Health system readiness for non-communicable diseases at the primary care level: a systematic review

Ashraful Kabir, Md Nazmul Karim, Rakibul M Islam, Lorena Romero, Baki Billah, Ashraful Kabir, Md Nazmul Karim, Rakibul M Islam, Lorena Romero, Baki Billah

Abstract

Objective: To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs).

Design: Systematic review.

Data sources: Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice.

Eligibility criteria: Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs).

Data extraction and synthesis: Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework.

Results: Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research.

Conclusion: The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.

Keywords: primary care; public health; social medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart for study inclusion.
Figure 2
Figure 2
Number of published studies that investigated the primary healthcare system’s readiness between January 1984 and July 2021, broken down by NCD type, NCD focus and WHO region. AFR, African Region; AMR, Region of the Americas; CRD, chronic respiratory diseases; CVD, cardiovascular diseases; DM, diabetes mellitus; EUR, European Region; HIS, health information system; HF, health financing; HSD, health service delivery; HTN, hypertension; HW, health workforce; L&G, leadership and governance; MI, mental Illness; MPK&T, medical products, knowledge and technologies; NCDs, non-communicable diseasesSEAR, South East-Asian Region; WPR, Western Pacific Region.

References

    1. World Health Organization . Noncommunicable diseases: key facts, 2021. Available:
    1. Marrero SL, Bloom DE, Adashi EY. Noncommunicable diseases: a global health crisis in a new world order. JAMA 2012;307:2037–8. 10.1001/jama.2012.3546
    1. Beaglehole R, Epping-Jordan J, Patel V, et al. . Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. Lancet 2008;372:940–9. 10.1016/S0140-6736(08)61404-X
    1. Capizzi S, De Waure C, Boccia S. Global burden and health trends of non-communicable diseases. A systematic review of key issues in public health. Springer, 2015: 19–32.
    1. Bloom DE, Cafiero E, Jané-Llopis E. The global economic burden of noncommunicable diseases. program on the global demography of aging, 2012.
    1. Assembly UG. High level meeting on prevention and control of non-communicable diseases: political Declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. DocumentA/66/L. 1. New York, NY: United Nations General Assembly, 2016.
    1. World Health Organization . Global action plan for the prevention and control of noncommunicable diseases 2013-2020, 2013. Available:
    1. World Health Organization . World health statistics 2016: monitoring health for the SDGs sustainable development goals, 2016. Available:
    1. NCD Countdown . Ncd countdown 2030: pathways to achieving sustainable development goal target 3.4. Lancet 2020;396. 10.1016/S0140-6736(20)31761-X
    1. Dodd R, Palagyi A, Jan S, et al. . Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region. BMJ Glob Health 2019;4:e001487. 10.1136/bmjgh-2019-001487
    1. Rohde J, Cousens S, Chopra M, et al. . 30 years after Alma-Ata: has primary health care worked in countries? Lancet 2008;372:950–61. 10.1016/S0140-6736(08)61405-1
    1. Organization WH . Primary health care: report of the International Conference on primary health care, Alma-Ata, USSR, 6-12 September 1978, 1978. Available:
    1. Alvarez FN, Leys M, Mérida HER, et al. . Primary health care research in Bolivia: systematic review and analysis. Health Policy Plan 2016;31:114–28. 10.1093/heapol/czv013
    1. Bitton A, Ratcliffe HL, Veillard JH, et al. . Primary health care as a foundation for strengthening health systems in low- and middle-income countries. J Gen Intern Med 2017;32:566–71. 10.1007/s11606-016-3898-5
    1. Dineen-Griffin S, Garcia-Cardenas V, Williams K, et al. . Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice. PLoS One 2019;14:e0220116. 10.1371/journal.pone.0220116
    1. Albelbeisi AH, Albelbeisi A, El Bilbeisi AH, et al. . Public sector capacity to prevent and control of noncommunicable diseases in twelve low- and middle-income countries based on WHO-PEN standards: a systematic review. Health Serv Insights 2021;14:117863292098623. 10.1177/1178632920986233
    1. Kabir A, Karim MN, Billah B. Primary healthcare system readiness to prevent and manage non-communicable diseases in Bangladesh: a mixed-method study protocol. BMJ Open 2021;11:e051961. 10.1136/bmjopen-2021-051961
    1. Organization WH . Everybody’s business-strengthening health systems to improve health outcomes: WHO’s framework for action, 2007. Available:
    1. Bart C, Pirad M ON, Van der Vennet J. Basic concepts in public health. Antwerp: Institute of Tropical Medicine, 2013.
