Health system readiness to deliver integrated noncommunicable disease and antenatal care in Kyrgyzstan, Tajikistan, and Vietnam

Abstract

Introduction: Globally, noncommunicable diseases (NCDs) are a leading cause of death among women of reproductive age. Reproductive, maternal, newborn, and child health (RMNCH) services provide an important opportunity to prevent, detect, and manage NCDs. Yet, NCD and mental health care remain poorly integrated into RMNCH services in many settings. We aimed to explore the feasibility of integrating NCD and mental health interventions into RMNCH interventions in Kyrgyzstan, Tajikistan, and Vietnam. Materials and Methods: We conducted a secondary analysis of data from a WHO project on integrating NCD and mental health interventions into RMNCH services across three countries. Our analysis used the WHO health systems building blocks framework to structure inquiry and synthesis across key areas such as service delivery, workforce, and governance. Results: Maternal mortality remains high in all three countries and antenatal care is hospital oriented. We identified several common barriers at the primary care level, including inadequate knowledge of NCDs and mental health conditions among healthcare workers, a lack of essential equipment, and weak coordination among healthcare providers across levels of care. Integrated management is not routinely included in training programs and adherence to clinical guidelines remains low. Conclusions: The healthcare systems in all three countries are not well prepared to provide integrated care. Greater emphasis is needed on strengthening primary care to ensure high-quality integrated services. Alongside updating training programs and securing the availability of essential equipment and commodities, there is a need to update clinical protocols on integrated management and revise monitoring systems to support quality improvement. The global level needs to address the research gaps and provide more support to countries to prioritize integrated care.