Community mHealth Integrated Care (ComHIC) to manage hypertension/diabetes in Tanzania’s overburdened health system

Background

Although Tanzania has its noncommunicable disease (NCD) Strategic Plan, heavy overload to Tanzania’s health system with scarce human resources hinders effective management of its growing number of hypertension (HT)/ diabetes mellitus (DM) patients. mHealth (use of mobile phones for health care) is already widely used in care of reproductive health and HIV or TB patients and evidence of mHealth in control of NCD is done in other low- middle-income countries. We define “Community mHealth Integrated Care (ComHIC)” as the use of mHealth texting messages with support of Community Health Workers (CHWs) integrated in the local healthcare system to help patients manage diseases.

Aims

The aims of this research are:

1. to assess capacity of local health system for management of HT/DM patients,

2. to elucidate impacts of introduction of mHealth with support of CHWs for management of HT/DM patients, and (3) to develop strategies to improve management of HT/DM patients.

Project plan

This project conducts a two-arm cluster randomized control trial (RCT) of mHealth (text messaging) with support of CHWs in Dodoma region, Tanzania, with participation of national/regional health authorities, mHealth professionals, communities, and HT/DM experts.

Before starting a RCT, [

1. evaluation of supply, logistics, and performance of health workers for care of NCD patients by scoping review and document analysis,

2. assessment of readiness of CHWs for supporting NCD patients by focus group interviews of 2430 CHWs, and

3. qualitative evaluation of a pilot text-messaging program for HT/DM patients with participation of 30 patients will be carried out.

Based on these studies, and RCT of mHealth with support of CHWs will be carried out over 24 months. A total of 1600 patients diagnosed with HT and/or DM in 30 rural health communities in Dodoma region and 60 CHWs will participate in the study. Messages to enhance lifestyle modifications, health tips, and reminders will be sent directly to the patients under mHealth. CHWs will visit patients’ home and provide counseling following a protocol. Health examination surveys, 3 times at baseline, mid-term, and end of the trial as well as examinations of knowledge about NCDs of CHWs at baseline and end point will be conducted. By using the obtained information, impact on HT/DM management, to increase community capacity, to reduce social cost will be analyzed. Finally, strategies to overcome barriers using ComHIC to improve HT/DM management will be developed by multi-stakeholder meetings.

This proposal focuses on an intervention to improve HT/DM management using existing resources with evidence-based mHealth for NCD control and addresses strategies to overcome overburden on the health system. Multi-stakeholders research meetings will design and implement the study, and develop future strategies. This study will help increase the number of HT/DM patients adequately controlled.

Funding organisations

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