Non Communicable Diseases (NCD) workflow
Noncommunicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70% of all deaths worldwide. Almost three quarters of all NCD deaths, and 82% of the 16 million people who died prematurely, or before reaching 70 years of age, occur in low- and middle-income countries (WHO 2020). NCDs are the second leading cause of deaths in adults after HIV/AIDS in Malawi. They account for 16% of all deaths with 17% in males and 14% in females. Malawi has very high levels of hypertension at 32.9% in adults, which is much higher than many countries in the region.
The epidemic of NCDs poses devastating health consequences for individuals, families and communities, and threatens to overwhelm health systems. Community health programs can support in multiple functions in NCD programmes, including educating, screening and referring community members for NCD detection, linking them to care, accompanying them to clinic appointments, providing psychosocial support, palliative care support and making referrals to other services.
The NCD workflow seeks to enhance earlier referral to prevention, care, treatment and support for persons newly identified as having a NCD. This will help in reduction of NCD related deaths. CHWs can help to enhance the reach, uptake and quality of NCD services, as well as the dignity, quality of life and retention in care of people living with NCD.
The CHT Application with NCD workflows are used by health workers and clinical staff to:
- Conduct screening of NCDs symptoms
- Refer eligible persons to the health facility for further management
- Ensure on-time follow up of persons on NCD treatment programs for adherence counselling
- Check on side effects and danger signs screening for person on NCD treatment
- Conduct defaulter tracing of clients already in NCD treatment
- Tasks for monthly screening for all persons over 5 years of age
- Guided screening to ensure adherence to PIH NCD protocols
- Referral follow up tasks for referred patients
- Link between facility enrollment and community follow ups
- CHW follow up tasks for treatment defaulters identified at health facility
- Dashboards to monitor NCD related activities and outcomes
- Supportive supervision ratings to identify gaps and mentorship opportunities
- Educating all household members on NCDs
- Integrated Screening all household members over 5 years of age
- Follow-up on referred cases
- Monthly home visits for patients enrolled on NCD treatment
- Refer NCD patients with dangers signs
- Treatment defaulter tracing
- All new NCD patients are linked to care
- All NCD patients adhere to treatment
- All treatment defaulters are traced and returned to treatment
Assumptions
- Constant supply of NCDs drugs at the facility
- CHWs are we trained on the PIH Community NCD programme approach
- CHWs have community trust
- Facility staff regularly update the NCD register.
- Functioning connectivity and devices for health workers
Reduce NCD related deaths
Once a hierarchy of people and places is established, forms are added at different levels. This diagram indicates the forms that can be filled about a person in the app (in this case, family members at the household level), as well as the person/user who will access these forms and make the reports (CHWs at the CHW Area level). Some forms are accessible as actions from the family member’s profile as actions, others from the CHW’s task list as tasks, and some as either.
Non-Communicable Diseases workflows are defined to connect form actions and data with people. Detailed documentation for these forms and task schedules are linked from the workflow diagrams below. Accompanying this documentation are tips and insights into the design decisions made along the way, and suggestions for how and where to customize the forms.
