Program Profile

SMARThealth Extend

Cardiovascular disease (CVD) is one of the major causes of morbidity and premature mortality in many low and middle income countries, including India and Indonesia. It is estimated that 20% of Indonesian adults between 41-50 years and around 70% of those aged 51-60 years are at high risk of CVD. Furthermore, two-thirds of those at risk are not receiving appropriate treatment. The situation is similar for India, where recent data from rural Andhra Pradesh shows that almost 17% of the adult population are at high short-term risk of CVD and the vast majority of these individuals are not receiving any preventive drug therapy whatsoever. Despite the availability of evidence-based guidelines for the prevention of CVD, the use of simple, affordable preventive treatments such as smoking cessation strategies, medications to control hypertension and cholesterol is very low in these regions. In addition to population-wide measures, efforts need to be directed to identify individuals at high cardiovascular risk and to offer interventions to lower that risk. In the context of limited resources, prioritizing patients at high risk of heart attack or stroke for blood pressure (BP) lowering treatment is the most effective and cost-efficient approach to risk reduction. This is in line with the national primary healthcare guidelines in both countries.

Despite this, use of BP lowering treatments for CVD risk reduction in rural India and Indonesia is limited, even when low-cost medications are available in the primary healthcare formularies. This is where the SMART (Systematic Medical Appraisal Referral and Treatment) health, an android-based technology platform, aims to deliver low-cost, high-quality healthcare through the existing government-funded primary healthcare system. SMARThealth Extend proposes to test an innovative, multifaceted intervention that draws on three elements:

capacity strengthening of primary care doctors and non-physician health workers (NPHW); development of a mobile device-based clinical decision support system (CDSS) for use by these healthcare providers; and integration of this system within the existing public primary healthcare sector. The study tries to address the existing gaps (both manpower and technology) in the primary health care system by using an android application for measuring the CVD risk of adults between 40-85 years of age through household screening by trained non-physician healthcare workers (ASHAs in India and Cadres in Indonesia). Based on the analysis of patient data by the app, the NPHW can recommend preventive measures, such as behavioural changes relating to tobacco use, physical activity and diet, as well as refer those at high risk to physicians at the primary healthcare facility.

The physician at the facility also manages high risk patients with the support of the CDSS, by reinforcing behavioural change messages and prescribing preventive medications. The prime objective of the intervention is the risk reduction for CVD through optimal management of risk factors, utilizing methods to strengthen the existing public healthcare system. The aim of this demonstration project is to determine whether the SMARThealth platform can be appropriately and rapidly customized and implemented in two large rural communities (in the Indonesian province of East Java and the northern Indian state of Haryana). Mixed methods evaluation will be used to assess feasibility, acceptability, scalability and sustainability in both the sites while in Indonesia, an additional evaluation of effectiveness will be undertaken.

The data collection is ongoing and the study is expected to be completed by May 2018.

The intervention includes the following activities:

- Holding community meetings to raise awareness in the population about CVD and its risk factors.
- Conducting household visits to screen the population for CVD risk factors.
- Provision of training of non-physicians health workers (NPHW) and physicians.
- Implementation of a mHealth screening tool for CVD risk assessment and decision support for health care providers.

The Pfizer Foundation, provided grant funding to support The George Institute for Global Health’s implementation of this program.

The Pfizer Foundation is a charitable organization established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions.

The data for this program has been reviewed by both the companies and the Access Observatory team.