Health system readiness for non-communicable diseases at the primary care level: a systematic review

Abstract

ObjectiveTo synthesise evidence on the primary healthcare system’s readiness for preventing and managing non-communicable diseases (NCDs).DesignSystematic review.Data sourcesOvid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice.Eligibility criteriaAny English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs).Data extraction and synthesisTwo authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework.ResultsOut of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO’s health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research.ConclusionThe supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system’s readiness, may help to prevent and manage NCDs at the primary healthcare level.

Assessing service providers’ satisfaction with the chronic diseases package provided through the National Health Insurance Fund in Sudan

“…On the other hand, clinical practice guidelines and continues training are very important to improve both the quality or process of care and patient outcomes (16) An interesting finding in our study is that only 25% of participants received training about chronic diseases benefit package during the last three years while around 50% of the facilities lack effective national protocols or guidelines for treating chronic diseases. These finding come in line with study conducted in Sir-lanka where primary health care providers reflect the insufficient knowledge and training about preventive measure to control and improve the quality of chronic diseases management (15) , and cross-sectional study healed in Cape Town for NCDs at 30 PHC facilities. 14 health professionals were interviewed and they revealed shortage in time and indicated the importance of workshops and group meeting in patient education and empowerment beside that the study revealed significant gab in presence of these guidelines, also a qualitative study done in Palestinian showed that health providers did not used updated clinical guidelines, but this study was done in done in public hospitals not at PHC context.…”

“…These findings come in line with a systemic review that include 23 studies which assess the readiness of health system for providing integrated package for chronic diseases. The result of the review demonstrated that almost all countries' healthcare systems have suffered from inadequate supply side responses to medicine, technologies, equipment, trained healthcare professionals, health information and leadership and stewardship (15) .…”

Health system challenges and opportunities in organizing non-communicable diseases services delivery at primary healthcare level in Bangladesh: A qualitative study

“…It was reported that PHC levels across the south Asian and sub-Saharan countries have insufficient supplies of medicines, basic amenities, diagnostic facilities, and workforce ( 50 ). In line with our review paper, the findings of this study revealed that insufficient resource mobilization is affecting NCD service delivery that needs to be emphasized to make the health system more responsive ( 48 ). Functional referral services and record-keeping are the integral components of a strong health system that ensures patients have access to the best possible higher-level facilities, utilize resources, and maintain the standardized process in service provision ( 51 ).…”

“…The constant shortage of medicines, diagnostic facilities, equipment, and trained human resource remains a big challenge in NCD service delivery, which is a common feature of the PHC system in many LMICs, including Bangladesh ( 20 , 48 , 49 ). It was reported that PHC levels across the south Asian and sub-Saharan countries have insufficient supplies of medicines, basic amenities, diagnostic facilities, and workforce ( 50 ).…”

Yoga and Integrative Healthcare

“…The burden of noncommunicable disorders such as hypertension, heart diseases, type 2 diabetes mellitus, obesity, cancer, and mental health disorders continues to grow globally despite continued research and developments in biomedicine. [ 2 ] Considering the emerging scientific evidence and increasing demand from the patient population, the mainstream health systems world over are opening up for the process of integration with the traditional systems of medicine. Various committees were set up by the government to plan and implement integrative medicine from the 1940s onwards (Bhore committee, Chopra Committee, and Udupa Commitee).…”