CORE Group Global Health Practitioner Conference Fall 2017

1. BRIDGING THE
DIVIDE:
PARTNERSHIPS
FOR INTEGRATED
NCD CARE
JESSICA DALY, MPH
SENIOR PORTFOLIO LEAD, CHRONIC CARE
MEDTRONIC FOUNDATION
SEPTEMBER 27, 2017
CORE GROUP | BALTIMORE
No relationships to disclose

2. 2
Builds on
steady global
progress in
health,
beyond low-
income
countries
Recognizes
intersection of
health in all
policies
Focuses on
collective
targets

3. 3
WHY THE DISCONNECT BETWEEN EPI AND ACTION?
 Sub-national analysis shows
unique epi profile of
underserved, who experience
disproportionately poor
outcomes
 Patient-centered, integrated
care, is highly complex, locally
specific, and chronically under-
resourced
 Evidence base about what to do
is still emerging
SDG 3 targets demand integrated health service
delivery
Great! But….

4. 4
Promising strategies to integrate acute
and chronic NCD care low income
settings

5. INTEGRATE SCREENING AND DIAGNOSIS AT COMMUNITY
LEVEL; LINKED TO REFERRAL AND FOLLOW UP
 Door to door and community-based
screening and care, linked to
strengthened diagnostics and
monitoring capacity at PHC
 Pilot horizontally integrated NCD
electronic record, linked to
management information systems and
call centers for referral efficiency
 Train public and private providers
(including ASHAs, pharmacists) in
screening, follow-up and management;
enabled through electronic records
 Engage support groups for patient
empowerment, treatment adherence
Example : Community-Based Hypertension and Diabetes
Screening and Diagnosis – Udaipur, Rajasthan and Shimla,
India
Community
Spoke
Partners: Abt, IHME, CHAI, MAMTA

6. CUSTOMIZED CHRONIC DISEASE MANAGEMENT
CLOSER TO HOME
Example : Hypertension, Diabetes Management in
KwaZulu Natal and Northern Cape, South Africa
0
2,000
4,000
6,000
8,000
10,000
12,000
Prevalence Diagnosed Treated Controlled
Numberofindividuals
Diabetes- Pixley ka Seme
Partners: Abt, IHME, HSRC, Expectra, Project Hope
• Map patient pathways and identify gaps
in care
• Leverage existing HIV/TB platform,
including community health campaigns,
mobile screening in community hubs
• Train providers, community caregivers
in screening, referral, management
• Central Chronic Medicine Dispensing
and Distribution for patient convenience
• Post-diagnostic support with nutrition,
home visits, referrals
• Engage community support groups,
adherence support

7. ENHANCED SYSTEM EFFICIENCY & COMMUNITY
RESPONSE FOR TIME CRITICAL EVENTS
Example: Emergency System of care for Acute CVD in
Bangalore, Karnataka, India
Partners: RTI, UIC, IHME, M.S. Ramaiah Medical College
Community Awareness:
• Education & Training:
Community, General
Practitioners, School
Age Students
• Risk Assessment
Programs
Pre-hospital:
• Standardized
Protocols
• Centralized Call for
Help
• Training of Ambulance
Personnel
• Physician Champions
In-hospital:
• Hub and Spoke
coordination
• Fast Track Patients to
cath lab
Post Event:
• Collect data to
improve processes
and advocate for
policy development
locally and nationally
for improved acute &
chronic CVD
treatment
• Multidisciplinary
coordination of follow-
up care and
sustainable
programming
• Fast Track Patients to
cath lab

8. 8

9. DECENTRALIZED AND INTEGRATED CVD CARE
Example : Rheumatic Heart Disease Care in
Uganda/Tanzania
Partners: JCRC, Uganda Heart Institute, Case Western
 Leverage
HIV/AID; RNMCH
infrastructure
 Build community-
based RHD
screening and
management
 Employ Center of
Excellence
model, linked to
regional cardiac
clinics
 Improve other
CVD detection/
management

10. FINAL THOUGHTS
 Elevate patient
perspectives and
needs through public
and private partners
 Enable frontline health
workers to support and
navigate patient-
centered/relation-
centered care,
evidence to inform
public policy
 Strengthen systems,
including information
systems
 Innovate, integrate,
demonstrate, inform,
scale
Bridge the Divide
PPP FOCUS AREAS FOR EXPANDED NCD CARE