Redesigning primary care to tackle the global epidemic of noncommunicable disease

Margaret E Kruk, Gustavo Nigenda, Felicia M Knaul, Margaret E Kruk, Gustavo Nigenda, Felicia M Knaul

Abstract

Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.

References

    1. Murray CJL, Vos T, Lozano R et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–2223.
    1. Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260.
    1. World Health Organization. Global Status Report on Non-communicable Diseases 2010. Geneva, Switzerland: World Health Organization; 2011.
    1. Bonita R, Magnusson R, Bovet P et al. Country actions to meet UN commitments on non-communicable diseases: a stepwise approach. Lancet. 2013;381(9866):575–584.
    1. Murray CJ, Frenk J, Piot P, Mundel T. GBD 2.0: a continuously updated global resource. Lancet. 2013;382(9866):9–11.
    1. World Bank. Country and Lending Groups. Washington, DC: World Bank; 2014.
    1. World Health Organization. Global Health Observatory Data Repository. Geneva, Switzerland: World Health Organization; 2013.
    1. UN General Assembly. Political Declaration on the High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases. New York, NY: United Nations; 2012.
    1. Bloom D, Cafiero E, Jane-Llopis E . The Global Economic Burden of Noncommunicable Diseases. Cambridge, MA: Harvard School of Public Health; 2012.
    1. Knaul F, Gralow J, Atun R, Bhadelia A. Investing in cancer care and control. In: Knaul F, Arreola-Ornelas H, Atun R, editors. Closing the Cancer Divide: An Equity Imperative. Cambridge, MA: Harvard University Press; 2012.
    1. Knaul F, Arreola-Ornelas H, Mendez O. The global economic burden of cancer. In: Stewart BW, Wild CP, editors. World Cancer Report 2014. Lyon, France: World Health Organization; 2014.
    1. Knaul FM, Bhadelia A, Gralow J, Arreola-Ornelas H, Langer A, Frenk J. Meeting the emerging challenge of breast and cervical cancer in low- and middle-income countries. Int J Gynaecol Obstet. 2012;119(suppl 1):S85–S88.
    1. Ibrahim MM, Damasceno A. Hypertension in developing countries. Lancet. 2012;380(9841):611–619.
    1. Gakidou E, Mallinger L, Abbott-Klafter J et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bull World Health Organ. 2011;89(3):172–183.
    1. Samb B, Desai N, Nishtar S et al. Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries. Lancet. 2010;376(9754):1785–1797.
    1. Frenk J, Frejka T, Bobadilla JL et al. [The epidemiologic transition in Latin America] Pol Oficina Sanit Panam. 1991;111(6):485–496.
    1. McCoy D, Chand S, Sridhar D. Global health funding: how much, where it comes from and where it goes. Health Policy Plan. 2009;24(6):407–417.
    1. Donaldson M, Yordy K, Lohr K, Venselow N, editors. Primary Care: America’s Health in a New Era. Washington, DC: National Academy Press; 1996.
    1. World Health Organization. Alma-Ata Declaration. Geneva, Switzerland: World Health Organization; 1978.
    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(9642):940–949.
    1. Walley J, Lawn JE, Tinker A et al. Primary health care: making Alma-Ata a reality. Lancet. 2008;372(9642):1001–1007.
    1. Atun R, Jaffar S, Nishtar S et al. Improving responsiveness of health systems to non-communicable diseases. Lancet. 2013;381(9867):690–697.
    1. Frenk J. Reinventing primary health care: the need for systems integration. Lancet. 2009;374(9684):170–173.
    1. Kim JY, Farmer P, Porter ME. Redefining global health-care delivery. Lancet. 2013;382(9897):1060–1069.
    1. Grumbach K. Chronic illness, comorbidities, and the need for medical generalism. Ann Fam Med. 2003;1(1):4–7.
    1. Nolte E, McKee M. Caring for People With Chronic Conditions: A Health System Perspective. Maidenhead, UK: Open University Press; 2008.
    1. Rabkin M, El-Sadr WM. Why reinvent the wheel? Leveraging the lessons of HIV scale-up to confront non-communicable diseases. Glob Public Health. 2011;6(3):247–256.
    1. De Maeseneer J, Roberts RG, Demarzo M et al. Tackling NCDs: a different approach is needed. Lancet. 2012;379(9829):1860–1861.
    1. World Health Organization. World Economic Forum. From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases in Low- and Middle-Income Countries. Geneva, Switzerland: World Health Organization; 2012.
