STRiDE: Strengthening responses to dementia in developing countries (GCRF)

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Dementia is not a "developed world" condition: there are already more people with dementia in LAMICs than in high-income economies, yet LAMICs are typically less equipped to respond to the high and increasing prevalence. By 2050, there will be 90 million people with dementia in LAMICs (Prince et al 2015). People with dementia, particularly at more severe stages, require intensive care and support, which is very costly. These costs are mostly borne by unpaid family carers, primarily women, who often have to leave paid work, risking personal impoverishment and societal productivity losses. LAMICs face rapid growth in numbers of people with dementia without well-developed or well-funded health and care systems. Family care availability is decreasing as a result of demographic, societal and economic changes. We will build research capability using economics, epidemiology and policy analyses to help LAMICs respond to the needs of the growing numbers of people with dementia in an ethical and sustainable way. The co-applicants, from the UK and South Africa, have strong track-records in dementia research in high-income countries (HICs) and LAMICs, research on health and long-term (social) care in LAMICs. We will partner Alzheimer's Disease International (ADI), a federation of 85 national Alzheimer/dementia associations. We will work with local researchers and NGOs in 7 LAMICs: Brazil, India, Indonesia, Kenya, Jamaica, Mexico, South Africa. To build capability we will offer formal training in research methods, application of those methods to generate new evidence and tools, and training and practice in use of evidence to inform policy. We will apply the best methodological approaches and publish our results in peer-reviewed journals, but more importantly we will ensure that our research generates practical tools for use directly by stakeholders to develop services and improve practice, or to influence policy.We will use systematic reviewing and meta-analysis to review evidence on what works in LAMICs and what can be delivered in particular contexts, but also make that research available online and in DVDs as evidence summaries written in plain (dementia-friendly) language and translated to relevant local languages.We will use Theory of Change (ToC) to co-develop with local partners (researchers/NGOs) and stakeholders (including people with dementia and carers) the research and training agenda for the project to ensure that our activities achieve maximum impact. ToC will also help us develop indicators to evaluate the project's impact. Our research programme will involve development and evaluation of an intervention to increase dementia awareness and reduce stigma, a qualitative study of costs and other impacts of providing family care to people with dementia in different contexts, generation of quantitative evidence on impacts and costs of dementia on individuals and families, and instruments to collect these data.We will use the evidence generated to develop, for each country, credible estimates of the costs and impacts of dementia, and use simulation modelling to project future dementia care needs, the health and social services required to meet those needs, their costs, and the impacts of implementing evidence-informed dementia care pathways and better coverage. Models for each country will be simple to update and adapt. We will assess the policy implications of our projections, consider the barriers presented by current organisation and financing systems and the availability of trained workers, and outline reform opportunities to improve dementia, considering the wider health and social care systems.Finally, we will work with ADI and other policy partners to produce local recommendations to support the implementation of National Dementia Plans. We will organise stakeholder workshops in each country to present project outcomes, and high level stakeholder meetings in each of the regions, in collaboration with WHO.