Co-Designing a Multi-level Intervention for Improving Continuum of Care for Non-Communicable Diseases in Three Diverse Cities in Nepal: Heart’s Intervention Design Targeting Younger Adults & Ageing Population (HRIDAYA – Nepali word for ‘Heart’)

Background

Primary and community health care systems in Nepal are currently fragmented. We aim to co-design a multi-level intervention to determine what works, and in what dose, frequency and duration to improve the continuum of care for preventing, diagnosing and managing risk factors for non-communicable diseases (NCDs) in three urban cities. Our focus is on access to health services through strengthening of urban health clinics which mainly serve the urban poor and vulnerable populations, this being highly relevant to this call. Because urban health clinics are currently under the jurisdiction of local government, we will work with municipalities in preparing urban health clinics to diagnose and treat NCDs.

Aims

The aims of this project are to:

• co-design a multi-level Intervention for improving continuum of care for non-communicable diseases

• Augment the capacity of health care professional and community health workers to diagnose and manage hypertension and diabetes

• Evaluate the implementation and uptake of HRIDAYA and undertake a health economic evaluation

• Evaluate scalability of HRIDAYA using the Innovative Care for Chronic Conditions framework to understand reach and penetration, adaptation and impact

• Develop an implementation toolkit to facilitate subsequent scale up

Project plan

We will use a type-2 hybrid design using the Consolidated Framework for Implementation Research (CFIR) and the Practical, Robust Implementation and Sustainability Model (PRISM) to design and monitor the intervention across both clinical outcomes, such as control of risk factors, and implementation outcomes, such as acceptability, reach, adoption, fidelity, implementation cost and sustainability. The intervention package will encompass capacity building of urban health clinics embedded within existing health care system capacity development plans.

We will work with stakeholders in developing an equitable and sustainable model of care integrated and contextualised to the local health system. Stakeholder engagement is pivotal for longevity of the program. Consequently, our engagement plan includes strategies identified through the GACD’s Upscaling Working Group (co-led by CI Thrift) such as 2-way communication, networking, equitable partnerships, and training of the team in the language of policy, to maximise engagement. Advisory committees and working groups, local policy makers, researchers, implementing partners, CHWs, and people living with NCDs, will be established in each municipality to co-design, develop, implement and monitor the intervention package.

At the community level, existing community health workers (CHWs) will be empowered to identify people with hypertension, diabetes and chronic obstructive pulmonary disease, and track and refer them for appropriate care. At the health facility level, the health workers who receive these referrals will be trained to diagnose and provide guideline-based lifestyle and pharmacological care. CHWs will further follow-up patients to optimise adherence to medications. Health workers and CHWs will meet regularly to discuss monthly follow-up targets, monitoring of cases and any other operational issues.

Publications and output

To access publications and other outputs relating to this project, see our publications webpage

Funding organisations

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