    1. Mounier-Jack S, Griffiths UK, Closser S, et al. . Measuring the health systems impact of disease control programmes: a critical reflection on the who building blocks framework. BMC Public Health 2014;14:278. 10.1186/1471-2458-14-278
    1. Van Olmen J, Criel B, Van Damme W. Analysing health systems dynamics A framework. Studies in Health Services Organisation & Policy. 28, 2012.
    1. Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 10.1371/journal.pmed.1000097
    1. Hong QN, Pluye P, bregues S F. Mixed methods appraisal tool (MMAT), version 2018, 2018: 10.
    1. Olmen JV, Criel B, Bhojani U, et al. . The health system dynamics framework: the introduction of an analytical model for health system analysis and its application to two case-studies. Health, Culture and Society 2012;2:1–21. 10.5195/HCS.2012.71
    1. Adinan J, Manongi R, Temu GA, et al. . Preparedness of health facilities in managing hypertension & diabetes mellitus in Kilimanjaro, Tanzania: a cross sectional study. BMC Health Serv Res 2019;19:537. 10.1186/s12913-019-4316-6
    1. Bintabara D, Mpondo BCT. Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: evidence from Tanzanian national survey. PLoS One 2018;13:e0192942. 10.1371/journal.pone.0192942
    1. Duong DB, Minh HV, Ngo LH, et al. . Readiness, availability and utilization of rural Vietnamese health facilities for community based primary care of non-communicable diseases: a CrossSectional survey of 3 provinces in northern Vietnam. Int J Health Policy Manag 2019;8:150–7. 10.15171/ijhpm.2018.104
    1. Honey M, Waterworth S, Aung H. Older consumers' readiness for e-health in New Zealand. Stud Health Technol Inform 2016;225:178–82.
    1. Islam MR, Laskar SP, Macer D. A study on service availability and readiness assessment of non-communicable diseases using the who tool for Gazipur district in Bangladesh. Bangladesh Journal of Bioethics 2016;7:1–13. 10.3329/bioethics.v7i2.30785
    1. Katende D, Mutungi G, Baisley K, et al. . Readiness of Ugandan health services for the management of outpatients with chronic diseases. Trop Med Int Health 2015;20:1385–95. 10.1111/tmi.12560
    1. Mendis S, Al Bashir I, Dissanayake L, et al. . Gaps in capacity in primary care in low-resource settings for implementation of essential noncommunicable disease interventions. Int J Hypertens 2012;2012:1–7. 10.1155/2012/584041
    1. Musinguzi G, Bastiaens H, Wanyenze RK, et al. . Capacity of health facilities to manage hypertension in Mukono and Buikwe districts in Uganda: challenges and recommendations. PLoS One;10:e0142312. 10.1371/journal.pone.0142312
    1. Mutale W, Bosomprah S, Shankalala P, et al. . Assessing capacity and readiness to manage NCDS in primary care setting: gaps and opportunities based on adapted who pen tool in Zambia. PLoS One;13:e0200994. 10.1371/journal.pone.0200994
    1. Nyarko KM, Ameme DK, Ocansey D, et al. . Capacity assessment of selected health care facilities for the pilot implementation of package for essential non-communicable diseases (pen) intervention in Ghana. Pan Afr Med J 2016;25:16. 10.11604/pamj.supp.2016.25.1.6252
    1. Pakhare A, Kumar S, Goyal S, et al. . Assessment of primary care facilities for cardiovascular disease preparedness in Madhya Pradesh, India. BMC Health Serv Res 2015;15:408. 10.1186/s12913-015-1075-x
    1. Peck R, Mghamba J, Vanobberghen F, et al. . Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey. Lancet Glob Health 2014;2:e285–92. 10.1016/S2214-109X(14)70033-6
    1. Volk RJ, Foxhall LE. Readiness of primary care clinicians to implement lung cancer screening programs. Prev Med Rep 2015;2:717–9. 10.1016/j.pmedr.2015.08.014
    1. Biswas T, Haider MM, Das Gupta R, et al. . Assessing the readiness of health facilities for diabetes and cardiovascular services in Bangladesh: a cross-sectional survey. BMJ Open 2018;8:e022817. 10.1136/bmjopen-2018-022817
    1. National Institute of Population Research and Training . Bangladesh health facility survey: 2017, 2020.
    1. Aekplakorn W, Suriyawongpaisal P, Sirirassamee B. Assessment of capacity for cardiovascular disease control and prevention in Thailand: a qualitative study. Southeast Asian Journal of Tropical Medicine & Public Health;36:741–7.
    1. Kien VD, Van Minh H, Giang KB, et al. . Views by health professionals on the responsiveness of commune health stations regarding non-communicable diseases in urban Hanoi, Vietnam: a qualitative study. BMC Health Serv Res 2018;18:392. 10.1186/s12913-018-3217-4
    1. Panda R, Mahapatra S, Persai D. Health system preparedness in noncommunicable diseases: findings from two states Odisha and Kerala in India. J Family Med Prim Care 2018;7:565–70. 10.4103/jfmpc.jfmpc_111_17
