Project Details
- Name of the Project: Hearts Intervention Design targeting At Younger Adults and Ageing Population (HRIDAYA)
- Project Site / location:
| S.N. | Province | District | Municipality | Ward No |
| 1 | Gandaki | Kaski | Pokhara Municipality | All |
| 2 | Bagmati | Kathmandu | Kageshowri Manohara Municipality | All |
| 3 | Bagmati | Bhaktapur | Changunarayan Municipality | All |
3. Project Duration:
Date of Commencement: 2024/1101
Completion Date: 2029/10/30
4. Project Background:
Our aim is to improve the system of care and services for people living with high blood pressure and diabetes in urban areas. We aim to implement proven cost-effective solutions to improve the current gaps in the diagnosis, treatment and long-term management of diabetes and high blood pressure. We will co-design an intervention package with continuous engagement of policy makers, health workers, people living with high blood pressure and diabetes, community health workers (CHWs) and researchers for the timely detection, management and control of these conditions. We will engage consumers through Consumer Advisory committees set up in each of the three municipalities. Heart’s Intervention Design Targeting Younger Adults & Ageing Population (HRIDAYA – Nepali word for ‘Heart’) will be a co-designed multi-level intervention to improve diagnosis, treatment and control of hypertension and diabetes in three diverse cities in Nepal.
As part of the intervention, we will strengthen the community health system with training to build the capacity of CHWs to measure blood pressure and blood sugar in patients’ homes, provide lifestyle counselling, and refer those with elevated blood pressure or blood sugar to health facilities. To support CHWs, a mobile application will be customized to the local context and CHWs will be trained to use the app to correctly screen, counsel and refer relevant patients to health facilities. At the health facility level, the health workers who receive these referrals, via a computerized dashboard, will be trained in diagnosis, and trained to provide appropriate guideline-based lifestyle and pharmacological care. The CHWs will further follow-up patients to optimize adherence to medications. There will be regular meetings between health workers and CHWs to discuss monthly follow-up targets, monitoring of cases and any other operational issues. The computerized dashboards will also enable local policy makers to track the HRIDAYA progress on diagnosis, treatment, and control. The project aims to evaluate both clinical outcomes, in reducing blood pressure and blood glucose, and implementation outcomes, such as feasibility, acceptability, reach, implementation fidelity and sustainability of this new process of care.
In Nepal, deaths due to non-infectious diseases, such as heart disease and stroke, have risen over time, accounting for 66% of deaths in 2018, with ischemic heart disease contributing to one in six deaths and diabetes to 4% of deaths. These diseases also contribute to the highest healthcare spending of the Nepalese health budget, comprising a cost of NPR 37.73 billion (from 2012-2016) and 31% of all out-of-pocket costs. Early diagnosis and management of high blood pressure and diabetes, including modifying poor lifestyle habits, are critical for reducing mortality and disability from diseases such as heart disease and stroke, yet identification, treatment and control of these conditions in Nepal remains low.
The project has direct link with SDG 3, which focuses on Good Health and Well-being. This goal emphasizes the importance of ensuring healthy lives and promoting well-being at all ages. Hypertension is a major risk factor for cardiovascular diseases, the leading cause of death worldwide. Similarly, the 16th fifth year plan of Nepal envisioned healthier, educated and skilled human resources in the country and this project intervention will be helpful on reducing hypertension in project area enhance the healthier community.
5. Project Objective:
The project aims to improve the system of care and services for people living with hypertension and diabetes in urban areas. We aim to achieve following objectives:
1) Establish technical stakeholder and consumer groups to guide the implementation.
2) Conduct a feasibility assessment of the multi-level Intervention for improving continuum of care for non-communicable diseases.
3) To adapt HRIDAYA interventions within each primary and community health setting for sustained impact.
4) Develop and expand an enhanced model of care for optimizing monitoring and tracking of people with hypertension and diabetes.
5) Augment the capacity of health care professional and CHWs to diagnose and manage hypertension and diabetes.
6) Evaluate the implementation and uptake of HRIDAYA using the RE-AIM framework and undertake a health economic evaluation
7) Evaluate scalability of HRIDAYA using the Innovative Care for Chronic Conditions to understand reach and penetration, adaptation and impact.
8) Develop an implementation toolkit to facilitate subsequent scale up.
6. Activities to be carried out under Project/Program:
- Ethics approval
- Identify and need assessment
- Convene and hold annual meetings with a national stakeholder’s group
- Convene and hold quarterly H-CAC meetings
- Convene and hold quarterly H-TAC meetings
- Steering group meetings (Cis and representative from each municipality) biannually
- Need assessment (literature review, rapid assessment, expert opinion)
- Focus group discussion
- Data analysis from the routine HMIS
- Co-design and pre-implementation
- Co-design workshops and Package finalization
- System assessment for HMIS tracking
- Technical working group meetings
- Baseline data collection
- Implementation
- Health worker capacity building/training
- Mobile App testing and piloting
- Training of CHWs
- Home visit and referral by CHWs
- CHWs/Health Worker bimonthly meeting
- Midline and End line data collection
- Cost-effectiveness analysis
- Maintenance and sustainability
- Sustainability action plan development
- Project Dissemination
- Data analysis & manuscript preparation
- Dissemination at local/federal levels