Decentralizing NCD Care Through Primary Health Systems
Through the Empower Health program, hypertension and diabetes services were decentralized to 164 primary health care sites within a broader network of 245 facilities that enrolled over 89,000 patients. Over 12 months, blood pressure control at health centers and dispensaries nearly doubled from 32% to 63%, with average systolic blood pressure reducing by 12.9 mmHg—almost three times the reductions seen at hospitals. Diabetes control improved more modestly, underscoring the need for structured lifestyle support and consistent medicine availability. These results demonstrate that when equipped with digital tools, training and basic infrastructure, primary health care facilities can deliver high-quality NCD care, easing pressure on hospitals and bringing essential services closer to communities.
Overcoming Clinical Inertia with Digital Nudges
The Empower Health program, powered by the SPICE digital platform, tackled one of the toughest barriers in diabetes care across four African countries: clinical inertia. By embedding rule-based clinical decision support nudges into clinician workflows, the system generated 2,449 treatment intensification alerts and 1,193 lab reminders. Nearly 60% of treatment alerts led to adjustments, and patients who received intensified care were three times more likely to achieve glycaemic control (34% vs. 12%). While test completion lagged due to infrastructure gaps, the initiative proved that context-adapted, user-centered digital nudges can standardize care, improve outcomes, and offer a scalable path for strengthening NCD management in Africa
Closing the Care Cascade with Digital Technology
Afya Imara transformed hypertension and diabetes care in Tanzania by combining digital tools, community outreach, and health system strengthening across 21 faith-based facilities. Nearly 76,000 people were screened and 19,000 enrolled, with hypertension control rising from 18% to 57% and diabetes control from 25% to 76% in one year. While follow-up gaps and cross-sector coordination remain hurdles, the program offers a scalable model for Africa, proving that digitally enabled, community-centered approaches can deliver lasting impact in NCD care.
From Detection to Control – Bette Lyfe (Better Life)
The Bette Lyfe program in Sierra Leone showed how digital technology, community screening, and decentralized care can tackle the country’s rising burden of hypertension and diabetes. More than 25,000 people were screened and 11,000 enrolled, with control rates for both conditions more than doubling within a year. Despite strong outcomes, the program faced major challenges in patient retention and medication availability, highlighting the need for sustainable financing, stronger continuity strategies, and national system integration.
Bridging the Gap
The pilot in Bangladesh deployed a community-first, tech-enabled model across five Upazilas to tackle undiagnosed and uncontrolled hypertension and diabetes. Using the SPICE digital platform and CHWs (Shasthya Kormi), the program screened ~143,500 people (about a third of the target catchment), finding elevated blood pressure in 21% and elevated blood glucose in 22%. Of those referred, about one-third enrolled for care; among those who followed up, control rates rose from ~31% to ~72% for hypertension and from ~23% to ~47% for diabetes after 12 months. Barriers included inconsistent medication supply, weaker behavioural/lifestyle support, and fragmented care coordination. The model shows promising feasibility and impact, but scaling will require addressing system-level gaps and improving continuity of care.
Healthy Neighbor
The Virtua Toolkit documents the “Healthy Neighbor” model in Camden, New Jersey, where community health workers supported by digital technology improved care for people with hypertension and diabetes. Over 250 patients were enrolled, with the majority achieving significant improvements in blood pressure and blood glucose control. By blending medical and social care, home visits, and data-driven follow-up, the model demonstrates how trusted community workers and digital integration can address chronic disease in underserved populations and offers a replicable playbook for other health systems.