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RHD Action Announces 2018 Small Grants Programme Recipients (Open Round)

08 November 2018
Philippine Foundation for the Prevention and Control of RF RHD, Philippine Heart Association

RHD Action is pleased to announce the recipients of the open round of the RHD Action Small Grants programme. Four proposals were selected from almost 40 high quality submissions with projects set in Rwanda, Cameroon, the Philippines and Uganda.

All funded projects have a focus on the People and Communities section of the RHD Action Priorities Pyramid and involve activities and programmes for people living with RHD, and / or building health worker capacity, and promoting community awareness.

This year RHD Action also funded four additional projects in an invited round taking the number of funded projects for 2018 to eight projects.

Congratulations to all recipients in what was a very competitive process. We look forward to sharing the progress of our all of our 2018 Small Grants Programme recipients in the months ahead.

More details on the successful recipients and the funded projects in the open round can be found below:


Project Title:
“Improving Health Education Among Post-Operative RHD Patients”

Project Director:
Jeanne Umuhire, Country Director
Team Heart - Kigali, Rwanda

Rwanda represents a resource-limited setting; only six cardiologists are available to treat the entire population. There is no established cardiac surgery service in Rwanda. As a result, Rwandans with RHD have limited access to healthcare and die prematurely. Team Heart, working with the Rwanda Biomedical Center and MOH, has coordinated visiting surgical teams to provide open-heart surgery on an annual basis. Over 150 patients with advanced RHD have undergone surgery over the past ten years in this programme.

Team Heart founded a patient advocacy network, the Rwanda Cardiac Patients Network (RCPN), in 2008, with the support of the Rwanda Heart Foundation, to provide support for these post-op patients to manage the challenges that exist in access to medications and follow up care after cardiac surgery. Team Heart also addresses the behavioural changes that are crucial to reduce post-op complications.

This Small Grants Project team will conduct day-long health education workshops for post-operative RHD patients and NCD nurses at four district hospitals located throughout Rwanda. The aim is to improve knowledge on medication adherence, family planning, nutrition, and lifestyle behaviour to assist health care workers and empower patients to take control of their own health and well-being. About 150 participants and six health care professionals are expected to attend and/or facilitate the workshops. The workshop curriculum will be developed and delivered by cardiologists and trained healthcare professionals and the course contents will be validated by the Ministry of Health through the Rwanda Biomedical Center (RBC) and the Rwanda Heart Federation.

The RCPN and Team Heart databases will be used to acquire contact information for potential participants. Thereafter, NCD nurses at the selected district hospitals will invite patients to participate at the one-day workshop at the nearest convening hospital via telephone call. The workshops will focus on enhancing RHD knowledge among healthcare providers as well as patient attendees. Educational materials developed for the project will be used for pre- and post-op education of future surgical candidates.

Team Heart has an MOU in place with the Rwanda Ministry of Health as they have previously collaborated on a variety of projects, including echocardiography and anticoagulation management trainings, RHD screening projects and awareness raising campaigns. The MOH, will be invited to be involved in both the planning and execution of the workshops and to discuss the adoption of this training model in other district hospitals.

The Small Grant team at Team Heart hopes these workshops will be replicated at other facilities and in other contexts. This project is part of a larger country-wide initiative to address the burden of RHD through collaboration with multi-national teams. With awareness, prevention and early intervention as a component to increase public knowledge through empowerment of RHD affected patients.


Project Title:
“Initiating a Rheumatic Hearth Disease Clinic”
Project Director:
Yanwou Nguemnang Nathan Yves, MD
Mother and Child Health Center, Chantal Biya Foundation, Yaounde, Cameroon

In Cameroon, the prevalence of rheumatic heart disease has been reported to vary from 5.8%1 in the general population to a high of 62.1% in patients aged 10 to 19 years in some settings. But there are limited data on RHD - no registry, no national control program, no awareness campaign. Because of this, most people with RHD in Cameroon are first diagnosed with advanced disease requiring surgery. Surgery is expensive; many patients die while waiting for surgery.
The management of children with acute rheumatic fever and rheumatic heart disease by the Small Grants team in Cameroon has mostly been limited to prescribing antibiotics and counselling for patients and their carers. Strategies to improve adherence to secondary prophylaxis do not exist, thus many patients are lost for follow-up. However, recognising that preventive strategies are key to the eradication of ARF/RHD, their project calls for the initiation of a Rheumatic Heart Disease Clinic at the Mother and Child Health Center, Chantal Biya Foundation.

This project will target ten children, adolescents and their carers who will are hoped, in turn, impact their own communities. Five healthcare workers – three doctors and two nurses – will also be involved. The objectives of the project are to increase adherence to secondary prophylaxis and build leadership capacity among patients.
A database of children with documented rheumatic heart disease by reviewing the echocardiography register from 2013 to 2017. The children’s carers will be contacted for appointments with their respective children on the day the educational programme is launched. The programme will focus on the importance of secondary prophylaxis to slow or prevent progression to RHD.

