Strengthening Primary Healthcare Delivery for Diabetes and Hypertension in Eswatini

Summary

The WHO-PEN@Scale project is a three-arm cluster-randomized trial that is investigating the population-level effects of a healthcare reform in Eswatini, which aims to strengthen primary care for diabetes and hypertension. Prior to the reform, healthcare for diabetes and hypertension was mostly provided through physician-led teams in hospital outpatient departments. The healthcare reform aims to strengthen the provision of nurse-led care for diabetes and hypertension in primary healthcare facilities and community health worker-led care for these conditions in the facilities' catchment areas. The reform will broadly be guided by the World Health Organization's "Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings" (WHO-PEN). The trial will take place at 84 clusters (a primary healthcare facility and its catchment area) across the country.

Conditions

• Diabetes Mellitus
• Hypertension

Interventions

OTHER

DSD

This intervention consist of three Differentiated Service Delivery Models in which stable clients can be enrolled. The fast-track model gives preferential treatment to enrolled clients. Clients arrive at clinics, usually early in the morning, and can see the nurse as well as collect their medication without queuing. This model mainly targets the working population. The facility-based treatment clubs consist of bimonthly meetings where clients meet in groups of approximately 20 members. They receive health counselling, risk factor screening and medication prescription. This model mainly targets clients living close to the facility. The community advisory groups consist of groups of up to six clients. Groups are equipped with a point of care blood pressure and blood glucose measurement devices. They take turns in collecting the medication for the entire group and meet on a monthly basis. This model targets clients in hard-to-reach areas.

OTHER

CDP

Community Distribution Points are set up on a monthly basis in communities linked to the clinic. Healthcare staff sets up a temporary point of contact where clients can obtain screening for diabetes and hypertension, health counselling, referral to primary or tertiary facilities, and medication.

Sponsors & Collaborators

• Amsterdam Institute for Global Health and Development

  collaborator OTHER

• Swiss Tropical & Public Health Institute

  collaborator OTHER

• Clinton Health Access Initiative, Eswatini

  collaborator UNKNOWN

• University of Göttingen

  collaborator OTHER

• University of Eswatini

  collaborator UNKNOWN

• SWABCHA, Eswatini

  collaborator UNKNOWN

• Diabetes Swaziland

  collaborator UNKNOWN

• University Hospital Heidelberg

  lead OTHER

Principal Investigators

• Pascal Geldsetzer, MD ScD MPH · Stanford University

• Jan-Walter De Neve, MD ScD MPH · Heidelberg Institute of Global Health, Heidelberg University

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

40 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2021-11-01

Primary Completion

2023-12-05

Completion

2023-12-31

Countries

• Eswatini

Study Locations