During the four-year (2019-2023) implementation of WHO-Pen@Scale, the project has conducted a comprehensive evaluation of the two diabetes and hypertension health service provision models at the community and household levels in Eswatini.
The main findings from the study are:
• The trial findings from household survey 1 and 2 indicate that the WHO-PEN@Scale intervention did not have an effect on population health. It did not seem to reduce HbA1c, systolic blood pressure, and diastolic blood pressure. Further analysis is needed to assess possible explanations for this lack of positive effects.
• WHO-PEN@Scale interventions were found to be cheaper to implement with a more efficient delivery of care. At the same time, they did not exacerbate any existing health inequities in Eswatini and were found to slightly reduce the overall health expenditures incurred by the intervention arm study participants. It also found to be more efficient for delivering care in terms of seeing more patients while spending less time per patient, even as the reported workday duration of HCWs increased.
• The findings from syndemic analysis point to a clear need for health care delivery models to take comorbidities for NCDs into account. A health care provider at the primary care level in Eswatini can expect to encounter comorbidities in most NCD clients above 40 years of age. A client suffering from HIV and Diabetes, who lives alone is at particular risk of exacerbated burdens of disease, in particular depression, especially in Shiselweni.
• The evaluation of the developed app indicated that the developed mobile app was well-received by RHMs, guiding them through NCD counselling and improving job satisfaction.
• From the systematic review, using lay health workers in primary and community care may lead to small improvements in outcomes among people living with diabetes, compared to usual care.
• From the acceptability studies, decentralisation of diabetes and hypertension care to primary health care facilities was welcomed by clients, while nurses had mixed reactions. Differentiated Service Delivery (DSD) Models have the potential to improve retention in care and reduce defaulting among clients.
The comprehensive summary and the decision pathway are explained in the Evidence to Decisions framework (Deliverable 8.1) to inform the decision making in Eswatini.
Results of the project will be used to inform the decision of scaling up WHO-PEN implementation in Eswatini and the Southern African region in general.
