Integration of Noncommunicable Diseases into PHC in low-resource settings
Lessons learned
Dr Shanthi Mendis
Chronic Disease Prevention and Management
World Health Organization
1

PHC Reforms proposed (WHR 2008)
 Universal coverage
 Service delivery
 Leadership reforms
 Public policy reforms
2

WHO provides
Technical support for National Health Development process
(Driven by country needs)
 Bhutan
 Eritrea
 Sri Lanka
 Sudan
 Syria
3

 Challenges
 Opportunities
 Capacity
 Sustainability
 Affordability
 Balance
 Evaluation
4

Per capita expenditure on health
Expenditure
Less than 50 $
50 – 99
100-499
500-999
1000-1999
>2000
Number of countries
33
25
72
24
19
18
5

 Contribution to morbidity and mortality
(Cardiovascular diseases , diabetes, Cancer, CRD)
 Availability of cost effective interventions
 Feasibility of implementing in primary care
6

Service delivery
Back referral
Next level
Referral
PC
(NPHW)
10-<20% 20-<30% 30-<40% >40%
Low Medium High Very high
Very low risk
Manage in PC
7

WHO/ISH charts
To screen for risk of heart attacks and strokes
Using simple variables
Age
Smoking
Sex
Blood pressure
Blood cholesterol
Blood sugar
A
G
E
70
60
50
40
Non-Smoker
MALE
Smoker
4 5 6 7 8
Cholesterol
4 5 6 7 8
Non-Smoker
FEMALE
Smoker
4 5 6 7 8 4 5 6 7 8
8
180
160
140
120
180
160
140
120
180
160
140
120
SBP
180
160
140
120

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 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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1.
2.
3.
4.
Per capita health expenditure in many LMIC countries is inadequate to provide universal coverage
Range of cost effective NCD interventions can be integrated into PHC, even in low resource settings.
If sustainable approaches are used they can reduce morbidity and premature mortality due to NCDs .
PHC has the potential to reduce suffering from preventable NCDs and reduce health-care costs.
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