Integrated management of non-communicable diseases in low-income settings: palliative care, primary care and community health synergies

Abstract

Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030—Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found. This paper discusses the challenges of providing comprehensive NCD management in LMICs, the role of palliative care in addressing the huge and growing burden of serious health-related suffering, and also its scope for leveraging various aspects of primary care NCD management. Drawing on experiences in India and Nepal, and particularly a project on the India–Nepal border in which palliative care, community health and primary care-led NCD management are being integrated, we explore the synergies arising and describe a model where palliative care is integral to the whole spectrum of NCD management, from promotion and prevention, through treatment, rehabilitation and palliation. We believe this model could provide a framework for integrated NCD management more generally in rural India and Nepal and also other LMICs as they work to make NCD management as part of UHC a reality.

A Narrative Review of the Patient Journey Through the Lens of Non-communicable Diseases in Low- and Middle-Income Countries

“…At the remedial phase, the treatment decision following diagnosis, treatment experience influenced by treatment goals, access to services, follow-up, and adherence to the recommended therapeutic or lifestyle modification interventions determine the course of the patient journey for NCDs and the outcomes. Palliative care is recognized as an integral component of universal health coverage and must be available throughout the life course of PLWNCDs particularly in LMICs, where approximately 80% of the global population in need of palliative care resides [37,38]. Palliative care is essential for better control of symptoms and an improved quality of life for patients and also improves the physical and psychosocial well-being of families and caregivers [38].…”

Palliative care delivery in India during COVID-19 pandemic: role of faith-based hospitals – a qualitative study

“…Many FBHs in India have been increasingly involved with developing systems and services for chronic disease management including PC and in delivering universal health coverage in low-income areas. 3 The position paper by the Indian Association of Palliative Care served as a guide for healthcare professionals (HCPs) in care of individuals with PC needs both for COVID-19 patients and others. 4 There is little published on the role of FBHs in PC delivery during the COVID-19 pandemic.…”

Palliative Care Communication Among Home Health Interprofessional Staff: A Randomized Controlled Trial of Feasibility, Acceptability, and Preliminary Effectiveness

“…Home health (HH) is the fastest-growing healthcare setting and the largest long-term care modality in the U.S. 1 Home health is an appropriate setting for primary palliative care, defined as integrated care provided in local communities that includes early identification and triggering of specialist palliative care, as part of integrated and holistic chronic disease management. 2 The American Nurses Association (ANA) and the Institute of Medicine (IOM) have underscored the imperative to improve primary palliative care communication, which involves responding to emotions, exchanging information, and discussing goals of care. 3,4 To facilitate goal-concordant care, palliative care communication principles need to be integrated into all healthcare settings.…”