Addressing NCDs in Africa: Promoting Health Through Hospitals

Introduction

Non-communicable diseases (NCDs) are increasingly prevalent in sub-Saharan Africa due to lifestyle changes related to urbanization and socio-economic, cultural and environmental factors. Strategies to reduce the impact of NCDs on human development are urgently needed but mostly rely on population-wide interventions for prevention. The healthy settings approach is considered crucial in driving health promotion in South Africa and may be applied to health services, including hospitals. In this case study a rural district hospital in the Limpopo Province was transformed into a Health Promoting Hospital (HPH) according to standards developed by WHO-Europe.

Research design

The project was designed as intervention study using a participatory action research design integrated with the PRECEDE-PROCEED model as framework for program planning, including a comprehensive needs assessment among a stratified random sample of hospital staff (n = 295), patients (n = 212) and their relatives (n = 63). A cross-sectional survey was conducted using previously validated instruments to assess health promotion and education needs and individual risk factors for NCDs, including alcohol and tobacco use, dietary patterns and physical activity.

Results

Results indicated evidence of NCD risks among all subgroups, and a need for health education and promotion with regard to healthy lifestyles was identified, in particular with regard to dietary behaviour. Hospital staff considered health promotion boards to be most effective for delivering health education messages, while patients and relatives preferred health communication through the in-house radio/TV, followed by group and individual health education.

Impact

Based on these results recommendations were made and HPH program activities informed, including health communication and promotion initiatives related to healthy lifestyles with active involvement of hospital management and staff. The program was found to be successful and considered a pilot project by Provincial health authorities, representing an advance for health promotion practice in the region.