A sustainable approach for NCD screening and management at last mile communities

Summary:

In recent years, there has been a rapid increase in the incidence of Non Communicable Diseases (NCDs) in Bangladesh.With the decline in birth rate and death rate and a rise in the proportion of mortality due to noncommunicable disease, Bangladesh has moved towards an epidemiological transition (Health Systems review, 2015). As of 2012, a total of 59% of all deaths within the country resulted from some for NCDs (WHO, 2014). While there are several initiatives undertaken by Government, Non Government Organizations and Private sector, this continues to be a major issue in urban communities (Tuhin et al, 2017). More alarmingly this is feared to be an even larger threat in rural areas as communities do not have access to the relevant services necessary for early detection and management. This study focuses on how BRAC, the world's largest NGO based in Bangladesh used simple, yet effective behavioral change tools to influence communities on NCDs, leveraging its front line Community Health workers (CHWs). The study reviews the current gap in the market, approach in implementation, lessons and implications over the last one year in implementing a community based, NCD awareness programme in rural and urban communities leading to near 30,000 cases of patients, who paid for availing NCD screening services within April 2018 - 2019.

Background/Objectives:

In recent years, there has been a rapid increase in incidence of Non Communicable Diseases in Bangladesh. As of 2012, a total of 59% of all deaths within the country resulted from some form of NCDs (WHO, 2014). While there are several initiatives undertaken by Government, Non Government Organizations and Private sector, this continues to be a major issue in the country. BRAC Health Nutrition and Population Programme (HNPP) has addressed this issue by introducing NCD awareness and screening services at the community level, focusing on hyper tension and diabetes related screening.

Description of Intervention and/or Methods/Design:

BRAC focused on community perception regarding NCDs and preventive care. Market analysis revealed that communities depended on informal practitioners with limited medical training. Patients also visited doctors after suffering for long periods. BRAC saw the need for integrating focused services with its CHWs, who were focusing more on maternal and child health. From past experiences, it was identified that "information overload" on the disease, would lead to challenges in raising awareness. BRAC focused on simple messages, highlighting the disease, with pictorials of symptoms and effects. CHWs were trained to educate communities on risks and challenges of hyper tension and diabetes. Patients were also re-assured that such diseases can be prevented if they had their blood pressure and glucose levels screened. Patients were also educated on how investing in screening check-ups costing less than $1, can potentially lead to timely detection of NCDs and save thousands in treatment expenses.

Results/Lessons Learned:

BRAC launched its NCD intervention in April 2018. After 1 year of operation, the adoption of NCD education and services was gauged at the community level. It was observed that out of 211,000 households reached by BRAC's CHWs throughout the year, a total of 30,000 cases of screenings were conducted by patients, who availed the service commercially from CHWs. The health education based promotion and service delivery was effective for patients to understand the measures for timely prevention of the disease. Pricing of NCD screening services of below $1, reduced the barrier of patients, especially those with limited income from adopting the service. In addition to this, BRAC identified several patients who had limited orientation and understanding of the long term effects of suffering from the disease. It was also observed that patients are receptive, if some form of message on the disease is provided by Doctors.

Discussion/Implications for the Field:

BRAC has seen positive responses in educating communities on NCD awareness, however it served a small portion of the population at risk of NCDs (36% according Govt.). BRAC has started investing in capacity development of CHWs by partnering with private and public sector organizations working in NCD awareness. BRAC is also deploying interactive approaches for raising NCD awareness, utilizing videos, and digital content for orienting communities on the disease. In addition to this, BRAC is developing primary care centers, that have consultation, diagnostics and medicines to effectively manage referred patients over time.

Abstract submitted by:

Saqif Nayeem Khan - BRAC
Mir Aasif Zaman - BRAC