Brief Summary: (short description of the primary purpose of the protocol, including a brief statement of the study hypothesis)

Systematic Medical Appraisal, Referral and Treatment (SMARThealth) program is a novel primary care platform to support communities and healthcare providers in the prevention and management of common NCDs.

The overall SMARThealth package includes the Smart Tablet with the SMARThealth Application tailored towards identification of individuals at high risk for CVD and provide necessary counseling, referral and follow up. It draws on the principles of “task-sharing” whereby many routine clinical procedures are transferred from doctors to non-physician healthcare workers (NPHWs) in an effort to increase access to healthcare and reduce costs. This is facilitated by a suite of innovative, affordable digital technologies developed to provide evidence-based decision support to both providers and consumers

The main objective if the SMARThealth extend project is to demonstrate the extent to which the SMARThealth program can be rapidly customized and scaled up in health systems that might differ substantially (from the Indonesian province of East Java and the northern Indian state of Haryana), both geographically and demographically, from that in which the program was developed (West Godavari District of Andhra Pradesh).

Non-communicable diseases (NCDs) are already the leading cause of the disease burden faced by Indonesia and India. This burden extends from urban areas to many rural regions. In the 2010 Global Burden of Disease Project, stroke, ischemic heart disease, diabetes and chronic kidney disease (CKD) were ranked number 1, 7, 5, and 11, respectively, as the causes of premature mortality among all age groups in Indonesia. In Indonesia, it is estimated that one in five Indonesian adults aged 41-50 years is at high risk of cardiovascular disease (CVD). This proportion increases sharply to 70% for those aged 51-60 years. Furthermore, two-thirds of those at risk are not receiving appropriate treatment. There are marked geographical disparities, with rural residents much less likely to access CVD care. The situation is similar for India, where recent data from rural Andhra Pradesh shows that 18% of the population aged over 40 years has diabetes, and almost 40% of these cases were previously undiagnosed. Overall, almost 17% of the adult population was found to be at high short-term risk of CVD and the vast majority of these individuals were not receiving any preventive drug therapy whatsoever.

The study is to understand the issues in the rapid customization and scale up of SMARThealth platform in different geographical populations and health systems. The project would be implemented in Jhajjhar district, Haryana, India, covering 4 villages with population coverage of about 20000 and 4 villages in Indonesia with a population coverage of about 40,000.The data collection would occur in two occasions in each village – at baseline and at the end of the SMARThealth Extend implementation period. The intervention would focus on the routine visits by NPHWs to the households and evaluating those between 40-85 years for symptoms of CVD and with support of the Clinical Decision Support System (CDSS) counsel, refer and follow up the high risk individuals. Mixed methods evaluation will be used to assess feasibility, acceptability, scalability and sustainability. The key output will be a comprehensive policy-framed report for each country, describing the program implementation, reliability and evaluation mechanisms for integration into the health system framework for NCD prevention.