SC1-BHC-16-2018 - Global Alliance for Chronic Diseases (GACD) - Scaling-up of evidence-based health interventions at population level for the prevention and management of hypertension and/or diabetes
Proposals must focus on the scale-up of interventions at population level for hypertension and/or diabetes prevention and/or management in LMIC, and/or in vulnerable populations in HIC. Proposals addressing comorbidities with either hypertension or diabetes, including between them, are encouraged.
Proposals must align with commitments or planned commitments at a regional or country level to implement evidence-based interventions (including evidence of cost-effectiveness and affordability) across health or other sectors. Policymakers, intervention payers (excluding research funding agencies), researchers (including local researchers), implementers and beneficiaries should be involved at all stages of the intervention development and implementation design to identify the challenges to intervention delivery in real settings. Such partners will be integral to the success and sustainability of the programme and it is essential that they are engaged early, and participate actively in the design of the research proposal. Researchers should collaborate closely with the authorities responsible for the programme’s delivery. Those authorities must pay for and provide the interventions, possibly through loans contracted from development banks or other financial providers. Proposals will carry out the research associated with the scale-up of the intervention.
Proposals must build on evidence-based interventions (including evidence of cost-effectiveness and affordability) for the respective population groups under defined contextual circumstances and should seek to replicate and scale-up interventions. The selected interventions to be scaled-up should have been proven to be equitable, safe, effective, and efficient as well as making local health systems and health services more responsive and person-centred. In particular, proposals should:
- Be targeted at the regional or national level.
- Identify, develop, test, evaluate and/or refine strategies to scale-up evidence-based practices[[For instance: behavioural interventions; prevention, early detection, diagnostic, treatment and disease management interventions; quality improvement programmes]] into public health, clinical practice, and community settings.
- Identify, understand, and develop strategies for overcoming barriers to the adoption, adaptation, integration, scale-up and sustainability of evidence-based interventions, tools, policies, and guidelines. They should address a range of scale-up challenges, including complex processes, inefficient use of resources, inequitable allocation of resources, and supply and demand barriers to scaling-up and sustainability.
- Identify, understand, and develop strategies for measuring the unintended consequences of intervening at a system level.
- Use scale-up methods, tools, and approaches to enhancing equity, efficiency, people-centred, and responsive health systems, promoting a culture of evidence-informed learning, engaging stakeholders, and improving decisions on policies and programmes to achieve better health outcomes.
- Be aligned with existing policies, programme management, monitoring and evaluation processes. They may include important shifts in the practices, incentives, and engagement of global, national and regional health policy, regulatory frameworks, management, research, publication, and civil society stakeholders.
- Include health economic assessments as an integral part of the proposed research.
- Demonstrate that policy makers and health authorities are supportive of, and have been engaged in designing the research proposal.
Proposals should be multidisciplinary and cross-sectorial. Relevant gender and cultural aspects, as well as vulnerable populations, should be taken into account. Proposals may build on previous hypertension and diabetes projects supported under the GACD that have demonstrated the potential for impact.
The proposal will cover the research around the scaling up of the interventions. The research may cover:
- Identification of the best evidence-based interventions;
- Definition and implementation of optimum scale-up methods (e.g. pilots in multiple settings, defining a scalable unit);
- Embed real time monitoring/evaluation to refine protocols and ensure adaptability and effective uptake;
- Evaluation of health outcomes;
- Where appropriate, make recommendations for the replication of the applied scale-up interventions to other countries or very large regions.
Research under GACD involves regular exchange of research findings and information across participating projects by means of cross-project working groups and annual joint meetings. Wherever feasible, projects should harmonise and standardise their data collection and exchange data. Applicants must budget for annual costs of having two team members participate in one annual face-to-face meeting of the Annual Scientific Meeting (location to vary annually).
The Commission considers that proposals requesting a contribution from the EU of between EUR 2 to 4 million would allow this specific challenge to be addressed appropriately. Nonetheless, this does not preclude submission and selection of proposals requesting other amounts.
The Global Alliance for Chronic Diseases[[http://www.gacd.org/]] (GACD) aims to coordinate research on chronic diseases at a global level in order to enhance knowledge exchange across individual projects, and to better understand the impact of socio-economic, cultural, geopolitical and policy on research findings, so as to appropriately adapt interventions and scale-up to different geographical, economic and cultural settings. The GACD call will support research associated with the scale-up of interventions for the prevention and/or management of hypertension and/or diabetes in low- and middle-income countries (LMIC[[World Bank country classification based on estimates of gross national income per capita: databank.worldbank.org/data/download/site-content/CLASS.xls]]) and/or in vulnerable populations in high income countries (HIC).
Hypertension affects one billion people worldwide and is a major contributor to the growing global pandemic of cardiovascular disease and stroke. It is estimated that raised blood pressure indirectly currently kills approximately 8 million people every year[[Forouzanfar et al. JAMA. 2017;317(2):165-182. doi:10.1001/jama.2016.19043]] while cardiovascular disease accounts for approximately 18 million deaths a year[[Roth et al. J Am Coll Cardiol. 2017 May 15. pii: S0735-1097(17)37244-3.]], nearly one third of total deaths. Not only is hypertension more prevalent in LMIC, there are also more people affected because a larger proportion of the population live in those countries than in HIC.
Poor hypertension control and the absence of strategies to maintain normal blood pressure, particularly in LMICs and in vulnerable populations in HIC, reflect the challenges of effective and affordable implementation in healthcare and other sectors.
In the past twenty years the global death rate from diabetes has doubled and the World Health Organisation is predicting that this will increase by two thirds by 2030. It is currently estimated that 422 million adults worldwide suffer from diabetes of which 80% are from LMIC. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose[[WHO Global report on diabetes: http://www.who.int/diabetes/global-report/en/]].
Identifying and evaluating interventions to assess efficacy is not always enough to ensure their wide uptake in the real-world. Even when information, tools and interventions have been tested within real-world effectiveness studies, the development of knowledge to support their broader uptake[[For instance: cost and financing of the intervention, provider training, availability of resources, integration into healthcare systems, delivery to vulnerable or difficult-to-reach populations, monitoring the quality of intervention delivery]] has often remained outside the remit of research. Effectively implementing and scaling-up interventions, programmes, and policies to the regional and national levels are persistent challenges.
It is essential that policy makers, communities, families, caregivers, patients, as well as healthcare practice and other settings are equipped with evidence-based strategies to integrate scientific knowledge and effective interventions into everyday use. Researchers have found it challenging to ensure that tools and interventions deemed efficacious within clinical or community-based trials are readily adopted and implemented. Scaling-up interventions to large populations is not a straightforward task. In practice, translation from a pragmatic trial to the real-life commissioning and continuous delivery of an intervention across a health system is a huge political and economic challenge. Without intentional, guided efforts to scale-up, a new evidence-based intervention might not be broadly implemented.
(one of or combinations of):
- Enhanced programmes and policies that can significantly reduce the numbers of patients with hypertension and/or diabetes through prevention.
- Enhanced programmes and policies that can significantly increase the number of patients for whom hypertension and/or diabetes was previously undetected.
- Enhanced programmes and policies that can significantly increase the number of patients for whom hypertension and/or diabetes is controlled.
- Enhanced effective, efficient, equitable and sustainable health systems, to lesser inequalities and greater health equity and additional societal benefits, in the medium and long-term.
- Improved health services more responsive to the need of the comorbidities of hypertension and diabetes and other non-communicable diseases.
- Recommendations to translate findings to other countries or very large regions.
- Contribute to the attainment of the sustainable development goals for non-communicable diseases[[https://sustainabledevelopment.un.org/sdg3]].