CORE Group Spring Conference Advancing Community Health Across

the Continuum of Care Tuesday, April 14, 2015

Alexandria, VA

Driving the Advocacy Agenda for Non-Communicable Diseases:

Crafting Your Message

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Session Organization

• 4:00 – 4:05 Background • 4:05 – 4:40 Presentations, Q & A • 4:40 – 5:05 Small Group Discussion • 5:05 – 5:25 Small Group Sharing Out • 5:25 – 5:30 Session Wrap-Up

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Global Burden of NCDs • More than 38 million lives lost

to NCDs in 2012 • 16 million (~42%) premature and

avoidable • ¾ NCD deaths (82% premature

deaths) in LMICs

• NCDs and their behavioral risk factors major challenges for health and sustainable development in the twenty-first century

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Imaged adapted from (accessed April 10, 2015. http://www.emro.who.int/egy/egypt-infocus/stepwise-surveillance.html

Mental Health ----------------

Disabilities ----------------

Session Objectives

• Demonstrate an understanding of current efforts in the global fight against NCDs

• Learn and analyze how NCD efforts can be integrated into current and future projects

• Formulate appropriate key messages to drive action on addressing NCDs in their communities and projects

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Presentations Natalie Hendler Heather White Nikita Ramchandani Joy Baumgartner 5

Healthy Heart Africa Conquering Hypertension in Kenya

April 2015

Natalie Hendler Senior Program Officer Jhpiego

Cardiovascular Disease in Africa

Around 40% of adult Kenyans have raised blood pressure

Source: World Health Organization

Healthy Heart Africa A holistic approach to healthcare delivery

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Bar

riers

Education & Awareness

Provider training & Guidelines Access & Affordability

Solu

tions

Mobilise patients to seek screening and treatment

Promote routine screening and timely diagnosis

Improve access and adherence to treatment

Out

com

es

1. Increased awareness of risks of hypertension 2. Increased motivation to be diagnosed and seek the right treatment 3. Increased access to appropriate and affordable medicine

Healthy Heart Africa

A partnership approach

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Target Districts in Kenya

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Healthy Heart Africa- Training • A key element for

successful integration of hypertension screening into quality health care

• Jhpiego leads training, in collaboration with MoH, AstraZeneca, Kenyan Cardiology Society

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Healthy Heart Africa: Training

• Competency-based approach, using ToT as trainers and clinical mentors at facility level

• Train 104 service providers

• Orient 330 CHVs in hypertension awareness, screening and referral

12 CHV= Community Health Volunteer

Program Scale-Up Strategy

• Targeting16 priority health facilities for Phase One

• Training to expand to 100 additional clinics in Phase Two

• Evaluate information dissemination

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Scale-Up Community Awareness

• Key approach to increase HTN screening

• CHWs to conduct community awareness campaigns

• SMS messages, IEC materials available

• Community-based, family-centered

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500,000 adults to be screened for hypertension in target districts

Conclusions

• Integrate screening for HTN within primary care settings

• CHVs expand awareness of HTN, promote HTN prevention and control

• Significantly increase access to quality care

• Scalable, sustainable NCDs programming

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Target: 80% of diagnosed patients continue on treatment

Thank you!

• Mychelle Farmer- Mychelle.farmer@jhpiego.org • Jhpiego Kenya Team:

– Nancy Koskei – Moses Kitheka – Linda Archer – Anthony Gichangi – Manya Dotson – James Riungu – Isaac Malonza

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Heather White, DrPH NCD Technical Advisor

PS KENYA: HARNESSING THE POWER OF THE PRIVATE SECTOR FOR HEALTHY HEART AFRICA

PS Kenya’s Role in HHA

page 18

Leveraging existing services offered by Tunza clinics, PS Kenya is contributing to HHA’s goals through:

PAGE 19

Tunza’s scale and efficiency allows us to reach more

people with quality assured products and services.

