WHO-PENatScale · Scaling up the WHO-PEN package for diabetes and hypertension in Swaziland: a nation-wide cluster-randomised evaluation of three strategies in Swaziland (WHO-PEN@Scale)

Swaziland has a very high prevalence of both diabetes and hypertension, with the majority of those affected being undiagnosed. Like many other countries in sub-Saharan Africa (SSA), however, Swaziland provides care for diabetes and hypertension only through physician-led teams in hospitals. The country has recently conducted a successful feasibility pilot of the World Health Organisation’s Package of Essential NCD Interventions for Primary Health Care in low-resource settings (WHO-PEN). The WHO-PEN@Scale project aims to improve diabetes and hypertension control at the population-level by helping Swaziland identify and scale up the most effective healthcare delivery model for WHO-PEN implementation at scale. Specifically, we will conduct an innovative nation-wide two-phased adaptive randomised study to i) rigorously assess the effectiveness and cost-effectiveness of four novel community-based healthcare delivery models to scale up WHO-PEN for diabetes and hypertension nationally, ii) study in-depth the real-life implementation of the WHO-PEN national scale-up in Swaziland to generate lessons for other countries, and iii) actively disseminate the Swazi experience along with an open-source toolkit for WHO-PEN scale-up to policy makers in SSA. WHO-PEN@Scale will therefore provide a blueprint of primary health system strengthening for diabetes and hypertension – and ultimately non-communicable diseases (NCDs) more generally - for other countries in the region. WHO-PEN@Scale is highly relevant to this work programme because i) the interventions contained in WHO-PEN have been shown to be cost-effective, ii) the scale-up is government-led, and iii) we assess the impact of WHO-PEN@Scale on diabetes and hypertension control at the population-level.