Haregu Tilahun, Lim Shiang Cheng, Miranda Marcia, Pham Cong Tuan, Nguyen Nam, Suya Inthira, Ilagan Rogelio, Poowanasatien Amphika, Kowal Paul, Oldenburg Brian
Noncommunicable Disease and Implementation Science Lab, Baker Heart and Diabetes Institute; Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
RTI International, Kuala Lumpur, Selangor, Malaysia.
WHO South East Asia J Public Health. 2023 Jan-Jun;12(1):15-37. doi: 10.4103/WHO-SEAJPH.WHO-SEAJPH_140_22.
The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance.
The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions.
We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions.
Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively.
This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.
“更健康计划”一直在解决马来西亚、泰国、越南和菲律宾在预防和控制非传染性疾病（NCDs）方面的关键卫生系统问题。随着该计划接近尾声，问题的可持续性和扩大规模变得至关重要。
目的是评估可持续性和扩大规模战略在一个为期三年的多国技术计划的设计和实施中整合得如何；探索可持续性和扩大规模的推动因素和障碍；并确定可以提高“更健康计划”干预措施的可持续性和扩大规模的切实可行战略。
我们采用分阶段方法来探索障碍和推动因素，并确定改善四项非传染性疾病干预措施（基于社区的肥胖预防、包装正面标签、地方学习网络（LLNs）和非传染性疾病监测）的可持续性和扩大规模的切实可行战略。我们从同行评审文献和当地文件中提取证据。我们还对实施团队和关键利益相关者进行了深入访谈。我们对所得信息进行了主题综合，以确定改善这四项干预措施的可持续性和扩大规模的切实可行战略。
卫生系统高层利益相关者的大力参与被确定为主要推动因素，而地方政府资金和承诺有限被确定为可持续性和扩大规模的关键障碍。加强社区卫生志愿者的社会和机构基础、加强基于证据的包装正面标签宣传、开拓地方学习网络创新以及确保地方政府在实施非传染性疾病监测方面的承诺，分别是改善马来西亚、泰国、菲律宾和越南“更健康计划”干预措施的可持续性和扩大规模的关键战略。
本研究确定了改善非传染性疾病相关干预措施的可持续性和扩大规模的切实可行战略。实施具有高度优先性和可行性的战略将提高该计划在各国关键要素的可持续性。
