Models of care for non-communicable diseases for displaced populations in Iraq: a scoping review

Abstract

Non-communicable diseases (NCDs) are the leading cause of death and disability globally. Their importance in humanitarian settings is increasingly recognised, but evidence about how best to address NCDs in these setting is limited. This scoping review aimed to explore models of NCD care for displaced populations in Iraq, in order to build evidence to design context adapted models of care. A search of key databases (Medline, Embase, Scopus, EconLit, Global Health, Web of Science, and the Iraqi Academic Scientific Journals) was conducted and complemented with grey literature and snowballing searches. Documents were included if they referred to models of NCD care for displaced populations. We synthesised the data using a conceptual model of care framework. The findings were reported according to the PRISMA guidelines for scoping reviews. We identified 4036 documents of which 22 were eligible for inclusion. Only six documents were peer-reviewed studies with most being internal reports, commentaries, or press releases. Of the 14 documents that reported on their methods, most applied quantitative approaches (n = 7), followed by mixed-methods (n = 5) and qualitative approaches (n = 2). Only one document reported on outcome data and none applied longitudinal study designs. Documents generally described individual framework dimensions, mostly centring around medicines, facility-based services, and selected access dimensions. Most dimensions had few or no references. The most common model for displaced populations in Iraq was primary-level centred care that complemented or supported existing—mostly tertiary—public health system structures. Additionally, private facilities played an important role and were frequently accessed by displaced populations in most settings. Quality of care, particularly patient-perceived quality, emerged as a critical factor for designing context-adapted models of NCD care. This review also identified a strong regionality of NCD care, particularly in terms of access rates and barriers. We concluded that there is a scarcity of evidence on the effectiveness of models of NCD care for displaced populations in Iraq, calling for capacity building initiatives focused on implementation research and evaluation.

Health system strengthening in fragile and conflict-affected states: A review of systematic reviews

“…Limited access to healthcare has commonly been noted during active conflicts, influxes of displaced populations, and pandemic related restrictions. Besides, availability of medicines is a crucial aspect of access to healthcare, with public facilities generally performing poorer compared with camp-based primary healthcare services or private healthcare providers in settings with displaced populations [52]. The findings also highlighted significant variations in access rates across different areas and times, even within the same country, supporting the suggestion on the need of understanding local circumstances when designing healthcare models [38,52].…”

“…Apart from this, multiple factors hindered access to healthcare, particularly affecting vulnerable populations such as people from minority groups. These factors included the nature and burden of specific diseases, especially NCDs, as well as non-functioning facilities, inadequate staffing, distance to the nearest healthcare facility, and an influx of refugees or returnees, also recently, the COVID-19 lockdowns [37,52]. Limited access to healthcare has commonly been noted during active conflicts, influxes of displaced populations, and pandemic related restrictions.…”

“…Besides, availability of medicines is a crucial aspect of access to healthcare, with public facilities generally performing poorer compared with camp-based primary healthcare services or private healthcare providers in settings with displaced populations [52]. The findings also highlighted significant variations in access rates across different areas and times, even within the same country, supporting the suggestion on the need of understanding local circumstances when designing healthcare models [38,52]. Additionally, several barriers, including financial, logistical, organisational, and sociocultural factors, as well as the context of security, hindered implementation or success of new interventions [37].…”

“…Additionally, several barriers, including financial, logistical, organisational, and sociocultural factors, as well as the context of security, hindered implementation or success of new interventions [37]. The stage of humanitarian crisis was also found to be a critical factor in determining the feasibility of different healthcare models as for instance, disaster situations, particularly ongoing or recent conflicts impact people's healthcare seeking behaviour [52].…”

Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings

“…In the first phase of the partnership (September 2020 to February 2021), the partners worked on a scoping assessment of the ICRC- and DRC-supported NCD care models in Lebanon and Iraq ( Jaung et al, 2021 , Ansbro et al, 2022 , Schmid et al, 2022 ). In Lebanon, this formative research identified a lack of continuous, standardised, integrated care for NCDs, which was delivered by multiple disparate actors within a historically pluralistic and highly privatised national health system ( Willis et al, 2023 ).…”