Implementation of community-based health checks and peer-to-peer support to promote functional ability for older people living in rural Zimbabwe

Thanks to advances in health and sanitation, around the world people are living longer than ever before, with the greatest improvement in life expectancy happening in sub-Saharan Africa. In these added years of life, older people understandably want health and wellbeing, that is 'healthy ageing'. However, currently many African countries, with challenged healthcare services and limited resources, are struggling to provide for their rapidly ageing populations, meaning older people are more likely to be living with disability and dependence.

The World Health Organization (WHO) describes healthy ageing as an older person's ability to walk, see and hear, and function mentally within the place they live. As countries develop health services to meet the growing needs of ageing populations, there is an opportunity now to proactively plan innovative ways of providing holistic healthcare to help people age well. In sub-Saharan Africa most older people retire to their rural homes (called Kumusha in Zimbabwe). Here we will develop a 'Healthy Ageing Check-up', run by nurses and therapy technicians in local rural communities, where older people can be assessed and offered practical management to maintain health as they age. We will work with a range of stakeholders, healthcare experts and older people themselves, to develop a health check-up for people aged 65 years and older, that we will test in Zimbabwe. The check-up will assess for example, walking, balance, nutrition, memory, mood, eyesight, and hearing. We expect most older people will have problems in several areas. When we find a problem we will offer advice, practical solutions, local peer support meetings and, if needed, facilitate specialist referral. We will continue to work closely with local communities throughout the research to understand perspectives, seek advice, feedback progress and importantly, develop effective peer support groups, each led by a lay community champion, trained in particular aspects of healthy ageing by our team. Peer support groups will bring together older people with similar conditions to enable group-based self-management and activities (e.g., group exercises, group work on diet, cooking and nutrition, memory exercises).

We will test how well the roll-out of these health checks and the solutions work, for example how often we identify a health problem, how often we can offer a solution and, when we follow them up again after 4 months, how frequently the older person has taken up the recommendations. In theory, access to public healthcare is free for older people in Zimbabwe, although in practice this is not always the case. So, as well as calculating how much it costs to provide the health check-ups and care, we will see if people experience extra 'out-of-pocket' costs because of the health checks, and if so, the reasons for this. Throughout, we will gather detailed feedback from patients, families, and healthcare workers, about the health check-up programme, so that we can refine and improve the process.

Finally, communicating with the WHO, we will develop a 'Healthy Ageing Intervention Toolkit' to guide the structured, comprehensive, person-centred assessment and management of older people in community settings, suitable for scale-up to other countries across sub-Saharan Africa.

Zimbabwe is an ideal place to do this research, which we have agreed with WHO Africa, as the findings will reflect the situation in similar neighbouring countries in the region, where healthcare services face similar challenges. Plus, our research team have long-standing working relationships with the Ministry of Health, so that our research findings can directly inform healthcare solutions.

Over the four years, we will grow a highly skilled and experienced global health and ageing research team to ensure positive impacts on older people's health for many years to come, and build capability to conduct further important research in this area.

Life expectancy is rising rapidly in Africa. Whilst welcome, longevity alone is insufficient: maintenance of functional ability is key, i.e., Healthy Ageing, in order to avoid chronic disability and dependence. Functional ability consists of a person's intrinsic capacity within their environment, drawing on physical capacity to walk, see and hear, plus cognitive capacity. There is a time-limited opportunity to proactively plan innovative, integrated models of non-specialist delivered care for ageing populations in Sub-Saharan Africa.

We aim to develop and implement an evidence-based clinical framework for non-specialist assessment and management of chronic disorders of ageing which impact functional ability, to improve health and wellbeing of older people living in rural communities in sub-Saharan Africa.

Through formative work we will develop an integrated multi-component health check for rural community-dwelling older adults. We will validate screening tools for conditions affecting mobility, nutrition, cognition, depression, vision, and hearing. If identified, initial on-the-spot care will be provided +/- appropriate referral(s), using an integrated personalised care plan. Interventions will be evidence-based, sensitive to local health policies and provision, and older people's preferences. We will determine the feasibility, acceptability, effectiveness and cost of introducing community-based health checks in rural Zimbabwe, using a prospective hybrid effectiveness-intervention study design with a mixed-methods process and cost evaluation. Through community engagement and involvement, we will co-design and implement rural community-based peer support groups, promoting functional ability by facilitating self-management. Finally, we will co-develop a 'Healthy Ageing Intervention Toolkit' guiding a structured, comprehensive, person-centred approach for non-specialist assessment and management of functional ability in older people suitable for scale-up.