PS Kenya is recruiting providers from 90 clinics in 4 participating

counties.

Communications & Messaging

Meet Kioko

• Kioko has high blood pressure but is completely unaware

• Has a wife and two children and lives outside Nairobi • Earns approx. $300 per month, and has few savings • Doesn’t believe in exercise… he thinks its for the very rich or

poor… and admits that he’s slightly overweight.

• Eats two big meals a day, smokes and drinks beer socially • Doesn’t engage with healthcare system very often and has

never been told about hypertension

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How will we make Kioko aware of Hypertension?

Communicate importance of high blood pressure to over 2.5 million Kenyans using multiple communication channels

– poster campaigns, patient outreach, radio/TV and digital

Develop a core set of education and awareness materials in collaboration with all partners and the Ministry of Health, led by PSI using local Kenyan experts

Screen 750,000 people through screening events: clinics, home visits (CHW), workplaces, mbarazas and churches

Utilize Kenyan media to drive awareness of hypertension

PS Kenya using road shows and advertising to raise the awareness with general public

• Mass and mid media events to increase awareness • Roadshows – visiting communities, handing out health messages and

encouraging the general public to attend screening events

• Marketing campaigns

Communications via Other Partners

• AMREF reaching lower-income communities and screening colleagues

• AMPATH are integrating with the community: village market days and using community health volunteers

• CHAK are engaging religious leaders to help raise awareness and promote health messages

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Healthy Heart Africa Evaluation Nikita Ramchandani CORE Group Conference April 14, 2015

• Lack of documentation for HTN/CVD programming

• Opportunity to inform Kenyan stakeholders of what works as Kenya implements its NCD strategy

• Share evidence for effective clinical and community interventions for hypertension in Kenya and internationally

• Understand why programs were effective

• Inform scale up, replication and continuous learning

Rationale

The HHA Monitoring and Evaluation Strategy

Enabling long term sustainability by providing credible and independent data to support advocacy and partnership strategy

Providing independent data to test whether our strategy is working and inform how to continue to implement and

expand across Kenya & Africa

Baseline surveys

- Facilities - Households

Monitoring - Facilities - Community activities

Endline surveys - Facilities - Households Process Evaluation - In Depth Interviews

Baseline report- April

2015

- Monitoring dashboard - Quarterly reports

Impact and process

evaluation August 2016

Overview of M&E Project implementation

Data collection

M&E outputs

Project timeline

Baseline Report Data to guide implementation, including • Demographics and lifestyle of target

population • Awareness and attitudes • Treatment for hypertension • Barriers to receiving hypertension care • Health facility staff knowledge, attitudes,

and practice around hypertension care • Equipment, medications, and information

materials on hypertension at health facilities

On-going Monitoring

• Health care workers trained • Adults screened, referred, and

treated • % of patients entering treatment

who attend follow-up appointments • % of patients lost to follow-up at

each stage • Prevalence of (pre)hypertension

among those screened

Monthly data to guide implementation and track progress:

Endline: Impact Evaluation

Estimates of the impact of HHA on: • Awareness and knowledge • % of adults screened for hypertension • % of adults treated for hypertension • Provider knowledge, attitudes, and practice around

hypertension care

Endline: Process Evaluation Assessment of HHA implementation including:

• At an operational level – what aspects of the program worked

well? – what aspects didn’t work as intended or

faced significant challenges?

• What contextual factors presented challenges/facilitated the success?

• What are the concerns of stakeholders for scale-up?

