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Principal Investigators: Parveen Parmar, University of Southern California & Ruwan Ratnayake


The project will investigate and improve a community health worker (CHW) based model for non-communicable disease (NCD) care in a humanitarian emergency. The specific aims are:-
1) Using a population-based survey, establish the prevalence of hypertension and diabetes, barriers to accessing care, and proportion of cases not under care.
2) Using causal loop analysis with stakeholders of the CHW programme and primary health care, identify pathways for service provision, technical gaps, and areas for adaptation. Programme managers will modify the CHW-NCD programme accordingly.
3) Over six months, implement the re-designed CHW strategy (i.e., training in case identification, referral, prevention, monitoring). The Consolidated Framework for Implementation Research will be applied to examine implementation.
4) Research adherence to care and effects on disease control (cohort study among clinic attendees examining CHW-related and other predictors, physiological outcomes, and complications), implementation feasibility and acceptability of the strategy from the perspective of CHWs (qualitative research, routine programme data analysis), and cost-efficiency (documentation of costs associated with previous and improved models).

Expected Outcomes

Globally, more than 60% of refugees live in urban areas and have limited access to health systems. Increasing access to health services to urban refugee populations with NCDs is recognised as a major challenge for which humanitarian organisations are not well adapted. Moreover, NCDs disproportionately affect older adults, an under-served population in humanitarian practice.
If the effectiveness of the intervention is supported, then we expect that a) the health sector will reinforce delivery models that enable NCDs to be better detected and managed at the community level, b) quicker diagnosis at facilities, and c) improved patient adherence to treatment and counseling. This in turn should improve disease outcomes and minimize complications.
The study will provide a strong case for addressing the continuity of care for urban refugees through CHWs, similar to that used in more stable settings. As costing data will be collected, estimation of the cost-efficiency is possible. The implementation science approach will aim to identify whether or not this programming can be implemented well, and at what levels (patient adherence/satisfaction, clinical outcomes, etc).

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