The Bangladesh D:CLARE Project [Diabetes: Community-Led Awareness, Response and Evaluation]

Background

Our D:Magic trial of monthly group meetings led by lay facilitators who guided participants through a Participatory, Learning and Action (PLA) cycle focused on diabetes prevention and control in rural Bangladesh. Through a four-phase cycle, community members:

identified local behavioural, social and environmental threats to their health and prioritised areas for action;
planned strategies to address these threats;
implemented their chosen strategies, which typically included greater awareness-raising, local exercise groups, or lobbying markets for better access to healthy foods; and 4) evaluated the success of these strategies.

Facilitators were locally recruited men and women who received one week’s training in group facilitation and in the basics of diabetes prevention and control. Using robust measurements we compared population prevalence of intermediate hyperglycaemia and diabetes between intervention and control villages. After 18 months of intervention, the prevalence of diabetes and intermediate hyperglycaemia was 65% lower in intervention villages compared to control villages. Further, among individuals identified with intermediate hyperglycaemia before the intervention, the cumulative two-year incidence of diabetes was more than 60% lower in intervention villages. The intervention is cost-effective and could save around INT$2.5 billion in health care costs annually if scaled-up nationally in Bangladesh.

Aims

The robust evidence of impact of our low-cost, social intervention demands replication and scale-up in Bangladesh. We aimed to roll out the intervention across six Unions in Faridpur district, as well as all the control villages from our aforementioned trial. In total, the scaled-up intervention aimed to cover a population of approximately 215,000 people.

Project plan

In partnership with the Diabetic Association of Bangladesh, who were intervention implementers, UCL lead a programme of implementation research to:

engage with national stakeholders to identify optimal intervention delivery mechanisms, and develop strategies to strengthen scale-up systems across Bangladesh and the region;
characterise PLA implementation and impact of the intervention at scale using qualitative, economic and quantitative methods;
describe the sustainability and lasting health impacts of the PLA intervention in former intervention (trial) communities to better understand what happens when direct involvement of the implementing partners is withdrawn and communities are left to run the intervention on their own;
establish the feasibility and acceptability of the PLA intervention within a different, higher-risk population in urban Bangladesh.

Impact

The D:Clare project showed that community mobilisation through Participatory Learning and Action (PLA) is an equitable intervention that has lasting positive effects on non-communicable disease awareness, risk and important health outcomes in communities in Bangladesh. The project team were able to adapt and deliver PLA in the context of COVID-19 and ongoing adaptation and scale-up in urban and rural areas shows promise.

Engagement with a range of stakeholders has confirmed the need for preventative community engagement strategies such as PLA to address NCDs, and has identified the potential to utilise existing cadres to scale-up community-led interventions. Ongoing engagement with key stakeholders is needed to further develop sustainable, scaled-up models of implementation.

Publications and output

This project has a related case study Scaling-up community-led diabetes and NCD awareness and response in Bangladesh.

You may visit the project website for more information.