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Global Development Institute

Researchers work to tackle cardiovascular deaths in rural Indonesia

23 April 2018

A researcher from The University of Manchester's Global Development Institute has been part of a team testing an innovative new intervention in Indonesian healthcare, which could improve life expectancy in Indonesia.

In rural Indonesia, healthcare provision can be limited, with people only seeking primary care when urgently required. Volunteer health workers in the villages are organised by local hospitals, but as the health workers have no college education, they focus on issuing infant and maternal health information, with limited knowledge of wider health issues.

A new health intervention, called SMARThealth, aims to change that by providing the village health workers (locally known as kader) with training on blood sample collection, a smart phone to aid assessment and data collection, and health information specific to cardiovascular care. Data is then shared with qualified health professionals – resulting in a radical shift in the way healthcare is delivered and the potential for improved cardiovascular care.

GDI researcher Dr Gindo Tampubolon has been researching healthcare in Indonesia for decades, and his recent analysis into unmet needs of cardiovascular health in Indonesia came to the attention of the George Institute, who are tackling the rise of non-communicable diseases in developing and low- and middle-income countries. Non-communicable diseases are now the cause of 60% of deaths in developing countries.

Dr Tampubolon's early research in Indonesia demonstrated that nearly 70% of respondents with moderate to high cardiovascular risk didn't receive cardiovascular care. The George Institute's SMARThealth programme uses the proteins from blood samples that can predict cardiovascular death to identify those at risk and provide them with information that could help them manage their health. If the SMARThealth programme is successful then the low levels of cardiovascular care identified by Dr Tampubolon could be reversed.

The village health workers collected blood samples which were analysed and assessed against a 'clinical decision support system' - a simple traffic light system which indicates if a person was either not demonstrating symptoms, at risk and in need of treatment or was suffering irreversible health impacts.

Based on the project's early work, Dr Tampubolon identified that it was important to keep assessment simple - limiting categories to three risk levels – rather than the WHO's five levels.

While the health workers are easily able to visit adults with cardiovascular risks, one of the challenges of the project was to ensure that people in villages respected the knowledge of the health workers. This is where the mobile app and its connection to a digital data cloud played a pivotal role. The data collected by relatively untrained health workers could now be accessed by cardiovascular doctors in Indonesian hospitals to initiate appointments, issue referrals and information on critical scans.

This information linked doctors to the health workers' visit, reinforcing the legitimacy and elevating the role of the village health worker. And as the app and recommendations were devised by researchers and scientists, all involved could feel confident in the information they were getting.

"To see village women producing scientific information that cardiovascular consultants can actually use, and seeing the health worker's eyes light up when they realise how useful this has been – that's been an exciting part of the project," said Dr Tampubolon.

The research has been carried out in Kabupaten Malang in East Java, Indonesia, with primary care doctors and non-qualified healthcare workers serving a population of approximately 48,000. Over two years, SMARThealth has screened 12,000 individuals over the age of 40 – potentially reducing the effects of heart disease and diabetes. Initial findings will be published in September 2018.

After the findings are released, the next steps will be to look at the health supply side of administering treatment for cardiovascular health to ensure that prescription drugs can be consistently and reliably supplied over time.  The findings of this project will determine whether this healthcare delivery innovation could have a wider application across many parts of Asia and potentially improve the lives of hundreds of millions of people.

Co-investigating the success of SMARTHealth in Indonesia with Dr Tampubolon is Dr Sujarwoto, a University of Manchester alumni now  based at the University of Brawijaya, Malang, Indonesia; Dr Delvac Oceandy (Medical School, University of Manchester); Dr Asri Maharani (Neuroscience & Experimental Psychology, University of Manchester) and the George Institute, Hyderabad and Sydney.

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