Effectiveness

This work package will identify a set of evidence-based interventions and scaling-up strategies for prevention and management of hypertension and diabetes in the three project countries.

Analysing contextual factors that contribute to equitable, gender- and population-sensitive, safe, feasible and effective NCD services embedded in health systems.  Such systems should be responsive to the needs of patients and person-centred (micro-level).  This work package is responsible for analysing combinations of core components and critical success factors of the comprehensive community-based and primary health facility-based programmes, which are essential for a successful national strategy (meso-level).  At the macro-level, the work package will analyse the most effective scaling-up strategies taking into account the changing environments in community, organisation and programme.

Specific tasks per phase of the study are as follow:

Phase A: retrospective study

• Review of literature and relevant local and national documents on findings of comparable studies and relevant evidence-based reports;
• Initiation of stakeholder meetings to inform and obtain input from all stakeholders in each country;
• Detailed description of programmes, interventions, context, main achievements and challenges through document review and individual in-depth interviews and focus group discussions; if possible and feasible, also analysis of existing data;
• Assessment and analysis of the monitoring systems of the programmes and indicators used based on previously published conceptual frameworks; possibly a few interviews with health facility staff and Delphi-survey;

Meso-level

• Assessment of synergy between community-based and healthcare facility-based interventions through document review, observations and interviews
• Analysis of the follow-up after screening and adherence to treatment, if there is no collaboration between community health and primary healthcare providers.

Macro-level 

• Assessment of plans and intentions for scaling-up (theoretical, practical, financial)
• Assessment of effect of scaling-up through interviews and focus group discussions.

Phase B: baseline assessment; stakeholder meeting to discuss proposals for adjustments

This phase will allow adjustment to the initial plan. Findings at all levels will be presented and discussed. Key decisions will be made on improving interventions, scaling-up activities and indicators for monitoring.

Phase C: prospective study

Micro-level

• Integrate improvements in programme plans and monitoring systems; further develop a strategy plan to scale up programmes in each country
• Strengthen community groups (create new groups, or improve knowledge and activities of groups) and primary healthcare facilities through capacity building of staff
• Further implementation of scaling-up and standard monitoring by implementing organisations, advised by all research partners.

Meso-level

• Improvement of the plans for studying the scaling-up based on phase B; integration of indicators on synergy between community based- and facility-based scaling-up programs
• Assessment of synergy between community-based and facility-based interventions during scale-up of the improved programme through data analysis, observation and interviews. Evidence of synergy would include early recognition of risks, effective screening, referral and adherence to treatment.

Macro-level

• Ongoing review of scaling-up progress by implementing intermediate lessons learned on effectiveness and quality, based on data analysis and interviews.
• Assessment of the effect of scaling-up on relationships through interviews with the same persons performed in phase A, analyses of existing data (progress reports and minutes of meetings), interviews with key stakeholders and focus groups.

Phase D: Draw lessons for policy; final stakeholder meeting

In a final international meeting with all stakeholders representing all levels (micro, meso and macro level), findings will be presented, discussed and shared with related international agencies. Key lessons will be drawn for policy and practice on effectiveness of scaling-up NCD-interventions. Final reports will be produced and disseminated.

Work package leader:
Dr Jeanet Landsman
University Medical Center Groningen
Email: j.a.landsman@umcg.nl