India

Based on the major findings of the needs assessment, several recommendations were developed to guide the design of HealthRise interventions in Brazil. First, it was concluded that interventions should focus on patient empowerment by seeking to increase awareness of NCD risk factors and symptoms, available resources for treatment, and the importance of lifestyle behaviors and medication adherence in disease management. Second, it was recommended to improve health facility capacity in terms of the ability to diagnose and treat NCDs, improve patient satisfaction, and increase the quantity of appropriate staff to treat and counsel NCD patients. The third recommendation was to explore interventions involving home visits, which were believed to have the potential to increase access to care. Finally, improving the diagnosis and treatment of high cholesterol was identified as a priority area, considering the very low testing rates found for this condition.

In addition to these key recommendations regarding intervention design and focus, several information gaps were identified that were recommended to be addressed through stakeholder engagement. Conflicting evidence from patient reports and administrative data regarding wait times and appropriate staffing levels at health facilities required additional exploration. Given the interest in expanding the use of in-home visits, there was a need to determine existing numbers of in-home providers, as well as their management, perception among the population, and capacity for additional NCD-related activities. An understanding of supply chain failures was also needed to clarify reasons for the identified lack of sufficient equipment and pharmaceuticals for NCD diagnosis and treatment.

India

Based on existing data, the burden of NCDs was found to be high in Shimla and Udaipur, with the prevalence of hypertension in both districts above the national average. Among older adults, prevalence ranged from 42% among 65- to 69-year-old males in Udaipur to 76% among 75- to 79-year-old females in Shimla. Diabetes prevalence was lower overall, highest among females aged 75-79 in Udaipur (18%) and females aged 65-69 in Shimla (17%). Among hypertension patients, about 60% were found to be undiagnosed, and 59% of those on treatment did not have their disease controlled. For diabetes patients, 23% had not been previously diagnosed, and 40% who were on treatment did not have their condition under control. Data collected from patients and households indicated that awareness of the importance of routine checkups was low.

From the various data sources consulted, several key barriers emerged as impacting care-seeking and the provision of health services. Patients reported problems with the quality and cost of care. Facilities had shortages of equipment, staff, and pharmaceuticals. Only a few primary health centers and sub-centers were found to offer screening and preventive services; private facilities offered a greater variety of preventive services but at a higher cost. There were generally long wait times at facilities, particularly due to overcrowding in tertiary facilities that could diagnose NCDs and were able to provide comprehensive diagnostic and treatment services. ASHAs were found to be active in their communities, were perceived positively, and were viewed as a good resource for health information, particularly regarding maternal and child health. Overall, community members had low awareness of NCD-related interventions led by NGOs and CBOs.

Based on the major findings of the needs assessment, several recommendations were developed to guide the design of HealthRise interventions in India. The first focus area identified was promoting diagnosis-seeking by increasing awareness of the importance of routine checkups and strengthening capacity for community outreach and decentralized screening processes. Second, it was recommended to utilize collaborative efforts