driving the advocacy agenda
TRANSCRIPT
CORE Group Spring Conference Advancing Community Health Across
the Continuum of Care Tuesday, April 14, 2015
Alexandria, VA
Driving the Advocacy Agenda for Non-Communicable Diseases:
Crafting Your Message
1
Session Organization
• 4:00 – 4:05 Background • 4:05 – 4:40 Presentations, Q & A • 4:40 – 5:05 Small Group Discussion • 5:05 – 5:25 Small Group Sharing Out • 5:25 – 5:30 Session Wrap-Up
2
Global Burden of NCDs • More than 38 million lives lost
to NCDs in 2012 • 16 million (~42%) premature and
avoidable • ¾ NCD deaths (82% premature
deaths) in LMICs
• NCDs and their behavioral risk factors major challenges for health and sustainable development in the twenty-first century
3
Imaged adapted from (accessed April 10, 2015. http://www.emro.who.int/egy/egypt-infocus/stepwise-surveillance.html
Mental Health ----------------
Disabilities ----------------
Session Objectives
• Demonstrate an understanding of current efforts in the global fight against NCDs
• Learn and analyze how NCD efforts can be integrated into current and future projects
• Formulate appropriate key messages to drive action on addressing NCDs in their communities and projects
4
Presentations Natalie Hendler Heather White Nikita Ramchandani Joy Baumgartner 5
Healthy Heart Africa Conquering Hypertension in Kenya
April 2015
Natalie Hendler Senior Program Officer Jhpiego
Cardiovascular Disease in Africa
Around 40% of adult Kenyans have raised blood pressure
Source: World Health Organization
Healthy Heart Africa A holistic approach to healthcare delivery
8
Bar
riers
Education & Awareness
Provider training & Guidelines Access & Affordability
Solu
tions
Mobilise patients to seek screening and treatment
Promote routine screening and timely diagnosis
Improve access and adherence to treatment
Out
com
es
1. Increased awareness of risks of hypertension 2. Increased motivation to be diagnosed and seek the right treatment 3. Increased access to appropriate and affordable medicine
Healthy Heart Africa
A partnership approach
9
Target Districts in Kenya
10
Healthy Heart Africa- Training • A key element for
successful integration of hypertension screening into quality health care
• Jhpiego leads training, in collaboration with MoH, AstraZeneca, Kenyan Cardiology Society
11
Healthy Heart Africa: Training
• Competency-based approach, using ToT as trainers and clinical mentors at facility level
• Train 104 service providers
• Orient 330 CHVs in hypertension awareness, screening and referral
12 CHV= Community Health Volunteer
Program Scale-Up Strategy
• Targeting16 priority health facilities for Phase One
• Training to expand to 100 additional clinics in Phase Two
• Evaluate information dissemination
13
Scale-Up Community Awareness
• Key approach to increase HTN screening
• CHWs to conduct community awareness campaigns
• SMS messages, IEC materials available
• Community-based, family-centered
14
500,000 adults to be screened for hypertension in target districts
Conclusions
• Integrate screening for HTN within primary care settings
• CHVs expand awareness of HTN, promote HTN prevention and control
• Significantly increase access to quality care
• Scalable, sustainable NCDs programming
15
Target: 80% of diagnosed patients continue on treatment
Thank you!
• Mychelle Farmer- [email protected] • Jhpiego Kenya Team:
– Nancy Koskei – Moses Kitheka – Linda Archer – Anthony Gichangi – Manya Dotson – James Riungu – Isaac Malonza
16
Heather White, DrPH NCD Technical Advisor
PS KENYA: HARNESSING THE POWER OF THE PRIVATE SECTOR FOR HEALTHY HEART AFRICA
PS Kenya’s Role in HHA
page 18
Leveraging existing services offered by Tunza clinics, PS Kenya is contributing to HHA’s goals through:
PAGE 19
Tunza’s scale and efficiency allows us to reach more
people with quality assured products and services.
