To scale up a proof-of-concept community-based NCD prevention and care model in rural areas of Kaski district.
The proposed project is an expansion of a community-based Non-Communicable Diseases (NCD) prevention and care model, previously tested in semi-urban areas. The model, which involves mobilising Female Community Health Volunteers (FCHV) for the screening and management of diabetes, has proven effective in lowering blood glucose and blood pressure levels. The Ministry of Health and Population (MoHP) has replicated this model in two provinces based on the evidence from the first phase. The project aims to test the model in rural areas, to inform further expansion.Project Activities:1. Capacity Development of FCHV: for the prevention and care of diabetes and hypertension. 2. Strengthening Care Cascade: through training health post staff, improving treatment protocols and workflows, and upgrading four health posts to referral clinics with the capacity to manage minor complications.3. Strengthening Health Information System: through integrating community and health post NCD patient registry into NHMIS reporting flows, and strengthening capacity for data collection, storage, processing, and supply forecasting at all levels.4. Community-Based Diabetes and NCD Service roll outs: delivered by FCHV, including household-level risk factor assessment, screening, health education, and regular follow-ups.5. Community Awareness Programme: including home visits and various community events, such as World Diabetes Day celebration.
• 360 FCHV trained to provide diabetes and hypertension screening and management, health promotion, and outreach, covering the entire target area (approximately 80,000 population).• 90 health staff (health assistant, auxiliary health worker, community health assistant), representing 40 health posts, trained in diagnosis and management of NCDs (PEN package), covering the entire target area.• At least 25,000 people screened, with an estimated 2,000 people diagnosed and enrolled in comprehensive care.• App. 9,000 high-risk people counselled on healthy lifestyles.• 30,800 people have improved awareness of diabetes, NCDs, and a healthy lifestyle.• Performance and clinical impact indicators include blood glucose and blood pressure control, changes in BMI and behaviours.