Landscape Assessment Report - PATH

Gather insights into the status of cardiovascular disease (CVD) prevention and control programs and enabling drivers to design an intervention package that will reduce the cardiovascular risk for Ho Chi Minh City population health.

1. Vietnam country profile, CVD health burden, and directions to move forward

2. Review the outcome of the previous CVD program in Ho Chi Minh City

3. Baseline assessment of existing CVD health care services of health facilities in the project’s three priority districts

4. SwipeRx Survey Results: insights to inform pharmacy client selfScreening for CVD Risk in Viet Nam

5. The assessment of the current maturity level of using Artificial Intelligence in health care

Demographic

Population: 98.685.363 (2022 est.)

Ethnic groups: Kinh 85.7%, others 14,3%

Religions: none 81.8%, Buddhist 7.9%, Catholic 6.6%, others. Disparities across regions, groups can be a challenge to health services

Urban population: 37.3% (2020)

Population growth rate: 1% (2021 est.)

Fertility rate: 2.06 children born/woman (2021 est.)

Early marriage: 10.6% of women aged 20-24 married or in union before 18

Economy

GDP growth rate: 7.02% (2019 est.)

GDP: $271.158 billion (2020 est.)

GDP per capita: $8,65 (2020 est.)

Population below poverty line: 6.7% (2018 est.)

Unemployment rate: 3.1% (2018)

Employment: 37.2% in agriculture, 27.4% in industry, 35.3% in services (2019 est.)

Internet users: 70.35% (July 2018 est.)

Government

Type of government: one-party socialist republic

Administrative divisions: 63 provinces and municipalities

Chief of state: President Nguyen Phu Trong

Head of government: PM Pham Minh Chinh

Political party: Communist Party of Vietnam

Government Ministry of Health (MOH

• MOH’s departments

• Institutions under management of MOH (NIHE, Pasteur Institutes, etc.)

• Medical colleges

• Central hospitals (General and Specialized)

provincial Department of Health

• Provincial General/Specialized hospitals

• Centers for Preventive Medicine

• Provincial Secondary Medical school

• Pharmaceutical company

health administrative units

• District Health Centers

• Region polyclinics

(commune/ward)

HEALTH BURDEN AND DIRECTIONS TO MOVE FORWARD

Source: https://www.healthdata.org/vietnam

Source of hypertension & diabetes

Commune health stations

District health facility

Health care

Private health

1National Strategy for Prevention and Control of NCDs 2015–2025, National NCD Plan 2022 - 2025 and the Vietnam Health Program recognize the need for outreach services and management systems to promote early detection of CVDs in PHC.

3The government has shown a solid commitment to:

► Achieving 100% online public services across sectors, ► the nationwide introduction of electronic medical records (EMRs) for outpatients.

► Developing digital data storage, AI at all health care establishments to build national health databases.

2The national agenda for digital transformation emphasized a people-centered approach and the need to foster a digital culture

► Develop telemedicine platforms to provide remote medical services.

► Gradually develop and strengthen digital disease prevention and health care systems.

► Strive to achieve the “one doctor for each citizen” idea to create a digital personal health dossier.

► Establish easy access to telemedicine and electronic medical prescriptions.

Before January 1st, 2021, HCMC had 24 districts with 319 wards and communes. Thu Duc City was established when District 2, District 9, and Thu Duc District merged. HCMC has 22 districts (including 21 districts and 1 city) with 312 wards and communes and 310 commune health stations.1

Source:

1.https://thongtinduan.com/thi-truong-24h/9242-phuong-an-sap-nhap-cac-quan-huyen-tai-tphcm.html;

2. Census of the HCMC population (No. 223/UBND VX, dated Jan 21,2022);

3. https://worldpopulationreview.com/world cities/ho chi minh city population;

4 HCMC demographic yearbook 2019;

5. https://saigoneer.com/saigon-news/19291-saigon-aims-to-reach-over-$12,000-in-gdp-per-capita-by-2030;

6.https://en.wikipedia.org/wiki/Ho_Chi_Minh_City;

7. https://www.hcmcpv.org.vn/tin tuc/ty le nguoi hut thuoc la thu dong cao nhat tai cac dia diem quan bar ca phe tra 1491854799;

8. https://vnexpress.net/80 dan ong tp hcm uong ruou bia 3447585.html; 9. https://congluan.vn/685 dan so tp hcm luoi tap the thao-post58322.html

