System-level interventions to improve the availability, accessibility and quality use of essential medicine for CVD prevention in Indonesia

The overall goal of this research is to improve the availability, access and quality use of essential preventive cardiovascular disease (CVD) medicines in rural Indonesia. The target population is adult residents at high risk of CVD events in rural communities near Malang, East Java. The project builds on an existing community-based intervention, with its associated platform and data, and will focus on developing and pilot testing a multi-component intervention to address known constraints in the supply and utilization of CVD medicines. The intervention will comprise a voucher system to provide patients with a period of subsidized prescribed CVD medicines; a digital health solution to assist health clinics in procurement and inventory control of CVD medicines; training, support and incentives to health workers to deliver appropriate CVD care; and a community awareness program on CVD risk and its management. Mixed quantitative and qualitative methods will be used to co-produce this system-level intervention with policy makers, administrators, healthcare providers and community members. A subsequent pilot study will evaluate feasibility and provide preliminary evidence on effectiveness, acceptability, barriers, facilitators and costs. These data will be used to refine the intervention and develop a detailed proposal for large-scale implementation with rigorous evaluation. This proposal involves an established multinational collaboration with a track record of high quality applied health systems research and the required local expertise and networks to ensure success.