RESist-NCD: Building resilient and people-centred health systems for non-communicable disease prevention and control in Pacific and Southeast Asian countries

The RESist-NCD Partnership

RESist-NCD comprises a comprehensive four-year program of work (2024-2028) to support governments in Fiji, Papua New Guinea, the Philippines, Vietnam and Cambodia to develop interventions for the prevention and early treatment of diabetes and hypertension (a key cardiovascular disease risk factor). The RESist-NCD consortium includes: The George Institute for Global Health; UNSW, Sydney; and the Clinton Health Access Initiative (CHAI), and embeds strong partnership with relevant interest-holders in governments, health services, academic institutions, civil society organisations, communities and international agencies in the RESist-NCD partner countries.

The RESist-NCD program is addressing crucial gaps in NCD policy implementation through three integrated workstreams that take a whole systems approach. Our program will not only strengthen high quality, equitable diabetes and hypertension prevention, screening and management services integrated with primary health care but enhance critical health system building blocks required to support the sustainable of these services and withstand future shocks. Further, we recognise the necessity of tackling upstream determinants for long term reduction of non-communicable disease burden – specifically the food and water environment – and will deliver evidence-based and community centred policy interventions and implementation strategies to optimise these.

Background

The increasing burden of non-communicable diseases (NCDs) globally is a significant public health concern. In countries of the Southeast Asia-Pacific region, NCDs account for up to 86% of all deaths, among which diabetes and cardiovascular disease are responsible for up to one half. The high burden of NCDs is driven by various causes including high exposure to risk factors with limited regulatory constraints, lack of community awareness and diagnostic capacity at the primary health care level, and lack of access to adequate and affordable NCD prevention, screening and management services and commodities. In Papua New Guinea, only one-third of those living with hypertension are aware of a diagnosis, and less than one in five are on treatment. In Vietnam, as of 2024, only 40% of people with hypertension and 35% of people with diabetes knew of their status, and approximately one-quarter of people with detected hypertension or diabetes received treatment.

Implementing effective and equitable NCD interventions through primary health care can enhance early detection and management and enable continuity of NCD services during public health crises. While the five RESist-NCD partner countries have strong national NCD policy frameworks and have adopted the World Health Organization (WHO)-recommended Package of essential noncommunicable (PEN) disease interventions (a package designed to improve the coverage of appropriate services for people with NCDs services in primary care settings), most countries are struggling to implement them. For example, the Philippines adopted the WHO PEN Package in 2012 for integration within primary health care, yet to date has not evaluated implementation strategies or devised plans for national roll-out, while in Fiji, the PEN program has been piloted and evaluated in a select number of divisions, yet further investment in refinement and scale-up is of critical importance to ensure equitable access to NCD services within primary health care.

Aim

The overall objective of the RESist-NCD program is to support Pacific and Southeast Asian countries to deliver diabetes and hypertension policies, programs and services that are accessible, equitable, affordable, high quality and resilient to health threats.

RESist-NCD’s end-of-program outcomes include:

1. Primary health care services demonstrate strengthened prevention, screening, early detection and management of diabetes and hypertension;
2. Quality improvement across the health system building blocks, particularly access to essential medicines, workforce development and use of health data for decision making;
3. Communities mobilised to drive environmentally and culturally sensitive initiatives for NCD prevention and management.

Research Methodology

The RESist-NCD program is organised around three thematic workstreams (Models of Care, Resilient Health Systems, and Environmental Enablers) and two cross-cutting workstreams (Impact Assessment and Community Engagement).

• Workstream 1: Models of Care is implemented at the service level and will focus on implementing and evaluating primary health care services to effectively, cost-effectively and equitably address diabetes and hypertension by conducting rapid assessment of health systems, optimizing the use of digital health solutions in primary care, and developing and evaluating stronger diabetes and hypertension referral networks from primary to secondary care.
• Workstream 2: Resilient Health Systems is implemented at the system level and will focus on strengthening supply chains and procurement for diabetes and hypertension screening and medical products, enhancing data collection and interpretation capabilities for monitoring and planning, designing support packages to strengthen primary health care workforce, and establishing investment cases for the integration of diabetes and hypertension services within primary health care.
• Workstreams 3: Environmental Enablers is implemented at the community level and will focus on co-developing initiatives to promote healthier lifestyles in relation to NCD risk. This includes supporting community-led solutions to achieve food and water security, implementing measures to switch salt supply away from sodium-chloride to potassium-enriched salt, and facilitating interventions to promote lower salt and sugar diets through evidence-based, community-informed and led policy and service interventions tailored to local contexts.
• The two cross-cutting workstreams will focus on 1) developing a regional NCD policy impact assessment framework to increase national and regional capacity for evaluation, and 2) embedding community engagement and partnership informed by Traditional models of engagement in the design, delivery and evaluation of diabetes and hypertension prevention and management initiatives.

Embedded across the program is a commitment to integrating and strengthening efforts to promote gender equality, disability and social inclusion (GEDSI) considerations within all activities, including within the ways of working and research practices of the RESist-NCD consortium.

Current status

The RESist-NCD program has recently completed its inception phase (1 July 2024 – 31 December 2024) in which a major focus was the refinement of implementation plans, administrative processes, governance, personnel and partnerships. Some key developments in this period include:

• Discussions progressed with government and non-government partners in Fiji, PNG, the Philippines, Vietnam and Cambodia and led to the establishment of contractual agreements to support collaborative RESist-NCD program implementation.
• A GEDSI analysis was also completed to provide a strong, contextual understanding of the local GEDSI context across RESist-NCD partner countries and internally within the RESist-NCD consortium. This analysis informed the development of the RESist-NCD GEDSI strategy.
• CHAI Cambodia RESist-NCD team members completed an ‘NCD Community Perceptions Survey’ in Kampot Province (493 respondents) through a parallel project. The results from this survey will support the implementation of the RESist-NCD project in Cambodia.
• The RESist-NCD Cambodia team also supported the Cambodian Ministry of Health to develop and implement an NCD Excel Data Collection, Consolidation and Visualisation tool which will be used to support data collection throughout the RESist-NCD program.
• In PNG, the program has commenced work on a health systems and policy situational analysis to understand the contextual influences on NCD prevention and response.