Social Surveys is proud to have been part of a major international evaluation of community-based interventions for the detection and management of diabetes and hypertension in underserved communities in South Africa, Brazil, India and the USA. Diabetes and hypertension are two of the most widespread diseases in South Africa, especially among poorer citizens, but receive very little health system attention and funding. The HealthRise programme sought to improve patient outcomes in diabetes and hypertension by implementing health system strengthening interventions in select clinics in uMgungundlovu and Pixley ka Seme Districts in South Africa, as well as in Brazil, India and the United States.

While the quantitative impact methods of the study did not find a significant difference between patient outcomes at treatment and non-treatment facilities in South Africa, there were important findings from the qualitative study components. Existing health systems infrastructure and social determinants of health limit the potential effect of community-based programmes aimed at improving the detection, treatment and care of hypertension and diabetes. Continued work is needed to understand which community-based NCD interventions may work best given local contexts and needs. Furthermore, health system strengthening, increased financing for NCDs and a locally driven focus on how interventions and community factors together, may contribute to improving health for individuals.

Abstract

Introduction: As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.

Methods: The evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients’ biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.

Results: Almost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.

Conclusions: Findings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.

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