A Comprehensive Needs Assessment Tool for Planning RHD Control Programs in Limited Resource Settings

Abstract

Rheumatic heart disease (RHD) is an important cause of disability and death in low- and middle-income countries. However, evidence-based interventions have not been implemented systematically in many countries. We present a RHD Needs Assessment Tool (NAT) that can be used at country or regional levels to systematically develop and plan comprehensive RHD control programs and to provide baseline data for program monitoring and evaluation. The RHD NAT follows a mixed-methods approach using quantitative and qualitative data collection instruments. Evidence is mapped to a conceptual model that follows a patient through the natural history of RHD. The NAT has 4 phases: 1) situational assessment; 2) facility-based assessment of epidemiology and health system capacity; 3) patient and provider experience of RHD using ethnographic methods; and 4) intervention planning, including stakeholder mapping and development of a monitoring and evaluation framework. The RHD NAT is designed to paint a comprehensive picture of RHD care in an endemic setting and to identify the major gaps to disseminating and implementing evidence-based interventions.

Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments

“… Develop and convene a multisectorial coalition: This might include various stakeholders (such as government, civil society, and private sector) and sectors (such as providers from primary and specialized care, public health, and environment) Conduct a situational analysis: This involves an assessment of the country's epidemiological profile, healthcare system, and policy environment to identify targeted interventions in ARF and RHD control and prevention at the local and national level. To facilitate this, RhEACH has developed a Needs Assessment Tool (NAT) that makes use of scientifically validated methods and charts the patient journey through the health system to determine and quantify barriers and enablers to care[ 86 ] Conduct policy dialogs with multiple local stakeholders: Data acquired through the NAT process can then be used in discussions with multiple stakeholders to help identify and discuss specific barriers and local problems and plan relevant strategies that are appropriate to the given context[ 17 83 ] Develop a plan to evaluate implementation of the selected strategies. …”

“…Conduct a situational analysis: This involves an assessment of the country's epidemiological profile, healthcare system, and policy environment to identify targeted interventions in ARF and RHD control and prevention at the local and national level. To facilitate this, RhEACH has developed a Needs Assessment Tool (NAT) that makes use of scientifically validated methods and charts the patient journey through the health system to determine and quantify barriers and enablers to care[ 86 ]…”

RF and RHD Research

“…In particular, the comprehensive needs assessment tool for planning RHD control programs in low resource settings published in this issue of Global Heart will be an invaluable tool in dissemination and implementation research. 21 This needs assessment tool and other resources now provide clinical and public health research investigators, program developers, RHD advocacy groups, and policy makers invaluable tools for operationalizing the many calls to action for the prevention, treatment, and control of ARF and RHD.…”

Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: a systematic review and meta-analysis of diagnostic accuracy

“… 6 Echocardiographic screening to identify those with subclinical disease has been advocated as a means to support secondary prevention and potentially slow disease progression to overt clinical RHD. 7 8 Yet the feasibility of wide-scale echocardiographic screening remains hindered by high costs and the scarcity of trained personnel. 9 Alternative RHD screening tests, which are both accurate and affordable, are therefore needed in many endemic areas.…”