Investigator(s)
| WHO Technical Officer |
Pema Lethro National Professional Officer, WHO country office, Bhutan Pema Lethro 
|
| Principal Investigator |
Karma Tenzin Khesar Gyalpo University Medical Sciences of Bhutan Karma Tenzin
|
| Co-Investigator(s) |
Lora Sabin Global Health Department of Global Health Boston University School of Public Health Massachusetts Lora Sabin
|
Title(s) and abstract
| Scientific title | Evaluation of the PEN/SCCI interventions in the districts of Bhutan |
| Public title | Evaluation of PEN/SCCI interventions in the implementing districts of Bhutan |
| Background | Globally, noncommunicable diseases (NCDs) are an increasingly significant public health burden. Each year, over 15 million adults die prematurely from NCDs, among whom over 85% live in low- and middle-income countries.1 The World Health Organization’s (WHO)’s Package of Essential Noncommunicable Disease (PEN) Interventions for Primary Health Care in Low-Income Settings was launched in 2010 to help address this rising burden.2 The PEN program stresses integrated management of NCDs in primary health centers through a set of relatively simple and cost-effective interventions, including health education, promotion of healthy behaviors, early diagnosis of NCDs, identification of risk factors, regular follow-up, and timely referrals to larger facilities when necessary.2 The program has been implemented in a number of countries in recent years, including Myanmar3, Kyrgystan4, Moldova5,6, Tajikistan7, and Palistine.8 The published literature on these projects provide some early evidence of impact as well as implementation issues, including gaps in basic service provision at the primary care level.8 They highlight the need for more research on both implementation and evaluation. |
| Objectives | 1. To use mixed methods to assess the implementation of the PEN/SCCI program to date, including training, team building, mentoring, and supportive supervision activities. 2. To use mixed methods to assess impact on patient outcomes related to NCD care and treatment. 3. To identify gaps in program development to inform future expansion of the PEN/SCCI program in Bhutan and other resource-constrained settings. |
| Study Methods | Study population 4.4 Sample size We will collect data from both quantitative sources (health worker survey, facility checklist, and patient records) and qualitative sources. The latter will encompass in-depth interviews (IDIs) from health workers and patients. Below is the sample size for each source. Health worker survey: n=20 providers/hospital and 2-3 providers per BHU (maximum = 3/BHU; n=54). The total sample size for the survey will be n=29/district or n=174 total. Facility checklist: We will examine patient records at each facility. We will collect data from 6 hospitals and 18 BHUs, for a total of n=24 facility checklists. Patient Records: Patient Record Form A: NCD Patients Treated at Facility: n=12/hospital and up to 6 per BHU, for a total of n=30/district or n=180 total. Patient Record Form B: Homebound NCD Patients: n=4/hospital and 2 per BHU, for a total of 10/district, or n=60 total. Health Worker IDIs: n=24-32 total maximum. We will recruit health workers from the two intervention groups (3-4 health workers/hospital and 1-2 health workers per BHU). NCD Patient in-depth interviews (IDIs): n=40 maximum. We will identify patients for recruitment of up to 4 patients/facility in the two intervention groups (4 hospitals and 8 BHUs), aiming for a maximum of 10/district across all facilities. Homebound Patient IDIs: n=20 maximum. We will select a maximum of 5 patients in each district across all facilities. |
| Expected outcomes and use of results | The goal of the proposed study is to build on the prior evaluation and assess the impact of the PEN/SCCI trainings in the trained districts compared to those districts in Bhutan that have yet to implement any PEN or SCCI program to provide useful information for scale up in Bhutan and other resource-constrained settings. |
| Keywords | Evaluation, PEN, Bhutan |
Research Details
| Student research | No |
| Start Date | 17-Oct-2022 |
| End Date | 03-Oct-2023 |
| Key Implementing Institution | Khesar Gyalpo University Medical Sciences of Bhutan |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Non-communicable diseases & Healthy Lifestyles, Health Systems Research |
| Research field(s) | Non-communicable Disease, Health Care Seeking/Utilization |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Under Review |