Scaling up the Community Health Assessment Program in the Philippines (CHAP-P): Preventing hypertension and diabetes through primary healthcare

The Philippines, like many low- and middle-income countries (LMICs), experience high prevalence rates of non-communicable diseases (NCDs) especially hypertension, diabetes and their associated complications. About 90% of the population are at risk of developing these conditions, posing significant challenges to the health system. Due to geographical and cultural diversity, access to health services and programmes to prevent NCDs is challenging.

The Community Health Assessment Program in the Philippines (CHAP-P), tested through a large cluster randomized controlled trial, was proven to be effective in reducing the risks of hypertension and diabetes in selected rural communities. Building on this success, the CHAP-P research team secured further funding to scale-up this programme to the Zamboanga Peninsula Region in Southwestern Philippines. This scale-up effort was also supported by contributions from the local government (including human resources and funding for medications).

The Community Health Assessment Program in the Philippines (CHAP-P) is a community-based screening and health promotion initiative, aimed at improving access to essential health services and reducing the burden of NCDs through a health system-based intervention.

 

It has been adapted from a Canadian model, focusing on the assessment and education of NCDs, especially cardiovascular risk factors and diabetes. CHAP-P operates through bi-monthly sessions facilitated by trained community volunteers (‘Barangay’ Health Workers). During these sessions, community members attend walk-in health risk assessments, blood pressure and blood sugar screenings, and receive health education. Participants are also referred for medical consultation or to community health resources as needed. ​​

Similar to the Philippines Department of Health’s Essential Non-communicable Disease Programme (PhilPEN), CHAP-P also provides screening, education, and referrals without requiring specialist, involvement. However, it incorporates a clinical decision support system through a CHAP-P smart database to facilitate risk assessment and personalized health education for participants. Currently, the CHAP-P research team and leaders from the Philippine’s Department of Health are working towards the integration of the CHAP-P and PhilPEN programme to enhance the effectiveness and sustainability of both initiatives.

CHAP-P focuses on community dwelling older adults (aged 40 and above) in rural municipalities. Sessions are held in Barangay (Village) Health Stations or other accessible community-based locations. For the scale-up project, the CHAP-P was implemented in three provinces of the Zamboanga Peninsula Region: Zamboanga Sibugay, Zamboanga del Norte, and Zamboanga del Sur. Five public health personnel, including community volunteers and rural health nurses and midwives, from each ‘barangay’ were trained to implement CHAP-P in their respective areas. A total of about 1,500 public health personnel were trained to implement CHAP-P.

The scale-up project began in April 2019 and has included a range of activities to ensure effective implementation and evaluation. These include stakeholder engagement, interviews to assess willingness and readiness, health personnel training, fidelity checks, acceptability and appropriateness assessments, randomized community trials, and sustainability assessments. The project has been granted an extension until 2026 to complete its research and implementation goals,due to delays caused by the COVID-19 pandemic, which limited community engagements to virtual platforms and delayed training of health personnel.

Policymakers were actively engaged throughout the project ensuring strong collaboration at all stages. Stakeholders, including leaders from Regional Department of Health, were involved in conceptualizing and planning of the programme, including how the CHAP-P could be effectively adapted to the Philippine health delivery system. Key implementers such as the Barangay Health Workers were also involved in project implementation. By the end of the project, knowledge translation efforts included presenting the results to other regions, and to the regional and provincial health offices. Early and active participation from the policymakers at all levels created a sense of shared-ownership which was instrumental in successfully scaling-up CHAP-P across the region.

 

The intervention improved access to crucial health services such as screening, health education and referral for hypertension and diabetes.

 

This offered affordable and appropriate care for at-risk individuals in the community. CHAP-P’s scalability and the involvement of community health workers offer a cost-effective strategy for NCD management, especially in low-resourced areas with the potential to positively impact health systems and outcomes. The programme required some initial investment and organizational changes, but evidence suggests that CHAP-P is likely to lead to significant long-term benefits.

CHAP-P achieved significant individual and community-level outcomes. Participants experienced improved clinical outcomes, including reductions in blood sugar, blood pressure, and weight/BMI. Patient behaviors and knowledge of NCDs and their complications improved, along with increased medication adherence. At the community level, volunteers were equipped and engaged in providing NCD services at the grassroots level. In addition, the lowest organizational level of the health system (Barangay Council) developed an initiative to address their NCD issues through fund allocation for medications and resources.

CHAP-P was effective in improving community level outcomes related to hypertension, diabetes, and cardiovascular risk factors. Locally, these impacts can reduce the burden of NCDs by lowering morbidity and mortality rates and associated health costs. Rural areas where CHAP-P was proven to be effective represented typical rural communities in the Philippines, where healthcare access is more limited. The scalability outcomes show its potential impact to benefit other rural communities in the Philippines. The project team intends to share the results with the National Office of the Department of Health (DOH) in the Philippines and to propose the scale-up of CHAP-P nationally.

The best practices guides developed during the scale-up process can be used as a framework for national implementation. This could significantly reduce the burden of hypertension and diabetes in rural communities nationwide. Furthermore, CHAP-P can be adapted to other LMICs with similar settings and healthcare infrastructure, using the guides and best practices developed during the CHAP-P scale up in the Philippines.

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This research was funded by the Canadian Institutes of Health Research under the Global Alliance for Chronic Diseases (GACD) Scale Up Research Programme.

To access publications and other outputs relating to this project, see GACD’s publications webpage (under Scale up Research Programme publications project SU11, and Diabetes Research Programme publications project DM04)

For more information about this project, please see the project’s website or contact Gina Agarwal, McMaster University.