John Walley on improving health service delivery for chronic disease in primary care: using the COMDIS Health Service Delivery (HSD) approach

John Walley is a Professor of International Public Health at the Nuffield Centre for International Health and Development, University of Leeds. He is also the Co-Research Director of the Health Service Delivery Research Programme Consortium (COMDIS-HSD).

COMDIS-HSD is a £7.5 million DFID funded, seven country research programme, incorporating service delivery themes ofprimary care, urban health, community interventions and drug resistance. Within these themes research includes TB, HIV care, Malaria, noncommunicable diseases (NCDs) and family planning. In their work for COMDIS-HSD, John and his colleagues conduct operational research which is “embedded” within Low to Middle Income Country (LMIC) ministry of health services, by developing, piloting, evaluating and trialling interventions.  In relation to NCDs, he is currently leading the development of case management guides, training modules and other tools for early detection and treatment of diabetes, hypertension and cardio-vascular disease. These are for use in primary health care facilities and are being adapted to the country contexts, as well as being evaluated in several African and Asian countries. John’s research interests include designing service delivery interventions, strengthening integrated district health systems and developing a package of care that is replicable and sustainable at scale. John is a general practitioner and public health specialist with many years experience in Africa and Asia before joining the University of Leeds.

In this video John explains the COMDIS-HSD approach to improving health service delivery for chronic diseases focusing on primary care. The video illustrates the approach and explains the development and evaluation of a package of materials for cardiovascular diseases (CVD) and diabetes case management and prevention. The materials are designed for patient-centred care delivered through primary health care facilities, with up/down referral as required. They include: clinical and lifestyle education desk guides; an information leaflet; training modules; implementation guide; patient register and treatment card. These guidelines and related tools must be adapted to the local health service context in country. Adaptation is by the Ministry of Health and NGO partners in a technical working group process, using options included in the adaptation guide. The TB deskguide and materials, and the complete package of NCD-CVD guides and materials are available through the COMDIS-HSD website. These are freely available for non-commercial purposes, and for country adaptation.

A generic CVD-diabetes Desk Guide focuses on managing cardiovascular disease, diabetes and hypertension in adults in LMICs. The guide offers a concise “quick reference” for clinical officers, nurse practitioners and other clinicians when providing routine care and health education to all patients. A Health Educator Desk Guide provides a detailed guide on lifestyle advice and treatment support for nurses, paramedics and other educators. These guides are currently being piloted and are likely to undergo further revisions.

COMDIS-HSD aims to develop feasible and effective health service delivery strategies for underserved populations in low and middle income countries. A ‘How to’ Guide on research and development is available and describes COMDIS-HSD’s embedded approach to health research and service development. This is freely available for use by other researchers and health service development NGOs.

The World Health Organization has also developed guidelines for primary health care for the prevention and control of NCDs in low-resource settings. These guidelines are split into two sections, with the first focusing on the diagnosis and management of type 2 diabetes and the second focusing on managing asthma and chronic obstructive pulmonary disease. These include the evidence for diagnostic criteria, also included in the COMDIS-HSD guides.

Other resources relevant to the COMDIS-HSD approach are the WHO’s World Health Report 2008 and their Framework for Action for strengthening health systems to improve health outcomes.

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