Background:Village Health Teams (VHTs) or Lay health workers have been shown to a play an important role of increasing access to healthcare within communities and homes for infectious diseases such as malaria, pneumonia, HIV and Tuberculosis and in maternal and child health care. Innovations such as task sharing and mhealth/ telemedicine have been considered to increase the role of VHTs in the prevention and control of NCDs in the communities. Currently, an innovation seeking to use VHTs to screen, diagnose, prescribe and follow up patients with non-communicable diseases by linking them to doctors using mhealth has been proposed in Mukono district. However, the district health team is concerned about the feasibility, effectiveness and possible adverse effects of such an innovation in the community.Rapid Response Question:What is the feasibility and effects of task sharing to VHTs in the screening, diagnosis, treatment and follow up of patients with hypertension and or diabetes mellitus using m-health?Findings:There is scanty evidence on the effects of redistribution of tasks such as identifying, screening, referral and follow up of patients with non-communicable diseases to VHTS.There are a number of studies showing that it is feasible and cost effective for VHTs to identify, screen and educate and follow up patients with hypertension and or diabetes mellitus. VHTs have been shown to be able to identify, diagnose and follow up patients with hypertension using BP machines and or diabetes mellitus using glucometers.A study in India demonstrated the feasibility of mHealth using Lay Health workers to identify, screen, diagnose, link patients with hypertension and diabetes mellitus to doctors for consultations and prescriptions. The VHTs screened patients and sent obtained medical information to the doctorswho would, through interaction with the VHTs and/or patient diagnose and prescribe medicine for the patients. The prescription would then be printed out by the VHT using a portable printer for the patients to get medicine.There is however limited evidence on the feasibility and effects of VHTsâ ability to separately screen, diagnose, initiate treatment and refer patients with hypertension and diabetes mellitus. There is often improvement in the absolute reduction of mean systolic and diastolic blood pressure by only -2mmHg and HbA1c by -0.6%. These changes are of limited clinical importance. These studies do not report on the possible adverse effects of task sharing and m-health using VHTs to identify, screen, diagnose, treat and follow up patients with hypertension and or diabetes mellitus. However, qualitative studies have shown that effectiveness of using VHTs is limited if these considerations are not made during planning: ï· Community acceptance of VHTs to diagnose and initiate treatmentï· Complexity, intensity, scope and duration of training, supervisionï· Availability of resources such internet, functional BP machines, glucometersï· Presence of professional health workers for invasive techniques such as drawing venous bloodï· The number of VHTs included in the programme- these studies included very few VHTs and this might be problem if one were to ensure standards for more VHTsï· Sustainability after the end of the projectï· Linkage to healthcare system such as integrating patient records to the HMIS. This is important for continuation of care. ï· Resistance by other health professionalsï· Current prescription policies limits on who prescribes. These studies include portable printers and VHTs print these for the patientsï· Increased workload for the VHTsï· Complexity of training materialï· Lack of availability of doctors for referralï· Poor drug supply and access to the patients. Conclusion:Task sharing and use of m-health to identify, screen, refer and follow up by VHTs among patients with hypertension and or diabetes mellitus has been shown to be feasible, however there is limited clinical effect on the control of high blood pressure and hyperglycemia.
