Driving Change: Scaling up an integrated care package for diabetes and hypertension in Cambodia, Slovenia and Belgium

Effective interventions for prevention, detection, and management of both conditions are available, but do not reach all people in need as many countries struggle to scale up interventions effectively and sustainably. The Scale Up an integrated care package for diabetes and hypertension for vulnerable people in Cambodia, Slovenia and Belgium (SCUBY) project aimed to address that gap, by examining scale-up of existing evidence-based interventions for the control of HT and/or T2D.

The project set priorities for each country based on the findings of the formative research which identified common macro level barriers to integrated care (IC); governance and leadership, health financing, health information system and the health workforce. It assessed the level of implementation of the integrated care package (ICP) in each country and explored drop outs along the care journey for HT and T2D.

The SCUBY intervention for scale-up involved the development of country specific evidence-based roadmaps of strategies (see Table) and the organisation of policy dialogues.

At the its core is an Integrated Care Package (ICP) with five components:

1. identification of people with HT and/or T2D

2. subsequent treatment in primary care services,

3. health education

4. self-management support to patients and caregivers

5. collaboration between caregivers.

The SCUBY project developed, implemented and assessed roadmaps for the scale-up of the integrated care package for T2D and HT.

The roadmaps for the three countries had common elements:

1. task-shifting to decentralise and involve patients, carers, and their environment

2. strengthening monitoring and evaluation, and

3. creating an enabling environment for ICP implementation​​​​

However, the content of the three roadmaps also differed, reflecting different priority needs and the unique position of the SCUBY project team in each country.

In Cambodia, ongoing collaboration with NGOs and development partners supports national strategic plans. The roadmap aims to strengthen the Package of Essential Noncommunicable Disease Interventions (PEN) by identifying key strategies for health system enhancement. Led by the National Institute of Public Health (NIPH) in partnership with the Ministry of Health (MoH), the roadmap offers recommendations for MoH implementation.

In Slovenia, there is a broad range of policies supporting integrated care and multi-disciplinary teams; hence the roadmap focuses on low-level action and access by improving patient-centred care via patient empowerment and self-management. The roadmap was developed by the SCUBY team at the Ljubljana Community Health Centre, where an operational approach (i.e., the implementation of pilot projects) to stimulate self-management of HT and T2D was feasible.

In Belgium, despite existing projects and policies, essential support mechanisms for finance, collaboration, and integrated care are lacking. Led by the SCUBY partner the University of Antwerp, the roadmap aims to address these deficiencies through a networking approach, emphasizing science communication for stakeholder engagement.

The SCUBY project has influenced policy and practice in all three countries and informed new projects:

• The policy dialogues in each country have influenced the public policy debate and the information base for political decision making. The SCUBY project teams have been involved in decision-making processes on scale-up in the three countries. Clinical and health care practice in Slovenia and in Belgium are beginning to change. It is expected that the policy decisions taken (eg NewDeal practice Belgium, change in Standard Operating Procedure in Cambodia) will lead to better resource allocation.

• In each country, the SCUBY project has built capacity to monitor and evaluate scale-up through the tools of ICP implementation measurement and the cascade approach. These practices have been adopted by implementing partners in each country.

The results of SCUBY have informed new collaborations and projects at national and international level, including:

• JACARDI: Joint Action for Cardiovascular Diseases and Diabetes. This initiative aims to reduce cardiovascular diseases and diabetes burden in EU member states through practice change management.

• YIPEE: Focused on youth engagement in health, utilizing SCUBY’s realist evaluation approach.

• CITY-MOVE: To accelerate physical activity action in six cities across three continents, leveraging SCUBY partners’ expertise for intervention monitoring.