EMPOWER - Empowering People Living with NCDs & Frontline Health Workers and Leveraging Digital Health Technology, to tackle the Burden of Chronic Diseases in Sub-Saharan Africa
Project Abstract
With 74% of deaths and over 75% of all Disability Adjusted Life Years, noncommunicable diseases (NCDs) are the leading cause of death and disability worldwide. In low-and-middle income countries (LMICs), primary care providers often lack sufficient training and resources to effectively diagnose and manage NCDs, while health centres and information systems are poorly organised to ensure continuity of care. Consequently, treatment gaps—defined as the proportion of individuals with a disease who are not treated—are alarmingly high: 82% for hypertension, 80% for diabetes, and 75–85% for epilepsy and mental disorders. The situation is even more critical for individuals with multiple long-term conditions (MLTCs). EMPOWER aims to reduce the burden of MLTC NCDs in Benin and Togo by closing treatment gaps through interventions previously validated in Laos, Cambodia, and Myanmar.
The project will optimise existing human resources, such as community health workers (CHWs), nurses, midwives, and GPs, by training them in evidence-based NCD management strategies (WHO-PEN and WHO mhGAP) and equipping them with a digital tool. The android-based app will streamline the collection of key indicators for screening, diagnosis, and monitoring of NCDs, while enhancing communication among healthcare providers. CHWs will coordinate a comprehensive package of community-based activities, including NCD screening (targeting cardiometabolic diseases, mental disorders, and epilepsy), risk factor assessments, health education, regular care and follow-up.
The 4-year project comprises three phases: Phase A, a mixed-methods assessment to gather insights from patients, CHWs and healthcare providers, guiding the adaptation of intervention and tools; Phase B, the implementation of the intervention; and Phase C, a hybrid evaluation of effectiveness outcomes (treatment gaps, NCD-related events, clinical parameters, quality of life, stigma, cost-effectiveness - intervention vs control) and implementation outcomes using the RE-AIM framework. This will inform future scaling-ups.
Swiss TPH leads on the Workpackage 2 - the contextual analysis. The respective study shall examine how people living with one or several NCDs navigate through the health system, and the current provision of services for NCDs control at the community level. This study also aims to explore the readiness of CHWs to integrate digital health into their practice and the acceptability by health professionals and patients of an intervention which combines community health workers (CHWs) involvement and digital tools. To do so a mixed-methods approach (quantitative and qualitative) is used. It will be conducted in rural areas of Benin (Ouémé department) and Togo (Avé district).
The quantitative component will rely on a cross-sectional survey among health personnel (200 participants per country) to explore current service provision, practices, digital maturity, and acceptability of proposed interventions, as well as a household survey (210 people with NCDs per country) to document care pathways, use of health services, and acceptability of hybrid interventions. Data will be collected using ODK on tablets, with geolocation and secure transmission.
The qualitative component will consist of semi-structured interviews (20 with CHWs, 30 with patients and caregivers per country) based on an interview guide to explore in depth the representations, practices, and perceptions regarding NCDs, digital health, and health service provision. A hybrid deductive-inductive thematic analysis will be conducted.
The contextual analysis will produce several deliverables and concrete outcomes: (i) Mapping of existing services for NCDs control, identification of roles and competencies of CHWs, and description of care pathways; (ii) Assessment of the digital maturity level of the health system and CHWs, serving as the basis for the technical design of the digital tool; (iii) Measurement of the acceptability of hybrid intervention approaches (digital and community) by different stakeholders: patients, CHWs, health professionals, decision-makers; (iv) Practical recommendations to adapt the intervention strategy to local specificities and for co-creation workshops to validate results with stakeholders and co-define the content, modalities, and implementation schedule of the EMPOWER intervention.