Facilitated referrals as a service delivery strategy for integrating NCD & HIV care and treatment Joy Noel Baumgartner, PhD Duke Global Health Institute, Evidence Lab Social & Behavioral Health Sciences, FHI 360 14 APRIL 2015

Examples of FHI 360 Global NCD Activities

• Cardiovascular disease (CVD) and HIV integration – USAID projects in Kenya, Nigeria, Zambia; FHI 360 core support for some efforts

• Cervical cancer screening and HIV integration – USAID project in Nigeria

• Mental health and HIV integration – USAID & CDC projects in Vietnam

• Alcohol abuse (NCD risk factor) and HIV integration – Regional USAID HIV project in Rwanda, Tanzania, and Kenya

• Tobacco control (NCD risk factor) – Multiple projects funded by Atlantic Philanthropies, Johns Hopkins, and

corporate FHI 360 funding

• CVD screening, referral and treatment in two districts – FHI 360 funded project in Ghana

• Community-based public-private model for hypertension control – Novartis Foundation project in Ghana

NCD/HIV service integration

NCD risk factor policy and behavior change

General Pop NCD interventions

How to integrate NCD care into HIV services platform

• Integration a common strategy for providing NCD services

• Referrals are key component of integration; however referral follow-up is challenging across all health services

• Facilitated referrals are enhanced referrals that include components (e.g. escorting client) that support referral completion by strengthening linkages between two services or between community-based and facility-based services

• FHI 360 developed and tested a 7-step facilitated referral model for integrating family planning into HIV care and treatment services (Baumgartner et al., Health Policy & Planning; 2014)

• Model is generic and can used for other services integration

7 Steps for Facilitated Referral Model

Facilitated referrals for integrating NCD services into HIV care and treatment in Zambia

• Two hospitals will use facilitated referrals to support services for diabetes and depression among patients in HIV clinics

• Screening for diabetes from HIV Chronic Care Checklist and adding a depression screener for study (CES-D) – Diabetes care by clinical officers and nutritionists following MOH guidelines (additional training needed) – Depression care by psychiatric nurses trained on group counseling intervention (in line with WHO

guidelines for psychosocial services) • Study objectives

1. To determine the feasibility of integrating NCD care into HIV care and treatment by tracking service indicators, and

2. To assess the impact of mental health care on both depression symptoms and ART adherence (pre/post-intervention; 3 month follow-up)

How to advocate

• Look for opportunities to integrate existing services – Eg. psychiatric clinics in low-resource settings often focus on only the most severe disorders and they are

co-located with other health services; providers can be trained and supported to care for more common disorders like depression (WHO has guidelines for mental health interventions in low-resource settings)

• NCD programs can be enhanced by multi-sectoral approaches – Look beyond health sector programs (education, nutrition, environment, gender, economic development)

Photo by Rebecca Dirks

Acknowledgements

Team • Nathaniel Chishinga (co-PI) • Namakau Nyambe • Earnest Muyunda • Pai Lien Chen

Rebecca Dirks Mike Welsh Tim Mastro

Funding • FHI Foundation (Catalyst Grant)

Questions & Answers

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Small Group Discussions • Key questions to answer

• Integration • Key Messages, Channels, and Targets • Gaps

• Assigned facilitator (distribute evenly among tables) • Appoint recorder and reporter • 25 minutes: Small Group Discussion • 20 minutes: Sharing Out 42

Wrap-Up

• Understand scope and impact of current efforts • Crafting key messages for NCD integration into existing

health platforms • Identified implementation avenues for NCD prevention

and control

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Acknowledgements • Coordinators

• Mychelle Farmer, Jhpiego • Rebecca Dirks, FHI360 • Arti Varanasi, Advancing Synergy

• Presenters • Natalie Hendler, Jhpiego • Heather White, Population Services International (PSI) • Nikita Ramchandani, Abt • Joy Baumgartner, FHI360/Duke Global Health Institute

• AstraZeneca and partners, Healthy Heart Africa 44

After the Session

Dr. Arti Patel Varanasi avaranasi@advacingsynergy.com

Dr. Mychelle Farmer mychelle.farmer@jhpiego.org

45 www.ncdroundtable.org

CORE Group Spring Conference Advancing Community Health Across

the Continuum of Care Tuesday, April 14, 2015

Alexandria, VA

Driving the Advocacy Agenda for Non-Communicable Diseases:

Crafting Your Message

46