Post on 12-Jan-2016
description
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Integration of Noncommunicable Diseases Integration of Noncommunicable Diseases into PHC in low-resource settingsinto PHC in low-resource settings
Lessons learned Lessons learned
Dr Shanthi Mendis Dr Shanthi Mendis Chronic Disease Prevention and Management Chronic Disease Prevention and Management
World Health OrganizationWorld Health Organization
Integration of Noncommunicable Diseases Integration of Noncommunicable Diseases into PHC in low-resource settingsinto PHC in low-resource settings
Lessons learned Lessons learned
Dr Shanthi Mendis Dr Shanthi Mendis Chronic Disease Prevention and Management Chronic Disease Prevention and Management
World Health OrganizationWorld Health Organization
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PHC Reforms proposed (WHR 2008)PHC Reforms proposed (WHR 2008)PHC Reforms proposed (WHR 2008)PHC Reforms proposed (WHR 2008)
Universal coverage
Service delivery
Leadership reforms
Public policy reforms
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WHO provides WHO provides Technical support for National Health Development process Technical support for National Health Development process
(Driven by country needs)(Driven by country needs)
WHO provides WHO provides Technical support for National Health Development process Technical support for National Health Development process
(Driven by country needs)(Driven by country needs)
Bhutan
Eritrea
Sri Lanka
Sudan
Syria
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Lessons Lessons Lessons Lessons
Challenges Opportunities Capacity Sustainability Affordability Balance Evaluation
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Per capita expenditure on health Per capita expenditure on health Per capita expenditure on health Per capita expenditure on health
Less than 50 $
50 – 99
100-499
500-999
1000-1999
>2000
33 2572241918
Expenditure Number of countries
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Setting prioritiesSetting prioritiesSetting prioritiesSetting priorities
Contribution to morbidity and mortality (Cardiovascular diseases , diabetes, Cancer, CRD)
Availability of cost effective interventions
Feasibility of implementing in primary care
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PCPC(NPHW)(NPHW)
Very low risk Manage in PC
Next level
Back referral Referral
10-<20%10-<20% 30-<40% >40%20-<30%
Low Medium High Very high
Service delivery
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WHO/ISH charts
To screen for risk of heart attacks and strokes
Using simple variables
AgeSmokingSexBlood pressureBlood cholesterolBlood sugar
AGE MALE FEMALE
SBP
Non-Smoker Smoker Non-Smoker Smoker
180
160
70
140
120
180
160
60
140
120
180
160
50
140
120
180
160
40
140
120
4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8
Cholesterol
9
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PHC based Health System PHC based Health System PHC based Health System PHC based Health System
Define functions of all levels of the health system based on PHC: skills, requirements, equipment, medicines, interactions between levels and sectors
Financing models for different social and economic contexts and health systems
Service delivery models that promote continuity of care across different NCDs, levels and sectors of care
Type of training, support and supervision needed for delivery of interventions by physician/ non-physician
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Integration of NCD into PHC Integration of NCD into PHC Integration of NCD into PHC Integration of NCD into PHC
1. Per capita health expenditure in many LMIC countries is inadequate to provide universal coverage
2. Range of cost effective NCD interventions can be integrated into PHC, even in low resource settings.
3. If sustainable approaches are used they can reduce morbidity and premature mortality due to NCDs .
4. PHC has the potential to reduce suffering from preventable NCDs and reduce health-care costs.
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