Core concept

The key idea of the SUNI-SEA is to assess synergies between community activities and primary healthcare interventions in the field of prevention and control of non-communicable diseases (NCDs).

The project will focus on:

1. Community activities, which consist of health promotion and lifestyle as well as screening for NCDs within community groups or by volunteers.
2. Primary Health Care (PHC) facility interventions, which concentrate on early diagnosis and medical treatment within the facilities.
3. Interactions between communities and facilities to make the referral for diagnosis and treatment and counter referral for lifestyle interventions possible.

The project will also study the factors that enable or hinder these three functions. The figure below therefore reflects our core focus in the project in Indonesia, Myanmar and Vietnam.

The SUNI-SEA project will study ongoing programmes in Indonesia, Myanmar and Vietnam. Where needed, it will strengthen implementation of the programme, for example through capacity building.

Community-based interventions for prevention and control of NCDs

• Posbindu is a programme for people who are 15 years and older, with the aim to identify several risk factors for NCD all over the country. People are screened and referred to health facilities if hypertension or diabetes is found. The programme is taking place in communities, with the “5 tables” for screening and counselling after the findings. Community health volunteers provide these services
• Posyandu Lansia targets 2.5 million of older people (about 12%), provides health outreach and referral services as well as examination of activities of daily living (ADL). It is supervised by Puskesmas, synergising primary healthcare facility interventions and community-based interventions. Posyandu Lansia is implemented jointly by the community, cadres, non-governmental organisations (NGOs), private and social organisations. The cadres are responsible for a group of households, promoting older people’s attendance at the Elderly Integrated Posts activities.
• Persadia Club covers almost the whole country and focusses on improving the quality of life of diabetic patients.

The three types of interventions are supported by public and local government funds. They encourage community participation in early detection, monitoring and follow-up of people with NCD risk factors, integrated into other community activities (schools, workplaces and residences). 

Primary healthcare facility interventions for NCD diagnosis and treatment

Implemented at the primary health service level – i.e. at the Puskesmas (public health centre) or family doctor since 2010 – part of the basic package of health services. NCD services are covered by the National Social Health Insurance. In 2016, the National Social Health Insurance developed a mobile phone application for health screening. When there is a moderate or high risk of NCD, the participant is advised to consult the primary healthcare providers for a follow-up. More than one million of the national health insurance participants have been screened after using the app; however, a lot of people are not covered by this intervention.

Universal health coverage policy giving access to services

Since 1 January 2014, the National Social Health Insurance (BPJS Kesehatan) offers national health insurance for the entire population. More than 50% of the population is currently covered.

Community-based interventions for prevention and control of NCDs

• Inclusive self-help groups (ISHGs) promote health awareness and community mobilisation with trained volunteers, aimed to provide social security, strengthen community cohesion, and improve the delivery of essential NCD services.
• At this moment, there are around 150 ISHGs in Myanmar. In collaboration with HelpAge International, the Ministry of Health plans to scale-up these community services.
• Around Yangon there is a pilot of community-based screening and advice on healthy lifestyles.

Primary healthcare facility interventions for NCD diagnosis and treatment

Township clinics are implementing the Package of Essential NCD Interventions for primary care in low-resource settings as developed by the World Health Organization (WHO). They include both population and individual interventions. The government has now started to expand them in all townships of Myanmar.

Universal health coverage policy giving access to services

In 2017, the National Health Plan was launched with the aim of expanding the basic essential package of health services, increasing the availability of services and reducing out-of-pocket expenses by the population. The government is gradually introducing health insurance (to be complete by 2030), and a pilot has started in the formal employment sector.

Community-based interventions for prevention and control of NCDs

• Intergenerational self-help clubs (ISHCs) are community-based solidarity groups aiming at active and healthy ageing.
• There are 1,286 ISHCs in Vietnam. The National Programme of Action on Ageing 2012–2020 aims to have at least one ISHC in at least 50% of communes/wards by 2020.

Primary healthcare facility interventions for NCD diagnosis and treatment

Primary healthcare facility interventions in Vietnam include hypertension and diabetes screening and management, ensuring provision of medicines and basic equipment, and follow-up treatment at Commune Health Stations. At this moment Vietnam is testing various options for facility-based NCD programmes

Universal health coverage policy giving access to services

In October 2017, the government started rolling out health insurance (Resolution 20-NQ/TW) with the aim to achieve 80% coverage by 2018 and hopes to achieve 95% coverage by 2025 (coverage of 95% of commune, ward and township health stations to provide the basic beneficiary package of health services). With a great effort, up to June 2018, health insurance coverage in Vietnam is already 85%.