PS Kenya is recruiting providers from 90 clinics in 4 participating
counties.
Communications & Messaging
Meet Kioko
• Kioko has high blood pressure but is completely unaware
• Has a wife and two children and lives outside Nairobi • Earns approx. $300 per month, and has few savings • Doesn’t believe in exercise… he thinks its for the very rich or
poor… and admits that he’s slightly overweight.
• Eats two big meals a day, smokes and drinks beer socially • Doesn’t engage with healthcare system very often and has
never been told about hypertension
22
How will we make Kioko aware of Hypertension?
Communicate importance of high blood pressure to over 2.5 million Kenyans using multiple communication channels
– poster campaigns, patient outreach, radio/TV and digital
Develop a core set of education and awareness materials in collaboration with all partners and the Ministry of Health, led by PSI using local Kenyan experts
Screen 750,000 people through screening events: clinics, home visits (CHW), workplaces, mbarazas and churches
Utilize Kenyan media to drive awareness of hypertension
PS Kenya using road shows and advertising to raise the awareness with general public
• Mass and mid media events to increase awareness • Roadshows – visiting communities, handing out health messages and
encouraging the general public to attend screening events
• Marketing campaigns
Communications via Other Partners
• AMREF reaching lower-income communities and screening colleagues
• AMPATH are integrating with the community: village market days and using community health volunteers
• CHAK are engaging religious leaders to help raise awareness and promote health messages
26
Healthy Heart Africa Evaluation Nikita Ramchandani CORE Group Conference April 14, 2015
• Lack of documentation for HTN/CVD programming
• Opportunity to inform Kenyan stakeholders of what works as Kenya implements its NCD strategy
• Share evidence for effective clinical and community interventions for hypertension in Kenya and internationally
• Understand why programs were effective
• Inform scale up, replication and continuous learning
Rationale
The HHA Monitoring and Evaluation Strategy
Enabling long term sustainability by providing credible and independent data to support advocacy and partnership strategy
Providing independent data to test whether our strategy is working and inform how to continue to implement and
expand across Kenya & Africa
Baseline surveys
- Facilities - Households
Monitoring - Facilities - Community activities
Endline surveys - Facilities - Households Process Evaluation - In Depth Interviews
Baseline report- April
2015
- Monitoring dashboard - Quarterly reports
Impact and process
evaluation August 2016
Overview of M&E Project implementation
Data collection
M&E outputs
Project timeline
Baseline Report Data to guide implementation, including • Demographics and lifestyle of target
population • Awareness and attitudes • Treatment for hypertension • Barriers to receiving hypertension care • Health facility staff knowledge, attitudes,
and practice around hypertension care • Equipment, medications, and information
materials on hypertension at health facilities
On-going Monitoring
• Health care workers trained • Adults screened, referred, and
treated • % of patients entering treatment
who attend follow-up appointments • % of patients lost to follow-up at
each stage • Prevalence of (pre)hypertension
among those screened
Monthly data to guide implementation and track progress:
Endline: Impact Evaluation
Estimates of the impact of HHA on: • Awareness and knowledge • % of adults screened for hypertension • % of adults treated for hypertension • Provider knowledge, attitudes, and practice around
hypertension care
Endline: Process Evaluation Assessment of HHA implementation including:
• At an operational level – what aspects of the program worked
well? – what aspects didn’t work as intended or
faced significant challenges?
• What contextual factors presented challenges/facilitated the success?
• What are the concerns of stakeholders for scale-up?
