Link to: Get in touch
Introduction
Non-communicable diseases (NCDs) are the leading cause of mortality, morbidity, and disability worldwide. They pose immense health and socio-economic burden to all countries and particularly to the poorest segments of the global population that greatly lack access to quality health services. They constitute a major threat to public health and economic security.
Fortunately, NCDs are largely preventable by effective large-scale implementation of high-level political commitments made in 2011, 2014, 2015, and 2018 for the prevention and control of NCDs.
The World Health Organization’s (WHO) 2016 ‘Framework on integrated, people-centered health services’ emphasized the importance of organizing primary health care (PHC) around the comprehensive needs of people, rather than around a singular focus of specific diseases. When combined with population-wide preventative measures, people-centered PHC can prove very effective in tackling NCDs both at the population and individual levels.
This assessment is related to the Primary Health Care Measurement and Improvement (PHCMI) initiative framework and other NCD-related different surveys and assessments.
Structure and Inputs
Subdomains
Political Commitment and leadership adjustment to the population need
- (Operational) National multisectoral commission, agency, or mechanism to oversee NCD engagement, policy coherence, and accountability of sectors beyond health.
- A unit/branch/department in the ministry of health or equivalent with responsibility for NCDs and their risk factors
- At least one full-time technical or professional staff member dedicated to NCDs in a unit, branch, or department
Health Information
- Presence of a PHC facility-based patient record system which includes NCD status:
- Existence of a facility-level information system that includes CVD risk assessment, Diabetes, and Hypertension care
- Presence of regular national adult NCD risk factor surveillance, conducting assessments every 3 to 5 years (STEPS or other)
- Existence of a PHC facility-level register for patients with RF/RHD
- Are the NCDs among the national list of notifiable diseases?
- Percentage of facilities that provide the % of HTN patients stratifies by:
- Percentage of facilities that provide the % of diabetic patients stratifies by:
- Percentage of facilities that provide the % of cancer patients stratifies by:
- Percentage of facilities that provide the % of patients with chronic respiratory diseases stratifies by:
- % of NCD patients with regular follow-ups
- Estimation of populations at risk identified through surveys:
- Register of NCD complications exist at PHC facility level
- Assessment of availability and affordability of NCD medicines in the Public/Private sector
Health Financing
- % of Expenditure on Specific NCDs (CVDs, DM, COPD and Cancers)
- % of out of pocket expenditure on NCDs
- Funding sources for NCDs
General Government revenues,
Health insurance,
International donors,
National Donors,
Earmarked taxes on alcohol, tobacco, etc.
Other. - Are NCD interventions integrated in the benefits package of PHC:
Health Workforce
- The density of HWF for NCDs
- Existence of guidance on distribution of staff responsibility and/or task shifting for the management of NCDs at the primary health care level
- Existence of mechanism for continuing NCD-related professional development training for primary health care workers in the public and private sectors
Medicines and Health Products
- The essential list of Medicines for NCDs at the PHC level:
- list of Essential NCD technologies including standard priority diagnostics and equipment:
- % of PHC facilities with NCD EML correlated to a package of services delivered in PHC
- % PHC facilities with a list of Essential NCD technologies including standard priority diagnostics and equipment
- % of PHC facilities with functional essential technologies for early detection, diagnosis, and monitoring of NCDs are available (the public and private health sector)
- availability and affordability of NCD medicines in the public/private sector
Processes
Subdomains
Core services and Model of Care
- Establishment of a patient-centered approach
- Core benefit package of NCD intervention integrated into PHC includes:
- At PHC facility level is sore throat/ streptococcal suspicion:
- At PHC, secondary prevention of RF and RHD is implemented by registering patients on regular prophylactic penicillin.
- The formal efficient process exists at the PHC level for referral of NCD patients for other levels of management
Facility Organization and Management
- Existence of evidence-based national guidelines for screening and management of non-communicable diseases
- % of PHC facilities that utilize the evidence-based national guidelines/ protocols/ standards available for the management of each of the four main NCDs:
- In-facility, patient care pathways for tracer conditions for NCDs at the PHC level
Systems for improving quality of care
Output
Subdomains
Availability and Readiness
Assessment of PHC level Management for major diseases
- % of facilities providing Healthy Lifestyle Counselling
- % of facilities providing Hepatitis B Immunizations
- % of facilities implementing Early Detection for breast cancer
- % of facilities implementing Early Detection for cervical cancer
- % of facilities conducting Detection and Management of Hypertension
- % of facilities conducting Detection and Management of Diabetes
- % of facilities conducting Detection and Management of chronic respiratory diseases (COPD/Asthma)
Outcome
Subdomains
Effective Coverage
- Percentage of people aged 40+ years screened for Hypertension
- Percentage of people aged 40+ years screened for Diabetes
- Percentage of women between the ages of 30–49 screened for cervical cancer at least once, or more often, and for lower or higher age groups according to national programs or policies
- Percentage of women aged 50–69 years (and other age groups according to national programs or policies) screened for breast cancer in a three-year period with all positive cases found during screening provided effective and timely treatment.
- Percentage of individuals with raised blood pressure under treatment (at population-level)
- % of registered hypertensive patients at the PHC with BP <140/90 at last 2 follow up visits
- Percentage of individuals with raised blood pressure under control (at population-level)
- Percentage of individuals with diabetes under treatment (at population-level)
- % of registered diabetic patients at the PHC with fasting blood sugar controlled at last 2 follow up visits/A1C <7%
- Percentage of individuals with diabetes under control (at population-level)
- % of registered NCD patients with 10 years cardiovascular risk recorded in past 1 year
- Percentage of patients with 10 years CVD risk ≥ 30%
- Percentage of tobacco cessation (seeking services)
Impact
Subdomains
Mortality and Morbidity
- Premature NCD mortality
- Prevalence of RHD at the population level
- Overweight/ Obesity prevalence among the adult population
- DM prevalence among the adult population
- HTN prevalence among the adult population
- Tobacco use among the adult population
- Prevalence of raised blood pressure (age-standardized estimate) among the adult population