    1. Elias MA, Pati MK, Aivalli P, et al. . Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in South India. BMJ Glob Health 2017;2:e000519. 10.1136/bmjgh-2017-000519
    1. Meiqari L, Nguyen T-P-L, Essink D, et al. . Strengthening human and physical infrastructure of primary healthcare settings to deliver hypertension care in Vietnam: a mixed-methods comparison of two provinces. Health Policy Plan 2020;35:918–30. 10.1093/heapol/czaa047
    1. Thi Thuy Nga N, Thi My Anh B, Nguyen Ngoc N, et al. . Capacity of commune health stations in chi Linh district, HAI Duong Province, for prevention and control of noncommunicable diseases. Asia Pac J Public Health 2017;29:94S–101. 10.1177/1010539517717020
    1. van Dijk-de Vries A, van Bokhoven MA, de Jong S, et al. . Patients' readiness to receive psychosocial care during nurse-led routine diabetes consultations in primary care: a mixed methods study. Int J Nurs Stud 2016;63:58–64. 10.1016/j.ijnurstu.2016.08.018
    1. Van Minh H, Do YK, Bautista MAC, et al. . Describing the primary care system capacity for the prevention and management of non-communicable diseases in rural Vietnam. Int J Health Plann Manage 2014;29:e159–73. 10.1002/hpm.2179
    1. Bawazir AA, Al-Surimi K, Suwaidan SD, et al. . Capacity and readiness of primary health care centers for implementation of the basic strategy for prevention and control of non-communicable diseases in Saudi Arabia. A case study from the Ministry of national Guard-Health Affairs, Riyadh, Saudi Arabia. Saudi Med J 2019;40:614–8. 10.15537/smj.2019.6.24164
    1. Sacks E, Morrow M, Story WT, et al. . Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all. BMJ Glob Health 2018;3:e001384. 10.1136/bmjgh-2018-001384
    1. Allen LN. Financing national non-communicable disease responses. Glob Health Action 2017;10:1326687. 10.1080/16549716.2017.1326687
    1. Mendis S. The policy agenda for prevention and control of non-communicable diseases. Br Med Bull 2010;96:23–43. 10.1093/bmb/ldq037
    1. Robinson HM, Hort K. Non-Communicable diseases and health systems reform in low-and-middle-income countries. Pac Health Dialog 2012;18:179–90.
    1. Fonseca VA, Kirkman MS, Darsow T, et al. . The American diabetes association diabetes research perspective. Diabetes Care 2012;35:1380–7. 10.2337/dc12-9001
    1. Lastra G, Syed S, Kurukulasuriya LR, et al. . Type 2 diabetes mellitus and hypertension: an update. Endocrinol Metab Clin North Am 2014;43:103–22. 10.1016/j.ecl.2013.09.005
    1. Malekzadeh A, Michels K, Wolfman C, et al. . Strengthening research capacity in LMICs to address the global ncd burden. Glob Health Action 2020;13:1846904. 10.1080/16549716.2020.1846904
    1. Shigayeva A, Atun R, McKee M, et al. . Health systems, communicable diseases and integration. Health Policy Plan 2010;25 Suppl 1:i4–20. 10.1093/heapol/czq060
    1. Nigatu T. Integration of HIV and noncommunicable diseases in health care delivery in low- and middle-income countries. Prev Chronic Dis 2012;9:E93. 10.5888/pcd9.110331
    1. Esterson YB, Carey M, Piette JD, et al. . A systematic review of innovative diabetes care models in low-and middle-income countries (LMICs). J Health Care Poor Underserved 2014;25:72–93. 10.1353/hpu.2014.0037
    1. Gillam S. Is the Declaration of Alma Ata still relevant to primary health care? BMJ 2008;336:536–8. 10.1136/
    1. Maciocco G. [Alma Ata 30 years on. Evolution and perspectives of primary health care]. Ann Ig 2008;20:389–99.
    1. Mamudu HM, Yang JS, Novotny TE. Un resolution on the prevention and control of non-communicable diseases: an opportunity for global action. Glob Public Health 2011;6:347–53. 10.1080/17441692.2011.574230
    1. Ezzati M, Obermeyer Z, Tzoulaki I, et al. . Contributions of risk factors and medical care to cardiovascular mortality trends. Nat Rev Cardiol 2015;12:508–30. 10.1038/nrcardio.2015.82
    1. Kontis V, Bennett JE, Mathers CD, et al. . Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. Lancet 2017;389:1323–35. 10.1016/S0140-6736(16)32381-9
    1. Lloyd-Sherlock PG, Ebrahim S, McKee M, et al. . Institutional ageism in global health policy. BMJ 2016;354:i4514. 10.1136/bmj.i4514
    1. World Health Organization . A global review of primary health care: emerging messages: global report, 2003.
    1. Jeet G, Thakur JS, Prinja S, et al. . Community health workers for non-communicable diseases prevention and control in developing countries: evidence and implications. PLoS One 2017;12:e0180640. 10.1371/journal.pone.0180640
    1. World Health Organization . Preventing noncommunicable diseases. Available:
    1. Van Lerberghe W. The world health report 2008: primary health care: now more than ever: World Health organization, 2008. Available:

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