Community-based approach pushed to curb NCDs in Asia

Community groups in the Asia-Pacific are taking the lead on prevention initiatives for cancer, diabetes, heart disease and other non-communicable diseases (NCDs), which cause 36 million deaths globally. This APEC project helps counter the rise of these diseases by conducting outreach and education on the risk factors and preventive lifestyle changes at the local community level. Following a successful trial across Indonesia, the project developed a framework and guidebook for other APEC economies to replicate this grassroots approach over the next few years.

Led by the APEC Health Working Group, the project comes as the incidence of death through NCDs such as cancer, diabetes and heart disease continues to rise, especially in the Asia-Pacific region. According to the World Health Organisation (WHO), deaths from these diseases in Southeast Asia alone will grow by 15% over the next decade, reaching 10.4 million per year by 2020. In many cases, these diseases are detected at a later stage, resulting in higher economic cost for treatment.

“Non-communicable diseases are now the leading cause of death in many APEC economies,” says Dr Ekowati Rahajeng, Director of Non-communicable Diseases at the Indonesian Ministry of Health, who leads the project. “Cardiovascular disease accounts for about one-third of all deaths in Asia, with mortality rates, on average, 70 per cent higher than in OECD countries. Cancer alone causes an estimated 13 per cent of deaths in Asian economies.”

According to Dr Ekowati, raising awareness of the risk factors associated with these diseases—such as obesity, lack of exercise and smoking—is the most effective way to overcome the fatalities. “Our community-based approach has huge potential, because it teaches people how to protect themselves,” she says. “Without action, non-communicable diseases could have a catastrophic impact on health budgets.”

Community-based intervention: a different approach

The successful model for community-based intervention began in Indonesia over a decade ago, with a single pilot study. It involved experienced, local health workers partnering with community leaders to explain the risk factors that contribute to diabetes, cancer and heart disease, clearly and directly to groups of citizens.

“What makes this approach different is that activities take place in community areas such as schools or religious centres, rather than clinics,” says Dr Ekowati. “Also, activities are driven by local community members, who know how to stimulate attendance and participation.”

The initial pilot was soon replicated in four other provinces in Indonesia. The Community Co-ordinator for West Jakarta, Ms Joko, explains how the program works: “I am one of a group of eight friends, which includes a senior nurse, and through the community-based intervention project, we received training in non-communicable diseases at local health centres.”

Each month, Ms. Joko organises a consultation for between 50 and 70 people, which is supervised by a public health service official. A local doctor measures each individual’s vital signs as well as weight, and then tests blood sugar, and levels of cholesterol and uric acid.

“The sessions allows us to do three things: clearly explain the risks factors that contribute to cancer, diabetes and heart disease, assist with early detection, and then observe changes in behaviour over time,” she says.

Proven results, and expansion across Indonesia

The community approach enabled Dr. Ekowati’s project to closely monitor its effectiveness, and the results proved impressive. Between 2003 and 2006, the prevalence of high cholesterol among target groups in one district—Depok, West Jakarta—reduced by a third, from 31.65% to 19.6%; the prevalence of high blood pressure halved, from 9% to 4.5%, and mean body mass index (BMI) measurements fell for both men and women.

With clear evidence that the project’s unique community-based intervention approach had a concrete impact, the project gained acclaim. In 2012, the community-based model for NCD reduction was formally incorporated in Indonesia’s health strategy. Community programs were implemented in all 34 provinces in Indonesia, with approximately 11,000 community groups delivering risk-factor programmes in each of 500 local districts.

Gaining traction across the APEC region

In 2013, the APEC Health Working Group funded the project to expand the approach in the region—recognising that Indonesia’s model could help member economies take practical steps to respond to two key international health initiatives: the WHO Global Action Plan on non-communicable diseases 2013–2020, and the 2011 declaration on non-communicable diseases by the United Nations General Assembly.

Dr Ekowati proposed using the Indonesian community-based intervention experience to design and develop a comprehensive community programme that could be used by multiple economies—right across the Asia-Pacific region. It would include guidelines for community health discussions, and a framework to help community workers set up each local project.

With funding from the APEC Support Fund, Dr Ekowati convened a landmark workshop in April 2014 in Bali, Indonesia. The prospect of adopting a tried and tested strategy for non-communicable diseases prevention drew health experts, academics, and policy makers from Chile, Japan, Malaysia, Peru, the Philippines, Russia, South Korea, Thailand and the USA.

Input from these specialists resulted in an APEC guidebook for implementing the approach in other economies which was published in August 2014. The framework on community-based intervention explains how the concept works in practice, examines the challenges involved and provides recommendations to help APEC economies learn from Indonesia’s experience.

APEC member economies such as the Philippines and Thailand now intend to use this guidebook to help implement community-based prevention programs of their own.

The bigger economic picture

As the programme readies for APEC-wide rollout, its sponsor is quick to point out that the goal of containing and reducing these NCDs is inseparable from wider social and economic objectives.

“Cancer, diabetes, heart disease and other non-communicable disease are chronic illnesses that require long-term treatment,” Dr Ekowati says. “The costs of treatment and healthcare lead to higher health expenditure and lower productivity—and remember these diseases are the biggest cause of premature death.”

According to the WHO, NCDs cause an estimated 63% of global fatalities every year.

“Without these social programs, there will be an inevitable decline in the economic status of many people—in particular those on middle or low incomes. This programme has huge potential, not just to limit the impact these diseases have on prosperity today, but to prevent non-communicable diseases from dominating health budgets in the future.” (Press Release from Webwire)

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