Facilitated referrals as a service delivery strategy for integrating NCD & HIV care and treatment Joy Noel Baumgartner, PhD Duke Global Health Institute, Evidence Lab Social & Behavioral Health Sciences, FHI 360 14 APRIL 2015
Examples of FHI 360 Global NCD Activities
• Cardiovascular disease (CVD) and HIV integration – USAID projects in Kenya, Nigeria, Zambia; FHI 360 core support for some efforts
• Cervical cancer screening and HIV integration – USAID project in Nigeria
• Mental health and HIV integration – USAID & CDC projects in Vietnam
• Alcohol abuse (NCD risk factor) and HIV integration – Regional USAID HIV project in Rwanda, Tanzania, and Kenya
• Tobacco control (NCD risk factor) – Multiple projects funded by Atlantic Philanthropies, Johns Hopkins, and
corporate FHI 360 funding
• CVD screening, referral and treatment in two districts – FHI 360 funded project in Ghana
• Community-based public-private model for hypertension control – Novartis Foundation project in Ghana
NCD/HIV service integration
NCD risk factor policy and behavior change
General Pop NCD interventions
How to integrate NCD care into HIV services platform
• Integration a common strategy for providing NCD services
• Referrals are key component of integration; however referral follow-up is challenging across all health services
• Facilitated referrals are enhanced referrals that include components (e.g. escorting client) that support referral completion by strengthening linkages between two services or between community-based and facility-based services
• FHI 360 developed and tested a 7-step facilitated referral model for integrating family planning into HIV care and treatment services (Baumgartner et al., Health Policy & Planning; 2014)
• Model is generic and can used for other services integration
7 Steps for Facilitated Referral Model
Facilitated referrals for integrating NCD services into HIV care and treatment in Zambia
• Two hospitals will use facilitated referrals to support services for diabetes and depression among patients in HIV clinics
• Screening for diabetes from HIV Chronic Care Checklist and adding a depression screener for study (CES-D) – Diabetes care by clinical officers and nutritionists following MOH guidelines (additional training needed) – Depression care by psychiatric nurses trained on group counseling intervention (in line with WHO
guidelines for psychosocial services) • Study objectives
1. To determine the feasibility of integrating NCD care into HIV care and treatment by tracking service indicators, and
2. To assess the impact of mental health care on both depression symptoms and ART adherence (pre/post-intervention; 3 month follow-up)
How to advocate
• Look for opportunities to integrate existing services – Eg. psychiatric clinics in low-resource settings often focus on only the most severe disorders and they are
co-located with other health services; providers can be trained and supported to care for more common disorders like depression (WHO has guidelines for mental health interventions in low-resource settings)
• NCD programs can be enhanced by multi-sectoral approaches – Look beyond health sector programs (education, nutrition, environment, gender, economic development)
Photo by Rebecca Dirks
Acknowledgements
Team • Nathaniel Chishinga (co-PI) • Namakau Nyambe • Earnest Muyunda • Pai Lien Chen
Rebecca Dirks Mike Welsh Tim Mastro
Funding • FHI Foundation (Catalyst Grant)
Questions & Answers
41
Small Group Discussions • Key questions to answer
• Integration • Key Messages, Channels, and Targets • Gaps
• Assigned facilitator (distribute evenly among tables) • Appoint recorder and reporter • 25 minutes: Small Group Discussion • 20 minutes: Sharing Out 42
Wrap-Up
• Understand scope and impact of current efforts • Crafting key messages for NCD integration into existing
health platforms • Identified implementation avenues for NCD prevention
and control
43
Acknowledgements • Coordinators
• Mychelle Farmer, Jhpiego • Rebecca Dirks, FHI360 • Arti Varanasi, Advancing Synergy
• Presenters • Natalie Hendler, Jhpiego • Heather White, Population Services International (PSI) • Nikita Ramchandani, Abt • Joy Baumgartner, FHI360/Duke Global Health Institute
• AstraZeneca and partners, Healthy Heart Africa 44
After the Session
Dr. Arti Patel Varanasi [email protected]
Dr. Mychelle Farmer [email protected]
45 www.ncdroundtable.org
CORE Group Spring Conference Advancing Community Health Across
the Continuum of Care Tuesday, April 14, 2015
Alexandria, VA
Driving the Advocacy Agenda for Non-Communicable Diseases:
Crafting Your Message
46