Urban profile

Population 9,053,710 (2022 est)2

Population growth rate 2.71%3

Life expectancy 76.6 years old (2019 est)4

GDP per capita US$ 6,862 (2019 est)5

Literacy rate: (adult 15+) 99% (2019 est)4

Unemployment rate: 5.45% (2022 est)3

Ethnic demographics Vietnamese: 93.52%, Chinese: 5.78%, Khmer: 0.34%, Cham: 0.1%, other nationalities Koreans, Japanese, Americans, South Africans, Filipinos and Britons6

Rates of smoking, alcohol consumption, physical exercise

Smoking rate in males: 46.6% (2018 est)7 Alcohol assumption: 80% in males, 22% in females (2016 est)8 Physical exercise: 31.5% (2018)9

1HCMC plan on the implementation of the National Strategy for NCDs prevention and control in HCMC aims to control the increase of morbidity and mortality due to NCDs in which prioritizes for prevention and control of cancers, CVD, DM, Chronic obstructive pulmonary disease and asthma

The HCMC DOH issued regulations and mandates for sharing and managing data related to CVDs/hypertension (HTN) and diabetes mellitus (DM) between public hospitals and preventive medicine centers at district and commune levels.

5-year operation plan of the health sector in HCMC for the period of 2021-2025 highlights the goal of strengthening the NCD management and preventing of risk factors affecting population health.

Plan on EHR deployment citywide period 2019-2025 across 22 districts.

The “smart city” agenda entails developing and applying digital technologies in all sectors to improve public administration and ensure a sustainable, knowledge-based economy.

HCMC People Committee HCMC Department of Health

AND DIRECTIONS TO MOVE

District People Committee

District health administrative units

• Provincial General/Specialized hospitals

• Centers for Preventive Medicine

• Provincial Secondary Medical school

• Pharmaceutical company

Commune People Committee

• District Health Centers

• Region polyclinics

CHS (commune/ward) Village health workers

Tran Thi Mai Oanh, Tran Van Tien, Duong Huy Luong, Khuong Anh Tuan, Nguyen Khanh Phuong, Le Quang Cuong, Amy Taye, Gilbert Kombe, and Saul Helfenbein. March 2009. Assessing Provincial Health Systems in Vietnam: Lessons from Two Provinces.

Health program

prevention, primary health care and medical examination and treatment.

out of

professional medical examinations as well as treatment and PHC

22 DHs

Level I: 3

Level II: 16 Level 3: 1

health workers

2,285 doctors 85 public health staff 204 are assistant doctors 590 are pharmacists 3,754 are nurses, midwives, medical technicians 1,409 others.

DHCs main functions

diagnosis and treatment services.

Source: Ho Chi Minh City Department of Health’s plan on capacity building of the grassroots health system in the period of disease control in Ho Chi Minh City; a meeting on

• 2010 - now

• HTN, DM

• Capacity building, awareness raising, screening

• 2016 -2021

• HTN, DM

• Capacity buiding, awareness raising, screening, early diagnosis, treatment linkage, case management, stakeholder engagement (PPP, community collaborators, checkpoints), e-tracker

MOVE

HCMC PATH

• 2016-2020

• HTN, DM

• Awareness-raising, early diagnosis, treatment and management

Tran Thi Mai Oanh, Tran Van Tien, Duong Huy Luong, Khuong Anh Tuan, Nguyen Khanh Phuong, Le Quang Cuong, Amy Taye, Gilbert Kombe, and Saul Helfenbein. March 2009. Assessing Provincial Health Systems in Vietnam: Lessons from Two Provinces.

Project Year # of districts intervened*

3/2016 3/2017 1 district (at 5 CHSs)

Abundant Health (Pfizer Foundation)

6/2017 5/2018 1 district (at 11 CHSs)

9/2018 7/2019 24 districts (at 151 CHSs)

8/2019 9/2020 23 districts (at 292 CHSs)

Community for Healthy Hearts (Novartis Foundation)

Transforming the NCD response (Access Accelerated)

AND DIRECTIONS TO MOVE

98,903

Not analyzed Newly: 1,414 (1.4%)

6/2016 6/2019 4 districts (at 16 CHSs) 121,273 29,908 (for patients with known and unknown conditions)

6/2019 3/2021 1 district (at 16 CHSs) 16,739 7,940 (for patients with known and unknown conditions)

Previously: 18,412 (18.6%)

13,078 patients were treated at CHSs, including people screened by the CHSs and people who self-referred treatment from the hospital to CHSs

VIETNAM COUNTRY PROFILE, CVD HEALTH BURDEN 11,847 patients were referred to district hospitals for treatment

16,455 (13.6%) (including newly and previously conditions)

5,110 (including newly and previously conditions)

FORWARD 6,727 (56.8%)

Not measured

N/A Not measured

Note: * Non of CHSs received dual projects at the same time. **Including people with unknown and known conditions.

