Community-Based Chronic disease Care Lesotho (ComBaCaL)

More than 75% of NCDs deaths occur in low and middle income countries. Poverty and social determinants are closely linked to untreated NCDs. Lesotho has implemented a successful decentralized HIV testing and care model involving lay health workers to deliver accessible and equitable services even for the rural population, directly in their communities. This decreases the burden on overwhelmed health facilities, brings services closer to the community and reduces structural access barriers such as transport costs and travel time. In order to tackle NCDs, the Ministry of Health of Lesotho has therefore proposed in its NCD strategic plan that lessons learnt from HIV programs should be taken up, and that delivery platforms should provide integrated HIV/NCD services. Responding to this demand, the ComBaCaL initiative aims to establish and validate a large-scale community-based NCD care model, enabled through an eHealth application and data system. The project will initially focus on hypertension and diabetes, which affects respectively 22% and 6% of the adult population in Lesotho.[1] The model will be validated through a randomized control trial in the two poorest districts of Lesotho.

The Swiss added value to this project lies in the internationally recognized scientific and research excellency of the Swiss Tropical and Public Health Institute, who has the technical lead for the implementation of the research components. In order to create transformative changes, the project unites research, implementation and policy.

[1] World Health Organization. Non communicable diseases country profiles. Geneva, Switzerland: WHO; 2018. WHO. http://www.who.int/gho/countries/lso/country_profiles/en/ (accessed June 20, 2020).

Primary beneficiaries: At least 50’000 (51% women) people will directly benefit and more than 200’000 people (51% women) will indirectly benefit as primary beneficiaries from improved NCD prevention and care at the health facilities and in the communities through the innovative community-based care model. About half of these people live below the national poverty line.

Secondary beneficiaries: 100 lay health workers (95% women) and their families will directly benefit from jobs and improved income. 50 involved health professionals and scientists (50% women) will benefit from capacity building.

Potential beneficiaries at national scale up: more than 2 million people (51% women) (whole population of Lesotho).

1.     Health: Awareness, access, care and treatment for each NCD targeted by the project is improved at facility and community level in two districts of Lesotho.

2.     Policy: Key scientific outputs from the program are reflected in influential national and international guidelines, policies and donor’s strategies.

3.     Scale-up and sustainability:

        3a.  National institutions and international organisations implement lessons learnt and best practices from ComBaCaL outside the program supported area.

        3b. The economic independence of lay workers is improved.

Principaux résultats attendus:  

1)    An eHealth application and data system is developed, validated by a clinical team, integrated and operational.

2)    Community lay health workers provide effective community based integrated NCD care in coordination with health facility staff.

3)    Clinical facility staff effectively provide integrated NCD care.

4)    Cluster-randomized trial and sub-studies have been successfully set up, carried out and completed.

5)    Additional NCDs are integrated in ComBaCaL in line with national priorities and a roll-out plan is developed.

6)    Capacity building in Health and IT achieved.

Community lay health workers generate personal income through an established social enterprise.

Principaux résultats antérieurs:  

The research consortium funded in 2015 has received an r4d[1] open call grant for a research project that assessed community based HIV testing and start of antiretroviral treatment. The results of this successful trial were published in important scientific journals and influenced HIV guidelines in Lesotho, at the World Health Organization and in the USA.

[1] R4d is a research programme 2012-2022 co-funded by the SDC and the Swiss National Science Foundation.

Coordination with the SDC’s Health Focal Point as well as sharing of results with the health network and the health programmes in Eastern and Southern Africa.

The project will coordinate with key strategic actors such as the International Aids Society and the World Health Organization.