    1. Macinko J, Marinho de Souza Mde F, Guanais FC, da Silva Simoes CC. Going to scale with community-based primary care: an analysis of the family health program and infant mortality in Brazil, 1999–2004. Soc Sci Med. 2007;65(10):2070–2080.
    1. Unger J-P, De Paepe P, Buitron R, Soors W. Costa Rica: achievements of a heterodox health policy. Am J Public Health. 2008;98(4):636–643.
    1. Knaul FM, Gonzalez-Pier E, Gomez-Dantes O et al. The quest for universal health coverage: achieving social protection for all in Mexico. Lancet. 2012;380(9849):1259–1279.
    1. Mendonca CS, Harzheim E, Duncan BB, Nunes LN, Leyh W. Trends in hospitalizations for primary care sensitive conditions following the implementation of family health teams in Belo Horizonte, Brazil. Health Policy Plan. 2012;27(4):348–355.
    1. Ministério da Saúde. Política Nacional de Promocao da Saúde. Brasilia, Brazil: Ministério da Saúde; 2010.
    1. Borem P, Valle EA, Silva Monteiro De Castro M . Pay-for-Performance in Brazil: UNIMED-Belo Horizonte Physician Cooperation. Belo Horizonte, Brazil: Abt Associates Inc; 2010.
    1. Chi Y-L, Cashin C. Brazil: Incentive Program for Family Health Performance Improvements Implemented in Piripiri Municipality. Washington, DC: World Bank; 2011.
    1. Chen L, Evans T, Anand S et al. Human resources for health: overcoming the crisis. Lancet. 2004;364(9449):1984–1990.
    1. Frenk J, Chen L, Bhutta ZA et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–1958.
    1. World Health Organization. World Health Report 2006: Working Together for Health. Geneva, Switzerland: World Health Organization; 2006.
    1. Lekoubou A, Awah P, Fezeu L, Sobngwi E, Kengne AP. Hypertension, diabetes mellitus and task shifting in their management in sub-Saharan Africa. Int J Environ Res Public Health. 2010;7(2):353–363.
    1. Lehmann U, Van Damme W, Barten F, Sanders D. Task shifting: the answer to the human resources crisis in Africa? Hum Resour Health. 2009;7:49.
    1. Yu D, Souteyrand Y, Banda MA, Kaufman J, Perriens JH. Investment in HIV/AIDS programs: does it help strengthen health systems in developing countries? Global Health. 2008;4(8):8.
    1. Fairall L, Bachmann MO, Lombard C et al. Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial. Lancet. 2012;380(9845):889–898.
    1. Mdege ND, Chindove S, Ali S. The effectiveness and cost implications of task-shifting in the delivery of antiretroviral therapy to HIV-infected patients: a systematic review. Health Policy Plan. 2013;28(3):223–236.
    1. Chamie G, Kwarisiima D, Clark TD et al. Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda. PLoS ONE. 2012;7(8):e43400.
    1. Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W, Wright TC., Jr Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. JAMA. 2005;294(17):2173–2181.
    1. Luciani S, Munoz S, Gonzales M, Delgado JM, Valcarcel M. Effectiveness of cervical cancer screening using visual inspection with acetic acid in Peru. Int J Gynaecol Obstet. 2011;115(1):53–56.
    1. Ibrahim A, Aro AR, Rasch V, Pukkala E. Cervical cancer screening in primary health care setting in Sudan: a comparative study of visual inspection with acetic acid and pap smear. Int J Womens Health. 2012;4:67–73.
    1. Audet CM, Silva Matos C, Blevins M, Cardoso A, Moon TD, Sidat M. Acceptability of cervical cancer screening in rural Mozambique. Health Educ Res. 2012;27(3):544–551.
    1. Li R, Lewkowitz AK, Zhao FH et al. Analysis of the effectiveness of visual inspection with acetic acid/Lugol’s iodine in one-time and annual follow-up screening in rural China. Arch Gynecol Obstet. 2012;285(6):1627–1632.
    1. Ramogola-Masire D, de Klerk R, Monare B, Ratshaa B, Friedman HM, Zetola NM. Cervical cancer prevention in HIV-infected women using the “see and treat” approach in Botswana. J Acquir Immune Defic Syndr. 2012;59(3):308–313.
    1. Simmons RK, Echouffo-Tcheugui JB, Sharp SJ et al. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet. 2012;380(9855):1741–1748.
    1. Gupta R. Smoking, educational status and health inequity in India. Indian J Med Res. 2006;124(1):15–22.
    1. Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non-communicable diseases in South Africa. Lancet. 2009;374(9693):934–947.
    1. DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61(6):409–418.
