Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone

Abstract

Background: The growing burden of non-communicable diseases in low-and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic. Methods: This paper focuses on the case of Sierra Leone and uses a combination of participatory group model building at national and district level, in rural and urban districts, interviews with 28 key informants and review of secondary data and documents. Data is analysed using the WHO's health system assessment guide for NCDs. Results: We highlight multiple challenges typical to those encountered in other fragile settings to the delivery of preventive and curative NCD services. There is limited government and donor commitment to financing and implementation of the national NCD policy and strategy, limited and poorly distributed health workforce and pharmaceuticals, high financial barriers for users, and lack of access to quality-assured medicines with consequent high recourse to private and informal care seeking. We identify how to strengthen the system within existing (low) resources, including through improved clinical guides and tools, more effective engagement with communities, and regulatory and fiscal measures. Conclusion: Our study suggests that NCD prevention and control is of low but increasing priority in Sierra Leone; challenges to addressing this burden relate to huge numbers with NCDs (especially hypertension) requiring care, overall resource constraints and wider systemic issues, including poorly supported primary care services and access barriers. In addition to securing and strengthening political will and commitment and directing more resources and attention towards this area, there is a need for in-depth exploratory and implementation research to shape and test NCD interventions in fragile and post-conflict settings.

Rural–urban health-seeking behaviours for non-communicable diseases in Sierra Leone

“…Given the increased recognition that health and community systems operate as complex adaptive systems,27 28 we conducted participatory group model building sessions with both health system actors (national policy makers and district health representatives and urban and rural healthcare providers) and communities (urban and rural community leaders and members). We focus here only on community-related work and present all work pertaining to health system elements elsewhere16). Development of research questions and design of the study were informed by findings from a scoping review that was done earlier to gain an understanding of the priority areas of research for NCDs.…”

“…A literature scoping review,11 WHO country reports15 and analysis of Sierra Leone’s readiness to tackle the rising NCD burden16 suggest that several health system-related challenges exist. First, the management of NCDs is not supported via dedicated funding mechanisms.…”

Qualitative Phytochemical Fingerprint and Network Pharmacology Investigation of Achyranthes aspera Linn. Extracts

“…In Sub-Saharan Africa, NCDs are the second most common cause of mortality, accounting for 2.6 million deaths annually, which is equivalent to approximately 35% of all deaths in the region Yuyun, et al [1]. Healthcare systems in the majority of Sub-Saharan Africa countries are fragile, fragmented, under-resourced, inaccessible and inefficient for a quick and effective response to rising burden of NCDs and hence managing these chronic diseases in Africa represents a huge challenge [2,3]. Thus, in line with the World Health Organization's strategy, healthcare authorities in many low-resourced countries have been promoting a form of healthcare system that combines both traditional practices, predominantly the herbal traditional medicine, and conventional medicine to alleviate diseases.…”

Challenges and coping strategies in non-communicable disease management during COVID-19 in Addis Ababa, Ethiopia: A qualitative study

“…Non-communicable diseases contribute to 39% of total deaths in Ethiopia [13]. Insu cient health workforce and pharmaceuticals, high nancial barriers for users and lack of access to quality-assured medicines are the challenges for people with NCDs in developing countries [14,15]. The additional burden of the pandemic in countries like Ethiopia might become more demanding, since it has even challenged countries with well-developed healthcare systems [16].…”