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Non-communicable diseases are responsible for 70% of deaths in Bangladesh. BRAC is partnering with the Government of Bangladesh to tackle this, through a combination of community health workers and technology.
What is the biggest killer of people globally? Perhaps war comes to mind, or famine, or natural disasters?
The answer is much closer to home – the biggest killer globally is non-communicable diseases.
Non-communicable diseases are diseases not transmitted between people or animals, meaning diseases such as blood pressure disorders, diabetes or asthma.
One person dies of non-communicable diseases every two seconds around the world. Almost 9 out every 10 of these people are from low and middle-income countries. In Bangladesh, non-communicable diseases account for 70% of all deaths. Non-communicable diseases are often hard to see, and can take years to develop, resulting in them becoming a silent but rapidly worsening crisis in many Bangladeshi families. With many people in Bangladesh struggling to access basic healthcare services, non-communicable diseases also often result not only in people physically suffering, but can create a huge economic burden on families.
More than half of Bangladesh’s population will be over 35 years old by 2030. With population growth rates continuing to decrease, Bangladesh’s population is ageing – a trend which will continue. This will worsen the issue of non-communicable diseases – the older people are, the more vulnerable they are.
Bangladesh has been adapting its public health policy to tackle this crisis. The national healthcare system, which was heavily focused on tackling infectious diseases and maternal and child healthcare, is being transformed into an integrated primary healthcare system with strong outpatient care and community health components.
As first steps, Bangladesh’s Directorate General of Health Services started a Non-communicable Disease Control Programme, and, in 2018, began establishing dedicated non-communicable disease corners in every Upazila Health Complex. BRAC has been supporting these efforts by functionalising these corners and digitising the data which comes out of them, to track prevalence and look for trends.
Social capital joining forces with technology
Non-communicable diseases are unassuming killers. They take time to develop and their treatment regimes are generally not very invasive, which can give people a false sense of security – leading them not to take treatment seriously.
While an act like taking tablets is incomparable to the seriousness of open surgery, for example, serious effort is needed when those tablets need to be taken at the same time every day for consecutive years. Fighting non-communicable diseases is a slow and steady game of monitoring symptoms, complying with treatment regimes and consistently following up. As these actions rely on the attentiveness of the person suffering from the disease, the success rates of treatment rises when people are supported. It works even better when the person supporting has social capital with the patient.
The support needed is uncomplicated – encouraging a healthier lifestyle, ensuring medication is taken, and monitoring symptoms. These low-tech actions are exactly what BRAC’s brigade of community health workers do best, and they pride themselves on the social capital they have with their patients. A typical health worker is a familiar face in the community who visits the families in their community monthly, bringing affordable healthcare products, services and information to their doorsteps. They know families so well that they know babies before they’re even born.
Now where does tech come in? To build on the work of community health workers, we wanted to be able to track the support being given by all of them, to look for trends – and ensure workers could access the right information on non-communicable diseases at critical moments.
In 2016 we partnered with Medtronics to develop an app to do this. Preliminary results were promising—on average, 90% of both home-based and clinic-based patients showed clinical improvements, and 91% continued to follow treatment regimes
Then, we started working towards a multi-year partnership with Bangladesh’s Ministry of Health and Family Welfare to expand access and improve outcomes for people with non-communicable diseases. The proposed public-private partnership will be based on a ‘Joint Care Model’ between Government of Bangladesh, BRAC and Medtronic Labs. The focus will be on equipping healthcare providers to manage a cohort of hypertensive or diabetic patients remotely, with an aim to improve patient outcomes, conserve valuable resources, and decrease the long-term cost of care.
How will the partnership work?
BRAC’s community health workers will go door-to-door to do the primary screening, ensuring a community-centred healthcare delivery model. They will measure blood pressure and sugar levels and record their details, and enter all the data through an app on a tab. If the patients’ health is flagged, they will be referred to their nearest community clinic.
A Community Health Care Provider will screen the patients a second time at the community clinic, recording height, weight, blood pressure, blood sugar and any symptoms – and the app will produce a colour code. Green means risk-free, yellow is moderate risk and red is high risk.
High risk patients will be referred to the closest Upazila Health Complex, where they will receive free management services and any required medications. Community Health Workers will close the loop by going to patients’ doorsteps to ensure they follow their treatment plan.
In addition to improving individual patient outcomes, data collected will be used for public health trend analysis, research, and to inform policy recommendations.
An additional focus on prevention
In addition to the focus on curative care, as outlined above, there is an urgent need for increased efforts in prevention. BRAC is advocating for investment by the government in this, and, in parallel, providing health promotion services through community health workers.
BRAC Health programme caters to the healthcare needs of over 80 million people across Bangladesh, through a combination of community-based and facility-based services. Its community-driven healthcare approach employs 50,000 community health workers and volunteers who deliver quality affordable care to populations living in the most deprived and vulnerable conditions. BRAC’s community health workers are all women, who deliver door-to-door primary and essential healthcare, and facilitate linkages with formal providers.
Dr Imran Ahmed Chowdhury is a Programme Coordinator at BRAC Health programme.