Periodic Reporting for period 3 - SUNI-SEA (Scaling-up NCD Interventions in South East Asia)
Reporting period: 2022-01-01 to 2023-06-30
What is the problem?
The burden of Non-Communicable Diseases (NCDs), such as cardio-vascular diseases and diabetes, is increasing in low- and middle-income countries. In South-East Asian countries, and specifically in Indonesia, Myanmar and Vietnam more than half of all deaths are caused by NCDs.
Indonesia, Myanmar and Vietnam have the ambition to achieve universal health coverage, and scale up NCD prevention and control. These countries have national or large-scale evidence-based programmes to prevent and control diabetes and hypertension, to detect people at risk, and to treat patients. The countries apply different strategies in financing NCD prevention and control (health insurance and/or public funding). The project Scaling Up NCD interventions in South-East Asia (SUNI-SEA) strengthens the implementation of policies and practices concerning community-based NCD prevention and control.
Why is it relevant for society?
In order to reduce the burden of NCDs, the following must be achieved:
• More people in the community need to be aware of risk factors for NCDs, such as being overweight, having hypertension or smoking.
• More people need to participate in screening to get a proper diagnosis of a disease at an early stage, and to get advice on lifestyle reducing risks of NCDs.
• More people, diagnosed with an NCD, need proper treatment for and management of the diseases, through referral to a health facility after community screening.
What did we do?
The SUNI-SEA project created awareness of NCD risk factors and helped people in avoiding risk factors for overweight, getting hypertension or diabetes. The project helped people in applying a healthy lifestyle through health education and peer support.
The project offered screening for NCDs and risk factors to people living in Indonesia, Myanmar, and Vietnam. Persons with risk factors were identified as early as possible. The project provided them with personalised advice when needed
People with identified NCDs were referred to primary healthcare facilities to get proper treatment, both medicines and lifestyle support, to minimise complications that affect their wellbeing. People were referred back by PHC facilities to community groups for peer-supported lifestyle interventions to improve their health.
The project worked with local authorities and community organisations to scale up existing programmes in the three countries (Posbindu in Indonesia, Intergenerational Self Help Clubs in Myanmar and Vietnam). In the SUNI-SEA project we investigated the effectiveness and cost-effectiveness of the interventions, that were scaled up in the three countries. We identified barriers and facilitators for better screening and health promotion in communities. We explored possibilities for improved treatment at primary health-care level.We analysed the costs and benefits of the interventions.
The burden of Non-Communicable Diseases (NCDs), such as cardio-vascular diseases and diabetes, is increasing in low- and middle-income countries. In South-East Asian countries, and specifically in Indonesia, Myanmar and Vietnam more than half of all deaths are caused by NCDs.
Indonesia, Myanmar and Vietnam have the ambition to achieve universal health coverage, and scale up NCD prevention and control. These countries have national or large-scale evidence-based programmes to prevent and control diabetes and hypertension, to detect people at risk, and to treat patients. The countries apply different strategies in financing NCD prevention and control (health insurance and/or public funding). The project Scaling Up NCD interventions in South-East Asia (SUNI-SEA) strengthens the implementation of policies and practices concerning community-based NCD prevention and control.
Why is it relevant for society?
In order to reduce the burden of NCDs, the following must be achieved:
• More people in the community need to be aware of risk factors for NCDs, such as being overweight, having hypertension or smoking.
• More people need to participate in screening to get a proper diagnosis of a disease at an early stage, and to get advice on lifestyle reducing risks of NCDs.
• More people, diagnosed with an NCD, need proper treatment for and management of the diseases, through referral to a health facility after community screening.
What did we do?
The SUNI-SEA project created awareness of NCD risk factors and helped people in avoiding risk factors for overweight, getting hypertension or diabetes. The project helped people in applying a healthy lifestyle through health education and peer support.
The project offered screening for NCDs and risk factors to people living in Indonesia, Myanmar, and Vietnam. Persons with risk factors were identified as early as possible. The project provided them with personalised advice when needed
People with identified NCDs were referred to primary healthcare facilities to get proper treatment, both medicines and lifestyle support, to minimise complications that affect their wellbeing. People were referred back by PHC facilities to community groups for peer-supported lifestyle interventions to improve their health.
The project worked with local authorities and community organisations to scale up existing programmes in the three countries (Posbindu in Indonesia, Intergenerational Self Help Clubs in Myanmar and Vietnam). In the SUNI-SEA project we investigated the effectiveness and cost-effectiveness of the interventions, that were scaled up in the three countries. We identified barriers and facilitators for better screening and health promotion in communities. We explored possibilities for improved treatment at primary health-care level.We analysed the costs and benefits of the interventions.
The retrospective phase
In the first year of the project, we performed a situation analysis with regard to NCD prevention and control in Indonesia, Myanmar and Vietnam. We concluded that In Indonesia, Myanmar and Vietnam, the set-up of NCD prevention and control programmes offers good chances for success. However, implementation in the three countries is not always optimal. The SUNI-SEA project therefore embarked on improvement of the health education materials, the screening protocol for NCDs and risk factors, the training programmes for volunteers and health workers and ICT-based monitoring tools. The project engaged with policy makers to strengthen resource mobilisation and sustainability of the interventions.
Baseline study
After the retrospective phase, the project embarked on a baseline survey in the selected intervention areas and in control areas. The baseline survey served as reference for measuring the outcomes of the planning improvement of NCD prevention and control. We collected from the population background information, personal conditions, knowledges, practices and attitudes towards NCDs, risk factors and attendance to activities for prevention and screening of NCDs. The baseline survey was a mixed method study, with quantitative and qualitative elements including a representative sample of the population.
