Periodic Reporting for period 2 - SUNI-SEA (Scaling-up NCD Interventions in South East Asia)
Reporting period: 2020-07-01 to 2021-12-31
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). T The project Scaling Up NCD interventions in South-East Asia (SUNI-SEA) enhance the implementation of policies concerning community-based NCD prevention and control.
Why is it relevant for society?
In order to reduce the burden of NCDs, the following factors are vital:
• More people in the community need to be aware of risk factors for NCDs, such as being overweight, 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 their diseases, through referral to a health facility after community screening.
What do we do?
The SUNI-SEA project creates awareness of NCD risk factors and helps people in avoiding becoming overweight, getting hypertension or diabetes. The project helps people in applying a healthy lifestyle through health education and peer support.
The project offers screening to people living in Indonesia, Myanmar, and Vietnam. Persons with risk factors are identified as early as possible. The project provides them with personalised support to avoid the need for medical treatment for a disease.
People with identified NCDs are referred to primary healthcare facilities to get proper treatment, both medicines and lifestyle support, to minimise complications that affect their wellbeing. People are referred back to community groups for lifestyle interventions to improve their health.
These interventions can happen in communities and in primary health care facilities.
Building on existing programmes in the three countries (Posbindu in Indonesia, Intergenerational Self Help Clubs in Myanmar and Vietnam), we propose scaling up the community-based in primary healthcare-based interventions.
In the SUNI-SEA project we investigate the effectiveness and cost-effectiveness of the interventions, that we are scaling up in the three countries. Which are the barriers and facilitators for better screening and health promotion in communities? Which are possibilities for improved treatment at primary health-care level? Which are the costs and benefits? Can we demonstrate that this approach is saving money for society, through saving DALYs?
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). T The project Scaling Up NCD interventions in South-East Asia (SUNI-SEA) enhance the implementation of policies concerning community-based NCD prevention and control.
Why is it relevant for society?
In order to reduce the burden of NCDs, the following factors are vital:
• More people in the community need to be aware of risk factors for NCDs, such as being overweight, 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 their diseases, through referral to a health facility after community screening.
What do we do?
The SUNI-SEA project creates awareness of NCD risk factors and helps people in avoiding becoming overweight, getting hypertension or diabetes. The project helps people in applying a healthy lifestyle through health education and peer support.
The project offers screening to people living in Indonesia, Myanmar, and Vietnam. Persons with risk factors are identified as early as possible. The project provides them with personalised support to avoid the need for medical treatment for a disease.
People with identified NCDs are referred to primary healthcare facilities to get proper treatment, both medicines and lifestyle support, to minimise complications that affect their wellbeing. People are referred back to community groups for lifestyle interventions to improve their health.
These interventions can happen in communities and in primary health care facilities.
Building on existing programmes in the three countries (Posbindu in Indonesia, Intergenerational Self Help Clubs in Myanmar and Vietnam), we propose scaling up the community-based in primary healthcare-based interventions.
In the SUNI-SEA project we investigate the effectiveness and cost-effectiveness of the interventions, that we are scaling up in the three countries. Which are the barriers and facilitators for better screening and health promotion in communities? Which are possibilities for improved treatment at primary health-care level? Which are the costs and benefits? Can we demonstrate that this approach is saving money for society, through saving DALYs?
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 looked at population-based and provider-based factors that impact on the performance of community-based programmes for prevention and control of NCDs.
The national programme in Indonesia, Posbindu, is a community-based programme for screening and counselling the adult population on NCDs. The programme offers health promotion activities for people identified with risk factors.
We performed literature reviews to identify best practices in community-based NCD prevention and control, and in primary healthcare services. We concluded that contextual factors are crucial for success or failure. Too many interventions are not evidence-based and the duration is too short to make an impact. In Indonesia, Myanmar and Vietnam, the set-up of NCD prevention and control programmes offers good chances for success as they are embedded in national programmes and government strategies. However, implementation in the three countries is not always optimal. The SUNI-SEA project therefore embarked on improvement of the screening protocol, the training programmes and monitoring of effectiveness and cost-effectiveness.
