Evaluation of a scaling up strategy for noncommunicable diseases interventions using the RE-AIM framework –  A case study from Vietnam

Background: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in Vietnam. The government has a strategic NCD plan in place, which puts emphasis on community-based prevention and screening and primary healthcare-based early diagnosis and treatment. The project Scaling-Up NCD Interventions in Southeast Asia (SUNI-SEA) implemented community-based screening in Intergenerational Solidarity Groups (ISHGs) and capacity building for early diagnosis and treatment in Commune Health Stations (CHSs). Through creating synergies between community and PHC the project aimed at scaling up NCD prevention and control in Vietnam. This paper presents the methodology for monitoring processes and results in scaling up NCD prevention and control in Vietnam, and lessons learned for global action in this field. Methods: The project used the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) to develop quantitative and qualitative indicators for measuring the implementation. The project applied a sequential explanatory design to perform routine monitoring, surveys and in-depth interviews, leading to final conclusions. Results: The project managed to scale up NCD interventions successfully through horizonal scaling-up (reaching more people) and vertical scaling-up (increasing the package of services). Risk factors for diabetes and hypertension were identified in community-based screening, and early treatment started in CHSs. Health literacy of community members increased, and skills of health workers improved. The processes of scaling up were highly dependent on good communication and commitment of stakeholders (community members, community-based organisations, health workers, health managers), clear agreements on roles and responsibilities, as well as simple understandable interventions, with good protocols and guidelines. Technical support and continuous capacity building is required throughout the process. Organisational, financial and human resources constraints hamper scaling up. Conclusions: The RE-AIM framework is a suitable tool for measuring scaling up interventions. For application in routine situations, monitoring must be simplified. A sequential explanatory design helps to measure results and processes step by step. Barriers and facilitators for scaling-up NCD interventions were identified. Trial registration: NCT05239572 date 25 Oct 2023