What is ComBaCaL?
Community Based Chronic Care Lesotho (ComBaCaL) is a collaborative programme between Lesotho and Switzerland that develops, tests, and shares innovative approaches to expanding quality chronic disease care. Diabetes, hypertension, and other chronic diseases are the leading causes of disability and death worldwide. In southern Africa, chronic disease mortality has overtaken HIV/AIDS mortality.
Research
A five-year implementation research programme developing innovative chronic disease care solutions through a population-based cohort across two districts of more than 100 rural villages. In several randomized trials, ComBaCaL is collaborating closely with Community Health Workers (CHWs) to evaluate methods to best deliver care for chronic diseases including diabetes, hypertension, and HIV.
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In a pilot cohort of 10 villages, we are testing the feasibility and acceptability of the ComBaCaL model of care. The main cohort consists of 100 villages, with more than 16’000 participants. Here, CHWs, supported by the ComBaCaL digital application, provide regular screening, counselling and testing of several chronic diseases to all their villagers. In several embedded cluster-randomized trials (diabetes and arterial hypertension), we study the effect of VHWs when providing further care including treatment initiation and follow-up monitoring. As a next step, we will integrate HIV care as part of a randomized trial.
Digital Health
Developing innovative tools to support CHW management of chronic diseases in hard to reach settings.
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CHWs use Community Health Toolkit (CHT), an eHealth application with smart clinical algorithms designed by the ComBaCaL team to support the screening, diagnosis and treatment of diabetes and hypertension.
Health systems strengthening
Increasing access to chronic disease care through infrastructure and training at all facilities in Butha-Buthe and Mokhotlong will improve health outcomes for people across the region.
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The ComBaCaL team provides training, mentorship and supportive supervision to the physicians and nurses at twenty health centres and three district hospitals. Capacity strengthening, infrastructure and medical equipment improve the quality of care provided to the communities in the two districts. Newly developed cardiovascular risk factor and disease registries monitor the treatment outcomes and assist in the supervision of the diabetes and hypertension control programmes.
Capacity building
Providing educational opportunities for Basotho and Swiss students and health professionals.
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ComBaCaL supports the research work of nutrition, pharmacy, environmental health and nursing students from the National University of Lesotho - Faculty of Health Sciences as they gain valuable field experience. We have supported five African health professionals working towards their PhD in clinical research at the University of Basel in Switzerland.
Are you enrolled in a Master’s programme in Switzerland or Lesotho and seeking a thesis project in non-communicable diseases? Contact us for more information.
Micro-enterprise program
Developing businesses and creating sustainable income for community health workers.
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ComBaCaL aims to improve the long-term economic sustainability of CHWs by providing training, mentoring and financial support to enable them to develop small businesses and generate personal income. After completing the International Labour Organisation's 'Start Your Business' training, a pilot group of ten VHWs developed and proposed their business plans. Eight of these plans have already received a small interest-free loan while a total of 50 CHWs have now completed the training and will next develop their business plans. A dedicated micro-enterprise coordinator with a background in business management mentors and supervises the businesses grown and run by the CHWs.