Periodic Reporting for period 1 - WHO-PENatScale (Scaling up the WHO-PEN package for diabetes and hypertension in Swaziland: a nation-wide cluster-randomised evaluation of three strategies in Swaziland (WHO-PEN@Scale))
Reporting period: 2019-01-01 to 2020-06-30
Out of a study of 48 countries in sub-Saharan Africa, Eswatini was found to be the country with the fifth lowest proportion of the population (6.1%) residing within two hours of travel time to the nearest public hospital. Care for diabetes and hypertension is, therefore, in practice inaccessible to most of the population. In the standard of care, there is no proactive screening for diabetes and hypertension at the primary care or community level. Similarly, patients with diabetes or hypertension are initiated on medications and followed up almost exclusively at tertiary care facilities.
Our overall objective is to reduce the burden of diabetes and hypertension in eSwatini and the wider sub-Saharan African region. In pursuit of this overall objective, the WHO-PEN@Scale will develop and test three novel community-based programmes for diabetes and hypertension care in Eswatini over the project period.
During Reporting Period 1, the consortium and MoH redesigned the interventions for the treatment arms in Phase 1. With scientific guidance by the consortium, the MoH developed the standardized treatment guidelines and training materials for nurses and CHWs.
The University of Göttingen developed the smart-device app that will be used by the CHWs in Phase II. The app has been reviewed by the beneficiaries and MoH. A special focus was put on its intuitiveness, adequacy for the CHWs’ level of literacy, and its potential to support the CHWs in their daily activities. The app has been piloted and a feasibility study on equipping CHWs with battery-powered blood pressure machines were conducted. In addition, a Service Availability and Readiness Assessment was conducted.
Survey instruments have been developed and tested for all quantitative and qualitative studies (household survey, acceptability surveys, time-and-motion study, policy maker and health worker in-depth interviews). To date, telephone interviews have been done with 25 health care workers (nurses) across three regions namely Shiselweni, Manzini and Hhohho. Lubombo region and patient interviews are to follow shortly in August 2020.
The protocol for the Cochrane review “Lay health workers in primary and community health care for chronic conditions” has been developed.
The research results will not only inform the Swazi government but be of value to other governments in sub-Saharan Africa that plan to decentralize health care services for non-communicable diseases. We will estimate the health impact of the WHO-PEN intervention at the population level through household surveys. During these surveys, we will also collect data to assess the socio-economic impact of the health care service decentralization on the clients. First, we will look at changes in household income and wealth. Second, we will estimate changes in out of pocket health care expenditure. Third, we will also estimate whether there is a reduction in travel time – and thus absence from productive activities – related to accessing health care. Fourth, we will disaggregate the analyses by socio-economic status to verify that WHO-PEN enhances health equity. involving Community Health Workers that engage in activities at the community and household level. All these components will result in a comprehensive analysis.