SMARThealth focus for scientists in Australia, India and Indonesia

Contributed by Anushka Patel, ANU

Australian, Indian and Indonesian scientists are collaborating to implement and evaluate a cardiovascular disease prevention program in East Java called SMARThealth—Systematic Medical Appraisal, Referral and Treatment of cardiovascular disease. The program was developed through connections made at a joint Australia–Indonesia health workshop arranged by the Australian Academy of Science and the Indonesian Academy of Sciences in Jakarta in May 2015. It is funded by a US$1 million philanthropic donation.

Cardiovascular diseases (CVD) and related conditions are now a leading cause of premature death and disability in many low- and middle-income countries

Cardiovascular diseases (CVD) and related conditions are now a leading cause of premature death and disability in many low- and middle-income countries, including Indonesia. Rural communities in these countries have very few, if any, resources available for effective identification and management of people at high CVD risk.

About SMARThealth

Over the last several years, The George institute for Global Health has developed an innovative strategy to improve cardiovascular disease (CVD) risk management in these rural communities. The SMARThealth system comprises:

• a mobile device-based clinical decision support system for CVD risk management
• task-shifting traditional physician roles to non-physician healthcare workers
• integration of the overall system within the public primary healthcare infrastructure.

The system was developed and successfully implemented in the south Indian state of Andhra Pradesh, and is currently in the final stages of a randomised controlled trial involving approximately 80,000 adults at risk of CVD.

For broader impact, a crucial question is the extent to which the SMARThealth program can be rapidly customised and scaled up in health systems that might differ substantially from that in which the program was developed. The George Institute was approached by a philanthropic donor to consider extending the program to other systems, including in Indonesia. In a demonstration project, researchers from the University of Brawajiya will customise and implement SMARThealth to Kabupaten Malang (Malang Regency) in East Java, Indonesia, with trained primary care doctors and non-physician healthcare workers (Kaders) serving a population of approximately 48,000 adults. This will be undertaken in collaboration with local government, to maximise the potential for uptake and scale-up. Outcomes from this implementation study will be available in mid-2018.