Global NCD instruments

The work package ‘Global NCD instruments’ will provide capacity building to professionals in primary health care services and community organisations that will carry out preventive activities. It will evaluate perform research into existing training modules and clinical guidelines, and coordinate educational activities, based on clinical guidelines and internationally recognised best practices.

We will develop a series of steps designed to collect available and relevant information for the geographical areas of the study. These data (comprising guidelines for detection and treatment of the focal NCDs of SUNI-SEA project) will be compared with internationally recognised standards. Peer-reviewed literature will also inform the assessment of the guidelines and subsequent development of risk profile tools.

During the process, we aim to remain aware of context-specific local issues, for example, challenges concerning the availability or maintenance schedule of equipment required to detect the target health issues.

Work package 3 aims to improve and test guidelines and instruments for scaling-up prevention and management of hypertension and diabetes worldwide by:

• reviewing the critical success factors concerning sustainability of scaling-up the comprehensive community-based and primary health facility-based programmes (micro-level);
• sharing lessons learned from Indonesia, Myanmar and Vietnam for wider implementation of NCD interventions with an optimal synergy between management and prevention programmes worldwide (meso-level);
• reviewing and updating global scaling-up and assessment tools, which will be available via international agencies (macro-level).

In Indonesia, Myanmar and Vietnam, guidelines, operating procedures and manuals for diabetes and hypertension prevention and management have been developed, based on national and international evidence, for example, the WHO Package of Essential NCD Interventions protocols. First, we will measure to which extent they meet state-of-the-art levels of evidence-based medicine. Later, we will implement global instruments, train health workers and measure impact of the training. This knowledge will be incorporated in the international tools. Finally, we will develop protocols and derived rules, based on adapted guidelines.

Specific tasks per phase of the study are as follow:

Phase A: Retrospective study – Assessment of local training, instruction materials and compliance with evidence-based medicine

Micro-level

• The study will focus on primary healthcare facilities and community clinics in selected geographic areas. The first step will deal with mapping current practice and assess the extent of compliance with internationally recognised evidence-based The managerial component will also be studied. A repository of background materials will be established, accessible for all levels.

Meso-level

• The rules and practice of referrals to facilities and back will be evaluated in relation to international standards and guidelines.
• The roles of local authorities in managing the patients flow will be studied and gaps identified.

Macro-level

• National health policies will be studied to assess evidence-based health policies in the area of NCDs, the extent of implementation of evidence-based approaches, and to verify whether the Health in All Policies principle is followed.

Phase B: Adjustment phase – Implementation of global instruments in practice

Micro-level

• The study will continue with adapting and subsequently implementing evidence-based tools.

Meso-level

• Adapting and implementing evidence-based tools for collaboration between formal and informal settings to create synergies between them.

Macro-level

• Adaptation of guidelines and other evidence-based upscaling tools will be discussed and implemented at national levels, involving both governmental as well as non-government agencies, such as medical or nursing chamber or equivalents. Policy documents will be drafted.

Phase C: Prospective study – Promoting development of tools supporting the implementation of adapted guidelines

• At all levels, effectiveness in dealing with quality issues of local management in health facilities will be assessed, when using international standards. The focus will be on distance training tools using the Learning Management System as well as access to a library containing materials from the repository of documents. At the micro-level, a set of training and other educational activities will be executed.

Phase D: Draw Lessons for Policy

• Final guidelines, tools and instruments will be developed, and compared with existing international state-of-the-art Instruments will be shared. The Learning Management System will be made available internationally.

Work package leader:
Prof. Martin Rusnák
Faculty of Health Care and Social Work, Trnava University
Email: rusnakm@truni.sk