Source: HCDC’s consolidated reports of HTN intervention projects from 2016 to 2021

HTN screened ** BP elevated HTN diagnosed HTN treated BP controlled

Project Year # of districts intervened*

Project Year

Abundant Health (Pfizer Foundation)

Abundant Health (Pfizer Foundation)

Community for Healthy Hearts (Novartis Foundation)

Transforming the NCD response (Access Accelerated)

Transforming the NCD response (Access Accelerated)

3/2016 3/2017 1 district (at 5 CHSs)

DIRECTIONS TO MOVE

# of districts intervened*

DM screened

HTN screened ** BP elevated HTN diagnosed HTN treated BP controlled

98,903 Not analyzed Newly: 1,414 (1.4%)

3/20163/2017 1 district (at 5 CHSs) 89,059 Not analyzed

6/2017 5/2018 1 district (at 11 CHSs)

9/2018 7/2019 24 districts (at 151 CHSs)

9/20187/2019 24 districts (at 151 CHSs)

8/2019 9/2020 23 districts (at 292 CHSs)

8/20199/2020 23 districts (at 292 CHSs)

6/2016 6/2019 4 districts (at 16 CHSs) 121,273 29,908 (for patients with known and unknown conditions)

6/2019 3/2021 1 district (at 16 CHSs) 16,739 7,940 (for patients with known and unknown conditions)

6/20203/2021 1 district (at 16 CHSs) 6,739 2,940 (for patients with known and unknown conditions)

Newly: 487 (0.5%)

VIETNAM COUNTRY PROFILE, CVD HEALTH BURDEN AND Not measured

Known: 5,029 (5.6%)

Previously: 18,412 (18.6%)

FORWARD 6/20175/2018 1 district (at 11 CHSs)

13,078 patients were treated at CHSs, including people screened by the CHSs and people who self-referred treatment from the hospital to CHSs

4,268 patients were treated at the CHSs including people diagnosed by the CHSs and people who self-referred treatment from the hospital to CHSs

Not measured

16,455 (13.6%) (including newly and previously conditions)

1,367 (including newly and known conditions)

5,110 (including newly and previously conditions)

11,847 patients were referred to district hospitals for treatment

6,727 (56.8%)

367 patients were referred to district hospitals for treatment

Not measured

N/A Not measured

Note: * Non of CHSs received dual projects at the same time. **Including people with unknown and known conditions. Source: HCDC’s consolidated reports of DM intervention projects from 2016 to 2021

** BS elevated DM diagnosed DM treated BS controlled

Points of service providers

Community health stations

Health facilities

Health collaborators Checkpoints

Families & Communities

Diabetes & Hypertension control among adults

Approaches

1. Offer chronic care and support HTN and diabetes for patients along the patient journey

2. Enhance the quality of service provision

3. Increase patient awareness and empowerment, people centered-care approaches

4. Enhance e-tracking system for better patient management and support

5. Promote public private partnership

Community awareness about HTN (early detection, diagnosis, treatment, and adherence to HTN treatment) is limited.

Many health stations do not yet have enough equipment and drugs to provide diagnostic and treatment services for patients.

Low capacity of commune NCD staff.

Coordination between health care levels and health facilities in managing NCDs and HTN is weak

High turnover rate of CCs and checkpoints.

Limits in support supervision, monitoring, and ensuring data quality.

Currently there is no mechanism in place to share data between medical examination and treatment facilities & health stations.

Diversifying communication channels (traditional and non-traditional) to reach the community better.

Collaborators, checkpoints, non-health sectors, and community organizations are important forces to support the prevention, screening, care, patient management in the community.

HTN screening in the community is an effective solution to raise people's awareness and detect HTN early.

The support and involvement of local authorities, mass organizations, social organizations, businesses, and the community is needed.

Information technology to manage HTN data should be applied synchronously at public and private health facilities to improve the efficiency of diagnosis, treatment, management of patients and improve follow-up rates.

