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doctor in India takes a patient's blood sample with a finger prickHealthRise was a five-year global program funded by the Medtronic Foundation, designed to improve access to chronic care for individuals in underserved communities suffering from hypertension and diabetes. Its primary objectives were to increase screening, diagnosis, management, and control of cardiovascular disease and diabetes. The program was implemented in nine communities in Brazil (2 sites), India (2 sites), South Africa (2 sites), and the United States (3 sites) and grantees in each location developed programs uniquely tailored to each local context. Despite substantial variation in program design, all shared the same core principles: empowering individuals living with cardiovascular disease and diabetes, enabling frontline health workers to better address the needs of these individuals and communities, and supporting advocacy and policy that promotes effective care for non-communicable diseases.

IHME served as the independent evaluation partner and carried out three primary activities:

  1. Establishing baseline measurements and conducting a needs assessment
  2. Managing program monitoring
  3. Conducting an endline evaluation

The global framework for needs assessment and monitoring and evaluation was designed to align with Medtronic Foundation’s Continuum of Care.

The specific objectives of the needs assessments were to:

  1. Estimate the prevalence of diseases and risk factors
  2. Identify major gaps along the continuum of care
  3. Identify supply- and demand-side barriers that contribute to these gaps

The monitoring and evaluation activities conducted by IHME can be broadly grouped into two categories: the process evaluation and the endline evaluation. The process evaluation, which had substantial overlap with the monitoring phase, offered insights into the various activities being executed across each of the implementation programs and the endline evaluation measured changes in target health outcomes. Key outcome indicators for HealthRise included the number of individuals diagnosed with diabetes with their most recent blood glucose measurement below the threshold for controlled disease and the number of individuals diagnosed with hypertension with a decrease of 10% or more between their first and last blood pressure measurement.

For the endline evaluation, a mixed methods quasi-experimental approach was implemented in which both quantitative and qualitative data captured the different types of needs, barriers and opportunities. A combination of quantitative and/or qualitative data were collected at each site, and when possible, data were collected from both intervention and comparison areas. These data were compared with data collected at baseline to assess changes in patient outcomes, knowledge, and behaviors; provider knowledge and practices; the quality and availability of health services; and the reach of HealthRise programs. 

Survey instruments and protocols

Quantitative survey instruments are comprised of a health facility questionnaire and patient exit interviews including the collection of biomarkers. IHME developed and programmed all quantitative survey instruments in Surveybe, a computer-assisted personal interview data collection platform. Local data collection teams administered surveys on tablets in India and South Africa. Quantitative surveys were not conducted in Brazil or the US. All quantitative survey instruments and collected data are published and publicly available on IHME’s Global Health Data Exchange.

Qualitative data was collected in the form of focus group discussions and key-informant interviews. All interview guides and protocols were developed by IHME. Local data partners conducted qualitative data collection in Brazil, India, and South Africa. IHME conducted qualitative data collection in the US.

Data Collection Tools

Brazil

India

South Africa

US

*Note: All “Patient Survey” and “Facility Survey” data collection was conducted electronically via tablets using SurveyBe CAPI software. The guides are intended to provide readers with documentation of survey content, and were not used to collect data in the form in which they are presented here.  

Funding and partners

The program was funded by Medtronic Foundation. The HealthRise Evaluation team collaborated with and harnessed the expertise of numerous distinguished organizations to carry out this work:

Global Team

  • Medtronic Foundation
  • Abt Associates
  • Human Sciences Research Council (HSRC)
  • Instituto Sírio-Libanês de Ensino e Pesquisa (IEP)

Grantee Partners

  • HealthFinders Collaborative, Inc (HFC)
  • Regions Hospital Foundation
  • Pillsbury United Communities (PUC)
  • FAPEX
  • FUNDEP
  • Project HOPE
  • Expectra Health Solutions
  • Catholic Health Association (CHAI)
  • MAMTA Health Institute for Mother and Child (MAMTA)

Data Collection Partners

  • Dinamica Cursos
  • Tesla Gestao
  • Press Consultoria
  • Indira Gandhi Medical College (IGMC) Shimla
  • GfK Mode (Growth from Knowledge)
  • Development Solutions, Inc
  • Social Surveys Africa

Findings and reports

May 25, 2022
Endline assessment of a community-based program on hypertension and diabetes management in Brazil
Research Article
In this independent prospective evaluation, we used both quantitative and qualitative data to assess the potential impact of the Brazil HealthRise programs on improving clinical and health outcomes for hypertension and diabetes patients in Teófilo Otoni and Vitoria da Conquista. We hypothesized that participation in the Brazil HealthRise program could lead to reduced biomarker readings and increase the proportion of individuals meeting treatment targets for both conditions.
August 29, 2021
Assessing the impact of community-based interventions on hypertension and diabetes management in three Minnesota communities: findings from the prospective evaluation of US HealthRise programs
Research Article
Community-based health interventions are increasingly viewed as models of care that can bridge healthcare gaps experienced by underserved communities in the United States (US). With this study, we sought to assess the impact of such interventions, as implemented through the US HealthRise program, on hypertension and diabetes among underserved communities in Hennepin, Ramsey, and Rice Counties, Minnesota.
April 15, 2020
Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA
Research Article
 As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.
July 1, 2019
HealthRise Evaluation: Final Report
Policy Report
HealthRise was a five-year global program funded by the Medtronic Foundation, designed to improve access to chronic care for individuals in underserved communities suffering from hypertensions and diabetes. This report provides a short description of the nine demonstration projects; details of the  monitoring and evaluation framework; methods and key findings of the baseline measurements, needs assessment, and monitoring activities; and detailed methods and results from the endline evaluation. Specific results and conclusions are presented for each country, as well as cross-country themes and conclusions applicable to the HealthRise project as a whole. 
March 14, 2018
Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project
Research Article
The HealthRise initiative seeks to implement and evaluate innovative community-based strategies for diabetes, hypertension and hypercholesterolemia along the entire continuum of care (CoC)-from awareness and diagnosis, through treatment and control. In this study, we present baseline findings from HealthRise South Africa, identifying gaps in the CoC, as well as key barriers to care for non-communicable diseases (NCDs).
December 27, 2017
Identifying gaps in the continuum of care for hypertension and diabetes in two Indian communities
Research Article
Non-communicable diseases (NCDs) represent the largest, and fastest growing, burden of disease in India. This study aimed to quantify levels of diagnosis, treatment, and control among hypertensive and diabetic patients, and to describe demand- and supply-side barriers to hypertension and diabetes diagnosis and care in two Indian districts, Shimla and Udaipur.
July 27, 2016
Identifying High-Risk Neighborhoods Using Electronic Medical Records: A Population-based Approach for Targeting Diabetes Prevention and Treatment Interventions
Research Article
Increasing attention is being paid to the marked disparities in diabetes prevalence and health outcomes in the United States. There is a need to identify the small-area geographic variation in diabetes risk and related outcomes, a task that current health surveillance methods, which often rely on a self-reported diagnosis of diabetes, are not detailed enough to achieve. Broad adoption of electronic health records (EHR) and routine centralized reporting of patient-level data offers a new way to examine diabetes risk and highlight hotspots for intervention.