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Non-Communicable Diseases (NCDs) such as diabetes, high blood pressure and impaired mental health are the number one cause of death and disability globally. More than 75% of all premature NCD deaths occur in low- and middle-income countries. A consortium of implementation partners and researchers led by SolidarMed proposes a multi-disciplinary research for development program fighting this disproportionate health and socio-economic burden. The Swiss Agency for Development and Cooperation (SDC) will fund the program with 6 Mio CHF over the next five years.
Lesotho, similar to other sub-Saharan countries, faces a situation where the health burden of NCDs now overtakes HIV and other infectious diseases. The country has successfully managed to reduce HIV transmission and AIDS-related deaths due to a decentralized HIV testing and care strategy. A key attribute of this strategy is the involvement of community health workers (CHW) to guarantee access of testing and treatment to the rural population. The awarded program aims at applying similar approaches in the fight against NCDs.
The program called ComBaCaL (Community Based chronic disease Care Lesotho) has been jointly developed by a consortium led by the Swiss NGO SolidarMed together with the Swiss Tropical and Public Health Institute (Swiss TPH), the National University of Lesotho, the Lesotho Ministry of Health, and an affected community member. Further collaborators include the University of Zurich (Department of Informatics) and an eHealth start-up from Lesotho.
Both, HIV and NCDs are chronic diseases and require life-long treatment. ComBaCaL will build upon the lessons learnt from the decentralized HIV program. The program aims at improving NCD care at 23 health facilities through structured staff trainings and supervision, as well as at community level through CHW who will be trained and empowered to deliver NCD prevention, screening, diagnosis - and even care. A locally developed eHealth application will support the trainings, supervision and care provision at community and facility level and efficiently link the data.
“In the spirit of SDG 17 we aim to tackle the growing NCD pandemic through a multi-disciplinary South-North research for implementation partnership,” states Niklaus Labhardt, Research Group Leader at Swiss TPH and president of SolidarMed. His team of researchers, together with the local SolidarMed Lesotho team, has successfully validated and implemented several innovative community-based HIV test-and-treat models in Lesotho over the last 5 years (more information here). In a large-scale cluster randomized trial, they will evaluate the effectiveness of eHealth supported community-based care within ComBaCaL. “This trial will allow to assess if eHealth supported CHW could be a feasible, safe and effective approach to increase access to NCD care for communities living in remote areas,” says Alain Amstutz.
Poverty and social factors are closely linked to NCDs. The rise of these chronic diseases in turn impede poverty reduction in low- and middle-income countries. By offering innovative and high-quality NCD care close to people’s home, ComBaCaL will directly address this problem. Moreover, ComBaCaL aims to bring more holistic and structural change to the communities involved: The CHWs, mostly women, will be employed by a social enterprise, where they acquire entrepreneurial skills enabling them to set up small enterprises (e.g., trading goods) to earn a living. Thus, this initiative is driven by a health equity spirit, will strengthen rural communities, and create self-sustainable jobs. “I believe that ComBaCaL will have a transformative impact on NCD care in developing countries in an innovative self-sustainable way,” says Ilse van Roy, Head of International Programs at SolidarMed.