5: Population of

three prioritized

Total population: 1,969,4691

People aged ≥18: 1,480,3981

Estimation of people aged ≥25: 62%2

Source:

1. Census of the HCMC population reported by HCMC People’s Committee (No. 223/UBND VX, dated Jan 21,2022); 2. https://danso.org/viet nam/;

Chart 5: Seventy-two health facilities participate in the Population Health project

CHSs in Go Vap Dist.

CHSs in Dist.11

CHSs in Thu Duc city

CHSs

CHSs

Health workers

Doctors: 20.5% (87)

Assistant doctors: 29%

Nurses: 17% Pharmacists:13.9%

Midwives:14.2%

Others: 5.4%

of CHSs have doctors but without practicing license

Insured services for medical examination and treatment here are often interrupted

insured CHSs have doctors but without practicing license

Chart 8: Health workers are trained on CV risk screening, HTN and DM treatment

Of CHSs

confirmed that booklets for CV risk screening, HTN, and DM diagnosis, and treatment are available. 24% of them could list out the correct documents issued by the MOH in December 2019

CHSs

Received the training in

Recommendations

Have new health workers delegated to NCD tasks recently

60%: received the training in 2020 40%: in 2021

Total facilities # of facilities had health workers received training

# of facilities had no health workers received training

1. Provide refresher training for key staff of CHSs and DHCs on CVD risk screening, first-line treatment for HTN and DM;

2. Extend the training topics to stroke, acute myocardial infarction, arteriosclerosis, and CVD with COVID-19.

1Role and responsibilities of CHS in prevention, early detection, diagnosis, treatment, and management of NCDs.

Clinical case discussion on HTN and DM out-patient treatment at CHSs.

Guidance on early detection of some NCDs.

Practice on counseling and prescribing of dietary choices and physical activities in the prevention and treatment of HTN and DM

Guidance on integrated management of HTN and DM applying the principles of family medicine at CHS.

Flow of sharing HTN and DM patient information from hospitals to CHSs.

Improving the NCDs quality management at CHSs.

Guidance on using NCD management software.

Community collaborator network for the CV health program

100% of CHSs have collaborator networks (one in each neighborhood)

Collaborator networks mainly serve for population and reproductive health programs at each ward, managed by Ward PC.

100% of CHSs have limited financial capacity to incentivize collaborators

• 45% of CHSs have active collaborator networks.

• No dedicated collaborators for the CV health program.

Recommendations

1. Collaborators are the extension arm of the CHSs in public health communication and community mobilization, the HCMC authority should have an allocated budget to foster this force (this is also the recommendation of 72% of CHSs).

2. Advising the health authority to expand the scope of CV health/NCD program support to collaborators of the population program

.

Community collaborator network for the CV health program

Patient registration

Measure height, weight, and calculate BMI

Take blood pressure & test for capillary blood glucose

Consult screening results & give followup visit appointment

Task-shifting in health care:

• Apply at 100% of CHSs

• Flexible in some CHSs with shortage of staff

Care coordination and patient referrals between providers and care levels

Integrate lifestyle screening in these steps

Collaborator/ Nurse Collaborator/ Nurse Assistant Doctor/ Nurse Doctor Doctor

Follow-up treatment & patient management at the station Confirm diagnosis

Team of doctors, physician assistants, nurses, and collaborators

Recommendations

• No priority on patient registration for referred patients from CHSs to DHs

• No data connecting & sharing (CHS-DH)

• Patients with stable HTN/DM at DHs are NOT REFERRED to CHSs

1. Reinforce the task-shifting practice at CHSs have new staff delegated for the NCD program.

2. Develop a procedure for receiving priority patients referred from CHSs to DHs to create favorable conditions for patients to maintain the treatment continuously;

3. Promote data connection between DHs and CHSs so that doctors at all care levels can monitor previous treatment processes and provide appropriate consultation to patients.

Review of CVD

service performance at CHSs

Supportive supervision from the management level

Chart 9: Frequency of meeting review of CVD care service performance and take action

65% of them have recorded meeting minutes

2times/year

supportive supervision from HCDC/DoH to one selected CHS/district

4times/year

supportive supervision from DHCs to each CHS

Organize behavioral change communication (BCC) activities on CVD risk, HTN and DM

Chart 10: Places when CHSs normally conduct behavioral change communication sessions on HTN and DM during a calendar year

DHs DHC CHSs

At

100% in the hospital (through patient clubs on monthly or quarterly)

at the neighborhood

In & out of CHS facilities (integrated into local meetings or integrated with the health checkups held at CHSs)

quarters

Chart 11: Key challenges for CHSs to raising community awareness on CV risk prevention

Lack of leaflets

Lack of human resources

Lack of community collaborators

Language barrier (Chinese)

Community people is busy for livelihood

Lack of financial resources

Community awareness is low

Provide communication materials to HTN and DM patients

Communication materials are available at 100% of DHs, 67% of DHCs, and 84% of CHSs.