This first educational programme will serve as the forum to launch the RHD Clinic. Thereafter, clinics will be held every month and consist of penicillin injections and discussions on disease prevention. Patients will be empowered to raise awareness on RHD in their own communities. The goal is to build a conducive environment where both patients and health care providers can come together and share their experiences and, in the long run, establish a reference clinic in Yaounde for RHD patients. The team plans to advocate for free secondary prophylaxis for all those attending the clinic to encourage adherence and follow up.

A social media campaign will be launched using images and hashtags to announce the event and the creation of the referral clinic. Local radio and television will be approached to cover the first gathering. The project will be carried out in collaboration with the Ministry of Public Health.


Project Title:
“Creation of Standardized RHD Educational Materials to Support and Promote the National Implementation of Free Secondary Prophylaxis in the Republic of the Philippines”
Project Director:
Juliet J Balderas, MD, President
Philippine Foundation for the Prevention and Control of RF RHD
Council Chair RF RHD, Philippine Heart Association
Quezon City, Philippines

Acute Rheumatic Fever (ARF) continues to be the leading cause of acquired heart disease in children and adults in the Philippines. Over the past three years, the Philippine Heart Association Council of RF/RHD and Philippine Heart Center have worked to create standardised guidelines for the treatment of ARF/RHD. These efforts toward standardisation have included work on the creation of clinical pathways in ARF/RHD diagnosis, screening, and treatment, and drafting a national policy recommendation for RF/RHD Control.

This work paved the way to the approval of the recommendation by the Philhealth Board to the Philippine Health Insurance Corporation to provide free secondary prophylaxis in April 2018. This new benefit includes free secondary prophylaxis (BPN injection), a workup and echocardiogram.

This project proposes to create and disseminate the educational modules and materials on clinical pathways for healthcare professionals and patients as the new ARF/RHD standards and guidelines are rolled out across the country. Meetings are currently scheduled at five sites to introduce this new initiative between November 2018 and April 2019. The new educational materials will cover a spectrum of topics including the magnitude of RF/RHD in the Philippines; national recommendation for ARF/RHD control in the Philippines; sore throat clinical pathway for primary prevention; the New Jones Criteria; clinical pathway for suspected RHD and screening; algorithm for BPN injections and directly observed penicillin injections; and guidance for enrolling patients in the ARF/RHD registry.

The impact and success of the project will be measured by the number of healthcare personnel attending the educational sessions and receiving a Certificate of Attendance of the ARF/RHD Implementing Guidelines; and the number of Philippine Heart Association Chapters hosting an ARF/RHD Symposium using the educational materials developed with this award.


Project Title:
“Rheumatic Heart Disease Education and Awareness in Nakivale (Refugee Camp) – RHDEAN”
Project Director:
Dr Nampijja Dorah
Mbarara University of Science and Technology, Department of Paeds, Mbarara, Uganda

Dr Nampijja Dorah and her team have proposed the first of its kind awareness campaign in a refugee camp. Uganda is home to many refugees with multiple refugee settlement camps for people who have been displaced from their homes due to wars and political instability. Dr Dorah believes this project will be an eye-opener for education and awareness about RHD and ARF in other refugee camps around Uganda and the rest of the world. This project will impact residents, teachers, health workers and administrators living in the Nakivale Refugee Camp in the Isingiro District of south western Uganda.

RHD prevention in Uganda, like most African countries, is still a challenge. Access to primary preventive measures is limited. Access to oral pills or a single injection of penicillin for treatment of sore throat is not universal, and the situation is worse in refugee camps. Furthermore, there is a lack of awareness of the consequences of a simple sore throat on the heart. Many children with ARF go undiagnosed in Uganda, where health workers, parents and other people caring for children are not informed about the disease. Advanced surgical options for RHD are not easily accessible as they are expensive and not afforded by the impoverished people who are more prone to severe RHD.

Refugees have limited access to medical care making identification and comprehensive care for ARF/RHD a challenge. In addition, refugee settlement camps experience high levels of poverty, overcrowding, limited or no access to health care, and the high burden of RHD from their countries of origin.

The Small Grants team will prepare information, education and communication materials on RHD in English, and Runyankole and Kinyarwanda local languages to be used in consultation meetings with stakeholders at the district level, refugee camp administration and the medical teams, as well as the school heads in the refugee camp. Nurses and social workers, parents and school teachers in the refugee camp will also be trained on the RHD information package.

Training targeted for teachers will encourage them to identify symptoms and help children access timely medical care. Students will also be targeted for education about ARF/RHD, how it is spread, the early symptoms and seeking treatment earlier before the disease gets out of hand. Posters and talking signs will be used as constant reminders about RHD and to help learners and staff implement what they have learned. This ambitious project will also work with local radio talk shows to air information on RHD, prevention, risk factors.

Success will be measured by the numbers of people attending the various trainings, the number of radio and local tv talk shows aired; the number of posters and talking signs put up in schools; and the number of school visits accomplished. The training materials and content developed in this project will be made accessible for future use for nurses, community health workers, teachers and parents to train others about RHD.