NCDs
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Lesotho
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Last Mile Health: Community Based Chronic Care in Lesotho (ComBaCaL)
A woman having her blood pressure measured by a Village Health Worker (VHW) during a home visit in Butha Buthe district, Lesotho
(© The Hub, Meri Hyöky)
Situation:
Non-communicable diseases (NCDs), particularly cardiovascular diseases, are emerging as the leading causes of death and disability in Africa. The increasing burden of NCDs, such as diabetes and hypertension, is placing a heavy strain on the health system in Lesotho, alongside efforts to scale up and sustain interventions for HIV, tuberculosis, and maternal and child health.
Objectives:
This three-year project aims to improve chronic disease care in rural Lesotho by strengthening the existing health system and introducing an innovative and efficient care model that integrates prevention, screening, diagnosis and treatment of hypertension and diabetes.
Indicators:
- Screening: cumulative number of screening consultations conducted at all project health facilities and in communities
- Treatment: % of patients screened who are enrolled in care both in ComBaCaL health facilities and in communities
- Policy: cumulative number and profile of influential policy forums, guidelines, and policies referencing and applying the project’s key scientific outputs
Measures:
- Local anchoring: the Ministry of Health (MoH) has been involved from the onset of the project as a member of the project’s steering committee. This inclusive approach fosters acceptance of the project and enables results to be reflected in the national policies and guidelines with a sense of ownership by the Ministry of Health.
- Investing in the future generation: we invest in the future generation of practitioners and scientists through student internship programmes and supervised research.
Sustainability:
- The e-health application will be open-source and adaptable to ensure sustainable access and further adaptation if needed. The application, once validated, will be integrated into the existing DHIS2 of MoH.
- The lessons and successes generated from the project’s community-based care approach could be thematically expanded to other health conditions, such as HIV/AIDS, tuberculosis, and mental health, and geographically adapted to other rural settings with unmet needs for NCD prevention and care in Africa.
Special features:
- The development and use of the ComBaCaL app, a tailored clinical decision support tool to provide effective chronic care management to 15’000 participants in a pragmatic randomised trial.
- First project in Africa where Village Health Workers (VHWs) not only screen and diagnose, but also independently manage hypertension and type 2 diabetes in the community.
- VHWs are trained and supported to set up a microenterprise and generate additional income for greater economic independence and sustainability.
Here you can find further information.