BCC leaflets are no longer preferred and often not distributed to CHSs.

Projects with interactive, practical communication activities such as projects by PATH, the Novartis Foundation, the Pfizer Foundation, helped improve NCD, CVD communication methods, and outcomes tremendously.

Leaflets on stroke (symptoms, causes, treatment) are not available at CHSs.

Recommendations

1. Producing leaflet/posters to educate community people on CV risk prevention and control, especially for the stroke event;

2. Promoting the use of mass media and social media and advocating the collaboration with private partners to accelerate the communication activities and generate demand of community on CV risk screening.

Organize HTN and DM screening activities at CHSs

Chart 12: When CHSs conduct HTN and DM screening events

For DM screening

Vaccination days

TB screening day

Blood donation days

For HTN screening

Mostly combined with other existing health programs

65% organize a screening in community

World diabetic day (Nov 14)

Elderly health check-up (from Jun to Oct)

Vietnam Women's day (Oct 20)

World heart day (Sep 29)

Vietnam's War Invalids and Martyrs Day…

World No-Tobacco Day (May 31)

World hypertension day (May 17)

Founded date of HCM Communist Youth…

International women's day (Mar 8)

Quarters, markets, pharmacy stores, schools would attract more

76% had challenges when mobilizing people to screen

Lack of funds to incentive people

Lack of HR to organize activity

Community people are busy during office hour

Language barrier to the Chinese community

0 5 10 15 20 25 30 35

Chart 13: The places where CHSs organized screening vs the places that would attract more community members

the places where CHSs organized the screening

the places where CHSs think that would be effective to attract more community members for screening

At quarters At markets At school Home visit At pharmacy store

At pogoda At church At CHS At Ward People's Committee

Perform HTN and DM screening, CVD risk estimation

Chart 14: where do CHSs record the blood pressure index?

Chart 15: where do CHSs record the blood sugar index?

Paper-based

Chart 16: where do CHSs record the CV risk index?

HTN/DM Screening CV risk estimation

100% of CHSs provide screening service (using screening device + paper based screening form)

Results are mainly stored in the paper based system

69% of CHSs incorporated CV risk estimation into the HTN/DM screening 33% DHCs & 80%DHs only done for patients who registered for the CVD examination

A paper-based chart is mainly used (except for Thu Duc and Le Van Thinh Hospital)

Recommendations

1. Upgrading the mobile NCD screening app with a tool for total estimation of CVD risk referencing the chart recommended by the MoH;

2. Promoting to use of the screening app and digital registry system at the CHS level so that data can be automatically connected and generated for reference in real-time.

Paper-based

Chart

Reasons for drug insufficiency

Inaccurate drug forecast

Not order due to no qualified doctor

DHC stopped signing a sub-contract with DH

Insured drugs for dyslipidemia are not provided for use at the CHS

CV risk estimation

100% of CHSs haveanExceltoolto monitorandreportquarterlybloodpressureand bloodsugarindicesofpatientstreatedatCHSs.

100% DHC and DHs havea HIStostorebloodpressureandlabtestresults ofpatients►Nottoensurealldoctorswould enterdataintothesystem.

100% of CHSs havealistof HTN/DMpatientsinthelocalityformanagement

100% of health facilities haveNOautomatictooltosupportpatient adherencetotreatment ► remindpatient throughZalo/hotline

Recommendations

1. Advocating on providing sufficient insured drugs for CHSs & creating favorable conditions for junior doctors to receive a practicing license;

2. Working with the DHCs to improve CHS’s HIS on fully recording patient’s vital check results;

3. Promoting the use of mobile NCD screening app for reminding and tracking patient’s follow-up visits.

HTN&DM treatment and management at CHSs

Chart 19: The cascade of HTN care at CHSs in Thu Duc City

Screened High BP Newly diagnosed HTN Treated Controlled BP Reffered to

Chart 20: The cascade of HTN care at CHSs in Go Vap Dist.

