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A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem.

By D Maher, A D Harries, R Zachariah and D Enarson

Abstract

BACKGROUND: Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs), there is evidence now of a shift of attention to NCDs. DISCUSSION: Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV). The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1) identify and address modifiable risk factors, 2) screen for common NCDs and 3) and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for national implementation of these interventions (political commitment, case-finding among people attending primary care services, standardised diagnostic and treatment protocols, regular drug supply, and systematic monitoring and evaluation), and indicators to measure progress towards increasing the impact of primary care interventions on chronic NCDs. The framework needs evaluation, then adaptation in different settings. SUMMARY: A framework for a programmatic "public health approach" has the potential to improve on the current unstructured approach to primary care of people with chronic NCDs. Research to establish the cost, value and feasibility of implementing the framework will pave the way for international support to extend the benefit of this approach to the millions of people worldwide with chronic NCDs

Year: 2009
DOI identifier: 10.1186/1471-2458-9-355
OAI identifier: oai:fieldresearch.msf.org:10144/88050
Provided by: MSF Field Research
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  1. (2008). Adapting the DOTS framework for tuberculosis control to the management of non-communicable diseases in sub-Saharan Africa. PLoS Med
  2. (2003). Continuity of care: a multidisciplinary review.
  3. Control of non-communicable diseases in sub-Saharan Africa.
  4. (2008). Developing a global framework to address noncommunicable diseases. Diabetes Voice
  5. (2000). Enarson DA: Affordability of inhaled corticosteroids as a potential barrier to treatment of asthma in some developing countries. Int J Tuberc Lung Dis
  6. (2008). Foundation: The Chennai call for Action.
  7. (2008). From Alma-Ata to Agincourt: primary health care in AIDS. Lancet
  8. (2008). Garenne ML: Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study. Lancet
  9. Global Burden of Asthma. [http://www.ginasthma.com]. Developed for The Global Initiative for Asthma (GINA)
  10. Global Drug Facility for anti-tuberculosis drugs
  11. (2008). Global public health: a scorecard. Lancet
  12. (2007). Grand challenges in chronic non-communicable diseases. Nature
  13. (2006). Haines A: Implementation research is needed to achieve international health goals. PLoS Med
  14. (2009). HIV as a chronic disease. Clinical Medicine
  15. (2007). Hypertension: uncontrolled and conquering the world. Lancet
  16. (2008). Ijsselmuiden C: Responsive research in developing countries.
  17. (2004). Kitange H: Is it time to reassess the categorization of disease burdens in low-income countries?
  18. (2006). L: Chronic disease: an economic perspective. London: Oxford Health Alliance;
  19. (2004). NF: Organisation of non-communicable disease care. In Principles of medicine in Africa Third edition. Edited by: Parry
  20. (2009). Non-communicable diseases must have greater priority, says WHO (news).
  21. (2007). Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia. Bull World Health Organ
  22. (2007). on behalf of WHO Stop TB Department: Progress towards the 2005 international targets for tuberculosis control. Weekly Epidemiological Record
  23. (2008). Organization: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Geneva: World Health Organization;
  24. (2003). Organization: Adherence to long-term therapies. Evidence for action. Geneva, World Health Organization;
  25. (2004). Organization: The world health report 2004: changing history. Geneva: World Health Organization;
  26. (1994). Organization: WHO Tuberculosis Programme. In Framework for effective tuberculosis control Geneva: World Health Organization;
  27. (2002). Organization: World Health Report
  28. (2005). Preventing chronic diseases: how many lives can we save? Lancet
  29. (2002). Public policy and the challenge of chronic non-communicable diseases.
  30. Research needs for an improved primary care response to chronic non-communicable diseases in Africa. Tropical Medicine and International Health
  31. (2007). S: Prevention of chronic diseases: a call to action. Lancet
  32. (2009). The history of the DOTS strategy: achievements and perspectives. In Tuberculosis - a comprehensive clinical textbook Edited by: Zumla A, Schaaf HS.
  33. (2009). The vitalPage 6 of 7 (page number not for citation purposes) national support can be mobilised to extend the benefit of this approach to the millions of people worldwide with chronic NCDs. signs of chronic disease management. Trans R Soc Trop Med Hyg
  34. (2008). UNICEF: Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report
  35. (2004). Why is a recording and reporting system needed, and what system is recommended? In Toman's tuberculosis. Case detection, treatment and monitoring - questions and answers Second edition. Edited by: Friedman T. WHO,

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