function Testing

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Improving Hospital Capacity: (at 8 months)

Supported by:

Improving Public Awareness (at 8 months)

PUBLIC EDUCATION EVENTS

• May: Asthma Day Social media educationreached 20 million

• June: Father’s Day and Lung Function DaySocial media campaign reached 8.8 million

• September: Teachers’Day Lung function screening forteachers. Social media stories reached 50,000 readers.

• September-November: Community lung function screenings in Shanghai

• October: 70,000 Pediatric asthma picture books delivered

• November 18: Educational video for COPD

• December: Educational video for hormone therapy

Supported by:

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Lessons Learned

Bring together the right combination of stakeholders from thebeginning

Government, Medical Associations, Hospitals, Private Industry, Academia, NGOs

Build an evidence base for advocacy into the program activities

Produce guidelines and care standards that will bring long-term benefits for patients and health care systems

Think Big!! With the rightpartners and approaches,a lot can be achieved!

Supported by:

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Tackling the NCD Crisis:Reflections from India

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Challenges in India

• Diseases centered approach vs patient centered

• Strong bias towards curative vs. preventive care

• Integrated chronic disease management protocol

• Lack of skilled workforce at all levels:

– primary, secondary and tertiary care centres

• Low expenditure on health

• Large out of pocket health costs

• for the general population

• Low Insurance Coverage19

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UDAY: Comprehensive Diabetes and Hypertension

Prevention and Management program

1. Improving public knowledge and awareness about diabetes and hypertension

2. Improving provider knowledge and health system capacity

3. Improving patient education and behaviour

4. Task sharing/shifting of care

5. Leveraging mHealth technologies to improve prevention and control

6. Reporting and advocacy for research uptake with key stakeholders and policy makers

Implementing

Partners:

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Health Care Workers Knowledge

Improved Significantly

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Training Tools and

Methodology

Power Point Presentation

Case Studies and Role Play

Games and Group

Activities

Field Visits

Case Presentation

and Peer Evaluation

Handouts and Poster

Presentations

Homework and Classroom

Discussions

Practicals

• Trainings were well adapted to the audience capacity• Sessions were live, real, engaging, using practical experiences.

VIPP Training Approach(Visual, Innovative, Participatory Practice)

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Program Achievements

• Proven, well tested capacity building package to train CHW/counselors

• Comprehensive training manual on NCDs

• Enhanced capacity of Gov’t HCW for community interactions/counseling

• Increased knowledge of trainees for effective screening, counseling and referrals

• Increased the attention and involvement of government health personnel at the National and State levels for NCD health events

• Innovative – Developing positive deviance approach in patient networks for the first time in NCDs

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The Way Forward

• Policy shift and operational actions – Curative to Preventive

• Multi-sectoral action

• Strengthen Health Information System and review of data

• Scale up the “NCD Clinic” model- NPCDCS

• NCD curriculum – school, graduation and post-graduate level

• Train Healthcare workforce across sectors

• Increased public and private actions

• Increased focus of both unilateral and bilateral donors

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Thank You25