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 serves as measuring reference for the planned intervention. A big questionnaire was developed and validated, investigating background information, personal conditions, knowledges, practices and attitudes towards NCDs, risk factors and possible interventions 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
There are four areas of intervention:
1. Development of an improved NCD screening programme, to be applied in the three countries, with essential elements of measuring vital functions, including the FINRISK measurements. Counselling and health education elements were added. The SUNI-SEA project developed an NCD screening manual, that has been translated and is used in the three countries. In total thousands of people will be screened in the intervention phase.
2. Development of an improved training programme for health volunteers and cadres, that is adapted to the local context. In the three countries curricula were developed and implemented in Vietnam and Indonesia for in total hundreds of health volunteers and cadres. These people are now screening, counselling and providing health education concerning NCDs.
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. Training programmes are mainly taking place in Vietnam with a mix of online and physical training activities.
4. Scaling-up strategies that are locally effective. In the three countries, the community-based prevention and screening programmes are heavily dependent on local initiatives, with local volunteers and local funding (local government authorities, community funding, crowd funding). Scaling-up cannot take through national government directives, but require local commitment and contributions. The scaling-up strategy in SUNI-SEA therefore concentrates on local lobby and involvement of decision-makers, who can promote the sustainability of developed programmes. The strategy must be really bottom-up from village level, to district and regional level.
At the moment of reporting the prospective phase is underway and will last until mid 2023.
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 looked at population-based and provider-based factors that impact on the performance of community-based programmes for prevention and control of NCDs.
The national programme in Indonesia, Posbindu, is a community-based programme for screening and counselling the adult population on NCDs. The programme offers health promotion activities for people identified with risk factors.
We performed literature reviews to identify best practices in community-based NCD prevention and control, and in primary healthcare services. We concluded that contextual factors are crucial for success or failure. Too many interventions are not evidence-based and the duration is too short to make an impact. In Indonesia, Myanmar and Vietnam, the set-up of NCD prevention and control programmes offers good chances for success as they are embedded in national programmes and government strategies. However, implementation in the three countries is not always optimal. The SUNI-SEA project therefore embarked on improvement of the screening protocol, the training programmes and monitoring of effectiveness and cost-effectiveness.
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 serves as measuring reference for the planned intervention. A big questionnaire was developed and validated, investigating background information, personal conditions, knowledges, practices and attitudes towards NCDs, risk factors and possible interventions 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
There are four areas of intervention:
1. Development of an improved NCD screening programme, to be applied in the three countries, with essential elements of measuring vital functions, including the FINRISK measurements. Counselling and health education elements were added. The SUNI-SEA project developed an NCD screening manual, that has been translated and is used in the three countries. In total thousands of people will be screened in the intervention phase.
2. Development of an improved training programme for health volunteers and cadres, that is adapted to the local context. In the three countries curricula were developed and implemented in Vietnam and Indonesia for in total hundreds of health volunteers and cadres. These people are now screening, counselling and providing health education concerning NCDs.
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. Training programmes are mainly taking place in Vietnam with a mix of online and physical training activities.
4. Scaling-up strategies that are locally effective. In the three countries, the community-based prevention and screening programmes are heavily dependent on local initiatives, with local volunteers and local funding (local government authorities, community funding, crowd funding). Scaling-up cannot take through national government directives, but require local commitment and contributions. The scaling-up strategy in SUNI-SEA therefore concentrates on local lobby and involvement of decision-makers, who can promote the sustainability of developed programmes. The strategy must be really bottom-up from village level, to district and regional level.
At the moment of reporting the prospective phase is underway and will last until mid 2023.
SUNI-SEA will contribute to the global NCD evidence base, contributing to the efforts of the Global Alliance for Chronic Diseases, the Global NCD Alliance and the World Health Organization (WHO). The project will create training and learning materials, draw lessons learned from these three countries and provide recommendations for worldwide implementation of NCD interventions. The research findings will help strengthen effective action for achieving the Sustainable Development Goals (SDGs), in particular SDG Goal 3 on health. The duration of the project is from 2019-2022 and is financed by the European Union.