Low-cost sustainable interventions for the prevention and management of cardiovascular disease: China Rural Health Initiative

Cardiovascular disease CVD is the leading cause of morbidity, mortality, and disability in China, with a higher burden in the North than the South. The China Rural Health Initiative has created a platform to test innovations to respond to NCD, and the initial project has two interventions:

• a simple low cost prevention and control programme for CVD delivered by primary care
  providers (village doctors, once known as “barefoot doctors”).
• a community based salt reduction and health promotion programme, delivered by community health workers.

The project is a large randomised controlled trial based in 120 villages: 30 villages are receiving
both interventions; 30 one or the other; and 30 neither. The primary healthcare package began in
2010, and the salt reduction programme began in 2011.

The primary healthcare package is aimed at men over 50 and women over 60 who have had
CVD, stroke, diabetes, or hypertension diagnosed by doctors. The package comprises these
components: technical training for primary healthcare workers, enabling them to screen,
classify and manage high risk patients; a case management record; a digital central
database and performance feedback system; and a performance based economic incentive
for health workers.

The salt reduction and health promotion programme aims to reduce mean sodium intake.
The programme is delivered by community health educators, and targets patients with high
blood pressure. In addition, the programme promotes the sale of low sodium salt through village
convenience stores.

A pilot study has shown that the salt reduction programme can reduce blood pressure
significantly – enough to cause a considerable reduction in stroke and heart attacks.

The intervention is to last for two years, ending in October 2012. The main outcome measures
will be blood pressure reduction for the primary healthcare intervention and 24 hour urinary
sodium levels for the salt reduction programme. The project also hopes to raise awareness and
understanding of hypertension, and to improve treatment and control rates.