    1. Bleich SN, Jarlenski MP, Bell CN, LaVeist TA. Health inequalities: trends, progress, and policy. Annu Rev Public Health. 2012;33:7–40.
    1. Kankeu HT, Saksena P, Xu K, Evans DB. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst. 2013;11:31.
    1. Basu S, King AC. Disability and chronic disease among older adults in India: detecting vulnerable populations through the WHO SAGE Study. Am J Epidemiol. 2013;178(11):1620–1628.
    1. Kruk ME, Goldmann E, Galea S. Borrowing and selling to pay for health care in low- and middle-income countries. Health Aff (Millwood) 2009;28(4):1056–1066.
    1. McIntyre D, Thiede M, Birch S. Access as a policy-relevant concept in low- and middle-income countries. Health Econ Policy Law. 2009;4(pt 2):179–193.
    1. Jamison DT, Summers LH, Alleyne G et al. Global health 2035: a world converging within a generation. Lancet. 2013;382(9908):1898–1955.
    1. Cerdas M. Epidemiology and control of hypertension and diabetes in Costa Rica. Ren Fail. 2006;28(8):693–696.
    1. Arredondo A, Zuniga A. Epidemiological changes and financial consequences of hypertension in Latin America: implications for the health system and patients in Mexico. Cad Saude Publica. 2012;28(3):497–502.
    1. Fernald LC, Hou X, Gertler PJ. Oportunidades program participation and body mass index, blood pressure, and self-reported health in Mexican adults. Prev Chronic Dis. 2008;5(3):A81.
    1. World Health Organization. Innovative Care for Chronic Conditions: Building Blocks for Actions: Global Report. Geneva, Switzerland: World Health Organization; 2002.
    1. Friedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AM. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ. 2012;345:e4759.
    1. El Arifeen S, Christou A, Reichenbach L et al. Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh. Lancet. 2013;382(9909):2012–2026.
    1. Brownstein JN, Chowdhury FM, Norris SL et al. Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med. 2007;32(5):435–447.
    1. Prince M, Acosta D, Albanese E et al. Ageing and dementia in low and middle income countries—using research to engage with public and policy makers. Int Rev Psychiatry. 2008;20(4):332–343.
    1. Fu D, Fu H, McGowan P et al. Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial. Bull World Health Organ. 2003;81(3):174–182.
    1. Lorig K, Holman H. Arthritis self-management studies: a twelve-year review. Health Educ Q. 1993;20(1):17–28.
    1. Coomes CM, Lewis MA, Uhrig JD, Furberg RD, Harris JL, Bann CM. Beyond reminders: a conceptual framework for using short message service to promote prevention and improve healthcare quality and clinical outcomes for people living with HIV. AIDS Care. 2012;24(3):348–357.
    1. Kahn JG, Yang JS, Kahn JS. ‘Mobile’ health needs and opportunities in developing countries. Health Aff (Millwood) 2010;29(2):252–258.
    1. Piette JD, Lun KC, Moura LA, Jr et al. Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? Bull World Health Organ. 2012;90(5):365–372.
    1. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010;32(1):56–69.
    1. Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med. 2009;36(2):165–173.
    1. Wei J, Hollin I, Kachnowski S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. J Telemed Telecare. 2011;17(1):41–48.
    1. Car J, Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev. 2012;7:CD007458.
    1. Guy R, Hocking J, Wand H, Stott S, Ali H, Kaldor J. How effective are short message service reminders at increasing clinic attendance? A meta-analysis and systematic review. Health Serv Res. 2012;47(2):614–632.
    1. Liang X, Wang Q, Yang X et al. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med. 2011;28(4):455–463.
    1. Free C, Knight R, Robertson S et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011;378(9785):49–55.
    1. Piette JD, Mendoza-Avelares MO, Milton EC, Lange I, Fajardo R. Access to mobile communication technology and willingness to participate in automated telemedicine calls among chronically ill patients in Honduras. Telemed J E Health. 2010;16(10):1030–1041.
    1. Piette JD, Mendoza-Avelares MO, Ganser M, Mohamed M, Marinec N, Krishnan S. A preliminary study of a cloud-computing model for chronic illness self-care support in an underdeveloped country. Am J Prev Med. 2011;40(6):629–632.

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