2024/10/28 Challenges of Delivering NCD Care through Primary Health Systems in South Asia

A new review published in The Lancet Global Health examines the state of non-communicable disease (NCD) prevention and control services within primary health care (PHC) across five South Asian countries. The findings reveal high-level political commitment to addressing the NCD burden, but persistent health systems weaknesses that impede effective implementation at the PHC level.
 
In the south Asian region, delivering NCD prevention and control services through existing PHC facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, yet the implementation of PHC to address NCDs is insufficient. This review considers evidence from five south Asian countries to derive policy-relevant recommendations for designing integrated PHC systems that include NCD care. Findings reveal high political commitment but poor multisectoral engagement and health systems preparedness for tackling chronic diseases at the PHC level. There is a shortage of skilled human resources, requisite infrastructure, essential NCD medicines and technologies, and dedicated financing. Although innovations supporting integrated interventions exist, such as innovations focusing on community-centric approaches, scaling up remains problematic. To deliver NCD services sustainably, governments must aim for increased financing and a redesign of PHC service.
 
The rising non-communicable disease (NCD) burden in south Asian countries and its disproportionate effect on disadvantaged and marginalized populations requires urgent action. Political commitment to multisectoral NCD action plans is widespread across the region, as is the recognition of the need for health in all policy approaches; yet, implementation is sluggish and uncertain. Consistent with a primary health-care approach, countries have adapted the WHO package of essential NCD interventions for national-level implementation; however, shortages in human and financial resources, poor capacity of the front-line health workers, requisite infrastructure, and interruptions in supply of essential medicines and technologies impede effective implementation. Given the major role of private and non-government organizations in service provision, successful coordination of NCD activities requires strengthened and centralized oversight and governance. South Asian countries have jump-started the use of information and communication technology and trained health-care workers to extend NCD services to rural, remote, and hard-to-reach areas. Creative yet feasible innovations that address NCDs at the primary health-care level and accommodate the realities of low-resource settings should be supported and scaled-up to the national level.
 
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00118-9/fulltext