EMPOWER · EMpowering People living with NCDs and frOntline health Workers and levERaging digital health technology, to tackle the burden of chronic diseases in sub-Saharan Africa. (EMPOWER)

With 74% of deaths and over 75% of all Disability Adjusted Life Years, noncommunicable diseases (NCDs) are the leading cause of death and disability worldwide. In low-and-middle income countries (LMICs), primary care providers often lack sufficient training and resources to effectively diagnose and manage NCDs, while health centres and information systems are poorly organised to ensure continuity of care. Consequently, treatment gaps—defined as the proportion of individuals with a disease who are not treated—are alarmingly high: 82% for hypertension, 80% for diabetes, and 75–85% for epilepsy and mental disorders. The situation is even more critical for individuals with multiple long-term conditions (MLTCs). EMPOWER aims to reduce the burden of MLTC NCDs in Benin and Togo by closing treatment gaps through interventions previously validated in Laos, Cambodia, and Myanmar. The project will optimise existing human resources, such as community health workers (CHWs), nurses, midwives, and GPs, by training them in evidence-based NCD management strategies (WHO-PEN and WHO mhGAP) and equipping them with a digital tool. The android-based app will streamline the collection of key indicators for screening, diagnosis, and monitoring of NCDs, while enhancing communication among healthcare providers. CHWs will coordinate a comprehensive package of community-based activities, including NCD screening (targeting cardiometabolic diseases, mental disorders, and epilepsy), risk factor assessments, health education, regular care and follow-up. The 4-year project comprises 3 phases: Phase A, a mixed-methods assessment to gather insights from patients, CHWs and healthcare providers, guiding the adaptation of intervention and tools; Phase B, the implementation of the intervention; and Phase C, a hybrid evaluation of effectiveness outcomes (treatment gaps, NCD-related events, clinical parameters, quality of life, stigma, cost-effectiveness - intervention vs control) and implementation outcomes using the RE-AIM framework. This will inform future scaling-ups.