SPICES PROJECT- Improving NCDs health centre capacities and championing community transformation

Written by Edith Mukantwari

Attending the SPICES project dissemination workshop on Thursday 29^th August 2019, was a truly life altering moment for me, in the best way possible. When I got the call to attend and give a talk on the patient’s experience, I was nervous. As always, I had too much to say and didn’t really know how to organise my thoughts. I’m always afraid that I’ll forget something very important and the pressure is high. When the day finally came though, I was very calm for the first time since I’ve been attending these events. The event did not disappoint and I am so happy that I get a chance to report about it so that more patients have a chance to know and keep up with ongoing developments in healthcare so they can get the best chance to get relevant care and interventions.

Dr. Geofrey Musinguzi, MUSPH, presenting project impact and updates at the dissemination workshop

SPICES is an acronym that stands for “Scaling up Packages of Interventions for Cardiovascular disease prevention in select sites in Europe and Sub-Saharan Africa” that you can read more about here. It is a collaborative undertaking by six Universities – The University of Manchester & Nottingham Trent University in the UK, University of Antwerp in Belgium, the University of Limpompo in South Africa, Brest University in France and Makerere University in Uganda. The study is funded by the European Union’s Horizon 2010 research and innovation programme. You can also follow the SPICES Uganda project on Twitter or Facebook.

Dr. Joseph Otware, Director General, MOH, giving the key note speech

SPICES is a five year project that started in 2017. In Uganda, the implementation phase started in this year, January 2019 and is collaboratively undertaken by the Makerere University School of Public Health, The Uganda Ministry of Health, the district health department of Mukono and Buikwe Districts and the primary health care facilities and communities in 20 selected parishes. The aim of the project is to implement and evaluate a comprehensive cardiovascular disease prevention program and understand barriers and facilitators of implementation at the community and health facility levels.

Before commencement of the implementation, the project kicked off with a community baseline survey, a capacity and readiness assessment at the health facilities to better understand the problem and benchmark the indicators for planned interventions. Likewise, baseline understanding of the various challenges and barriers to implementation were explored. The interventions started in 2019 consisting of training health workers from several health centres IIIs, IVs and a hospital. The facilities are Kawolo Hospital, Kojja HC IV, Mukono HCIV, Goma HCIV, Busabaga Health Centre III, Ssi-Bukunja HC III, Katoogo HC III, and Nabalanga HC III. In addition, 20 village health team members were trained to support community sensitisation activities of the project.

Guests of Honour awarding certificates to trainees

To share preliminary results, update participants on project progress and award certificates to trainees, Makerere University School of Public Health organised a one day dissemination workshop and a certificate award ceremony at Collin hotel which was attended by over 150 participants. Key baseline finding include a persistent risk factor prevalence of cardiovascular diseases such hypertension at 23%, obesity at 30%, and poor diet at 88%.  Seventy four (74) health workers who successfully attended the 8 module training program over the 8 day training period were awarded certificates of attendance.

Besides training the health workers, all the eight health facilities were equipped with medical equipment like blood glucose meters, stadiometers, weighing scales, strips and blood pressure gauges to facilitate testing of blood sugar and blood pressure and other risk factor profiles. More importantly, the team adapted and developed a risk scoring tool which the health facilities are currently using to screen patients and characterise them as low, medium or high for developing CVDs and T2D.

The training of health workers also gave them the opportunity to screen for their own profiles and revealed interesting findings such as;

1.     A number of health workers discovered that they had elevated profiles such as high blood sugars and elevated blood pressure themselves and became aware of how to improve these. Some of these started treatment.

2.     Change of behaviours and positive attitude were reported among trained health workers with some reporting to have started introducing exercise and physical activity both for themselves and their patients. Learning about predisposing lifestyles like smoking, inactivity, excessive drinking, poor diet and nutrition including high fat, sugar and salt consumption and low vegetable and fruit consumption and how they damage our health empowered them with knowledge to make better choices.

3.     Health workers also learned to be more welcoming and friendly, improve the manner in which they handled patients, use motivational interviewing and provide a personalised approach and patients became more comfortable with seeking care from them with better healthcare outcomes. Patients’ faith in the healthcare system is also being restored.

4.     Improvement of accountability and reporting mechanisms at health centres to enable progress tracking and impact assessment has been established at these centres with the introduction of electronic screening devices provided by the project.

Group picture session

Significant strides have already been made by the exceptional teams involved in this project and still many more results are yet to come. While there are still some challenges, the teams keep on learning, evaluating and re-strategizing to keep the project on track in simple, relevant ways. I look forward to seeing the continued growth and exceptional results from the engaging collaborations. I was especially impressed by the trainees who took initiative and showed commitment to finish the training and their willingness to report all the benefits from it and expand its impact into communities too.

Edith sharing a lived experience and the transformative power of  an empowered patient

There is so much potential for this project and as a person living with type 1 diabetes, I truly appreciate this commitment to improving healthcare outcomes. I am especially grateful that health workers are seriously adopting a collaborative stance by working together with patients to come up with treatment goals and improve healthcare outcomes. The rise in patients championing this new knowledge and improved attitudes into their communities is also having unprecedented rippling effects in disarming NCDs like diabetes and hypertension in these communities.

As a nutritionist too, I am especially cognisant of the role healthy food choices play in improving outcomes for anyone living with NCDs and particularly for preventing NCDs altogether. The SPICES project has taken on nutrition education and is having dramatic positive results with this intervention as people get to understand the power of healthy food in helping us feel better, healthier and more productive. It is surely a new day in NCD care and management in Uganda and I for one, applaud it.