Prospective phase
We implemented activities in four areas:
1. Development of an improved NCD screening programme, with essential elements of measuring vital functions, including the FINDRISK measurements.
2. Development of an improved training programme for health volunteers and cadres, that is adapted to the local context.
3. Training and orientation of primary healthcare workers, to improve knowledge and skills concerning NCDs and to enhance collaboration with community groups in order to create synergies between community and PHC activities.
4. Scaling-up strategies that are locally effective. The scaling-up strategy in SUNI-SEA concentrated on local lobby and involvement of decision-makers, who can promote the sustainability of developed programmes.
Endline survey and evaluation
In the beginning of 2023 an enplane survey was conducted. The survey in Indonesia and Vietnam showed increase of knowledge and awareness about NCDs and risk factors among participants, improved attitudes for healthy lifestyles and in some cases improved behaviour. Due to the COVID-19 pandemic the implementation period was too short to measure actual physical changes like lower body weight or low blood pressure. Potentially the set of interventions in the community and PHC facilities has a positive impact on health. The interventions are cost-effective. After initial investments, later costs can be saved due to lower need for healthcare services, and increased productivity. An important condition for achieving cost-effectiveness is that quality of the interventions is maintained.
Other evaluations showed on increase of knowledge and skills of health workers and volunteers and increased commitment of government and community organisations to continue the programmes.
In the first year of the project, we performed a situation analysis with regard to NCD prevention and control in Indonesia, Myanmar and Vietnam. We concluded that In Indonesia, Myanmar and Vietnam, the set-up of NCD prevention and control programmes offers good chances for success. However, implementation in the three countries is not always optimal. The SUNI-SEA project therefore embarked on improvement of the health education materials, the screening protocol for NCDs and risk factors, the training programmes for volunteers and health workers and ICT-based monitoring tools. The project engaged with policy makers to strengthen resource mobilisation and sustainability of the interventions.
Baseline study
After the retrospective phase, the project embarked on a baseline survey in the selected intervention areas and in control areas. The baseline survey served as reference for measuring the outcomes of the planning improvement of NCD prevention and control. We collected from the population background information, personal conditions, knowledges, practices and attitudes towards NCDs, risk factors and attendance to activities for prevention and screening of NCDs. The baseline survey was a mixed method study, with quantitative and qualitative elements including a representative sample of the population.
Prospective phase
We implemented activities in four areas:
1. Development of an improved NCD screening programme, with essential elements of measuring vital functions, including the FINDRISK measurements.
2. Development of an improved training programme for health volunteers and cadres, that is adapted to the local context.
3. Training and orientation of primary healthcare workers, to improve knowledge and skills concerning NCDs and to enhance collaboration with community groups in order to create synergies between community and PHC activities.
4. Scaling-up strategies that are locally effective. The scaling-up strategy in SUNI-SEA concentrated on local lobby and involvement of decision-makers, who can promote the sustainability of developed programmes.
Endline survey and evaluation
In the beginning of 2023 an enplane survey was conducted. The survey in Indonesia and Vietnam showed increase of knowledge and awareness about NCDs and risk factors among participants, improved attitudes for healthy lifestyles and in some cases improved behaviour. Due to the COVID-19 pandemic the implementation period was too short to measure actual physical changes like lower body weight or low blood pressure. Potentially the set of interventions in the community and PHC facilities has a positive impact on health. The interventions are cost-effective. After initial investments, later costs can be saved due to lower need for healthcare services, and increased productivity. An important condition for achieving cost-effectiveness is that quality of the interventions is maintained.
Other evaluations showed on increase of knowledge and skills of health workers and volunteers and increased commitment of government and community organisations to continue the programmes.
The socio-economic impact of the project achieved is:
• Health education was provided, and awareness was raised about risk factors and NCDs. People are more knowledgeable and better able to take decisions about their own health and wellbeing.
• Motivation of community members increased to participate in screening and health promotion activities. They have a better insight into relevance of the activities for their own wellbeing and empowered to manage their actions.
• Screening on diabetes and hypertension, and counselling was provided free of charge close to the homes of people. This made it easy to participate. In Vietnam, a second round of screening was offered with equal high participation. People understand the benefits of regular screening. The health seeking behaviour has improved.
• People were referred to health facilities if indicated, and often health workers were present during the screening. Because both Vietnam and Indonesia have a health insurance scheme the barrier to visiting a PHC facility were low. Access to services has improved.
• The percentages of hypertension found and high risk for diabetes identified were high. Most of the people were unaware of their health risks. Through the project they have been sensitised. Early diagnosis definitely contributes to lowering the risk of complications and reducing the costs of treatment of complications.
• Health education was provided, and awareness was raised about risk factors and NCDs. People are more knowledgeable and better able to take decisions about their own health and wellbeing.
• Motivation of community members increased to participate in screening and health promotion activities. They have a better insight into relevance of the activities for their own wellbeing and empowered to manage their actions.
• Screening on diabetes and hypertension, and counselling was provided free of charge close to the homes of people. This made it easy to participate. In Vietnam, a second round of screening was offered with equal high participation. People understand the benefits of regular screening. The health seeking behaviour has improved.
• People were referred to health facilities if indicated, and often health workers were present during the screening. Because both Vietnam and Indonesia have a health insurance scheme the barrier to visiting a PHC facility were low. Access to services has improved.
• The percentages of hypertension found and high risk for diabetes identified were high. Most of the people were unaware of their health risks. Through the project they have been sensitised. Early diagnosis definitely contributes to lowering the risk of complications and reducing the costs of treatment of complications.