Scale-up of a primary care intervention for cardiovascular risk management in Malang, Indonesia

Background

SMARThealth is a technology-enabled ecosystem that aims to improve the delivery of high-quality essential primary healthcare to communities. A controlled demonstration project of SMARThealth in four villages of the Malang district in Indonesia, involving over 20,000 adults, provided evidence that the intervention had acceptable reach, was effective in improving CVD risk screening and management, and was adopted widely with good implementation fidelity.

In the four intervention villages, demand for ongoing provision for SMARThealth was strong, from both the community and the district health authority. This was a unique opportunity to scale-up this intervention more widely in the Malang district, funded by the Malang District Health Authority and Badan Penyelenggara Jaminan Sosial, with technical support and evaluation provided by a research consortium comprised of The George Institute for Global Health, Brawijaya University, and the University of Manchester.

Aims

Focusing on the SMARThealth program for cardiovascular disease (CVD) risk management in Malang district, Indonesia, SMARThealth-Scale Up aimed to:

Facilitate the process of scale-up
Evaluate the effectiveness and cost-effectiveness of scale-up in the local context; and
Evaluate the process of scale-up to contribute towards generalizable knowledge.

Project plan

This scale-up process was staged, with an initial “proof of concept” commitment to 100 villages in the Malang District; this application supported the activities of the research consortium through four phases:

Phase 1: a 9-12 month development phase using implementation science methods to ensure “institutionalisation” of critical intervention components;
Phase 2: a “test of scale-up” vanguard phase in ~20 villages, to help understand how localised adaptions can facilitate scale-up;
Phase 3: a 24-month implementation phase at scale; and
Phase 4: a 6-month evaluation period where all the continuously accumulated quantitative and qualitative data will be triangulated to provide evidence on both the process and effectiveness of scale-up.

The research consortium also took the opportunity to evaluate the process of scale-up to contribute to more generalizable knowledge in the field.

Impact

The SMARThealth community-based screening and treatment program in Indonesia has been able to increase the capacity to screen large populations, identifying those with elevated risk and improving treatment rates for common NCDs. In 2019, the Malang District Government received the Best Health Services Innovation Award 2019 from the Indonesian Ministry of Health for their role in implementing the SMARThealth programme. SMARThealth has been adopted by the district of Malang as its public health programme and has been scaled up to three million residents in the region.

Publications and output

View the case study published by the Australian National Health and Medical Research Council.