Screened High BP Newly diagnosed HTN Treated Controlled BP Reffered to hospital

Chart 21: The cascade of HTN care at CHSs in Dist.11

Screened High BP Newly diagnosed HTN Treated Controlled BP Reffered to hospital

interrupted from Feb to Apr

due to

** Service interrupted from May to Dec 2021 due to Covid 19 (the

The reported data is very high compared to the AH project’s report ~ 1.4%.

patients treated at DHC and DHs

Patients of CHSs and DH in Go Vap Dist. could opt to come to DHC to refill medicines.

of HTN and

Service indicators related to HTN and DM care at DHC and DHs

Number of HTN patients with stroke in 2021 vs 2020

❖ Reduced 91% (968 ► 506) of HTN patients with stroke hospitalized

• Reduced 81% (520 ► 288) of HTN patients with stroke living locally

❖ Reduced 69% (27 ► 16) of in-hospital deaths of stroke patients

• Reduced 44% (13 ► 9) of in-hospital deaths of stroke patients living locally

Chart 27: Number of HTN patients died from stroke reported by 58 CHSs

from the

People’s Committee)

# of HTN patients with stroke hospitalized

# of HTN patients with stroke living locally hospitalized

# of in-hospital deaths of stroke patients

# of in-hospital deaths of stroke patients living locally

Chart 28: Number of patients with stroke hospitalized

100% of health facilities have NO digital health tools for community people to do CV risks screening, referral of diagnosis, treatment selfmanagement, and health education

A dashboard with key CV health and non-health data does not exist at the health facilities

There is NO web provided by DOH/HCDC/DHC for online CME to upskill and reskill CHS's health workers

Data sharing is NOT made between CHSs and DHs

CHSs use Zalo to seek clinical consultation from experts* (except for one-stop-shop CHSs that have an established channel. They also use Zalo to offer clinical consultation and treatment follow-up to patients.

Recommendations

1. Promoting the use of mobile NCD screening app for the community people to self-screen CV risk and to self-manage their conditions,

2. Advocating and supporting data sharing at all care levels & building a dashboard for data real-time visualization reporting;

3. Building a webpage for continuously reinforcing and strengthening clinical knowledge & skills of CHS’s health care providers, and offering health education for community people;

4. Creating a clinical hub using the Zalo platform for clinical experts at the city and district level to offer clinical consultation to the CHS’s doctors.

No steering committee (SC) for CV health program established locally (except for Thu Duc city Health Center).

Current SCs: i) SC for Population Health Care, ii) SC for communicable disease prevention and control, iii) SC for Population and Family Planning.

The three SCs always have representatives of the health sector and other relevant sectors.

At the ward level, CHS Heads will have a monthly progress meeting with the Ward People’s Committee to share upcoming health activities

At the district level, there are quarterly and bi-annually socio-economic briefing meetings organized by the District People's Committee

Chart 29: Associations/Union are most active to support the health programs

Recommendations

Advise the HCMC DOH/PC to send official correspondence to district and ward PCs to establish an SC for non-communicable diseases or expand the scope of an annual action plan which will include details for the CV health program & NCDs.

Association of the Elderly Women Association Red Cross Association

Youth Union Veterans Association Fatherland Front

The city always allocates a budget amount for the prevention and control of HTN and DM.

Most DHCs and CHSs are not sure whether nonhealth sectors have annual plans on CV risk prevention or not.

Chart 30: City’s annual budget for HTN and DM prevention program

USD 180,000

USD 160,000

USD 140,000

USD 120,000

USD 100,000

USD 80,000

USD 60,000

USD 40,000

USD 20,000

USD -

From20182020,theallocatedbudgetwas dramaticallybeingdecreasedduetohaving additionalfundingfromprojects.In2021(withno project),theaverageamountforeachCHSto conductscreeningwasonlyUS$64peryear

Thebudgetwasincreasingsignificantlybecause since2020allCHSswerebeingrequestedfor HTN/DMcasemanagementlocally

Behavioral change communication*

Note:

* For activities conducted by HCDC and CHSs;

** Mainly allocated for CHSs;

*** For activities performed by HCDC.

Screening ** Training ** Treatment management ** Monitoring*** Scientific research*** Other activities*** Total budget

Year 2017 Year 2018 Year 2019 Year 2020 Year 2021

In 2021, all preventive activities for HTN and DM were halted temporarily to prioritize resources for COVID-19 response