Assessing capacity and readiness to manage NCDs in primary care setting: Gaps and opportunities based on adapted WHO PEN tool in Zambia

Abstract

IntroductionSub-Saharan Africa is experiencing an epidemiological transition as the burden of NCDs overtake communicable diseases. However, it is unknown what capacity and gaps exist at primary care level to address the growing burden of NCDs. This study aimed to assess the Zambian health system’s capacity to address in NCDs, using an adapted WHO Essential Non Communicable Disease Interventions (WHO PEN) tool.MethodologyThis was a cross-sectional facility survey in the three districts conducted from September 2017 to October 2017. We defined facility readiness along five domains: basic equipment, essential services, diagnostic capacity, counseling services, and essential medicines. For each domain, we calculated an index as the mean score of items expressed as percentage. These indices were compared to an agreed cutoff at 70%, meaning that a facility index or district index below 70% off was considered as ‘not ready’ to manage NCDs at that level. All analysis were performed using Stata 15 MP.ResultsThere appeared to be wide heterogeneity between facilities in respect of readiness to manage NCDs. Only 6 (including the three 1st level hospitals) out of the 46 facilities were deemed ready to manage NCDs. Only the first level hospitals scored a mean index higher than the 70% cut off; With regard to medications needed to manage NCDs, urban and rural health facilities were comparably equipped. However, there was evidence that calcium channel blockers (p = 0.013) and insulin (p = 0.022) were more likely to be available in urban and semi-urban health facilities compared to rural facilities.ConclusionOur study revealed gaps in primary health care capacity to manage NCDs in Zambia, with almost all health facilities failing to reach the minimum threshold. These results could be generalized to other similar districts in Zambia and the sub-region, where health systems remain focused on infectious rather than non-communicable Disease. These results should attract policy attention and potentially form the basis to review current approach to NCD care at the primary care level in Zambia and Sub-Saharan Africa.

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization’s African regional targets

“…Addressing these gaps requires a multi-sectoral response with a commitment to invest in PHC. Priority areas identified in this study include: (1) the need for substantial resource commitments to strengthen and expand the workforce; (2) adequate financing and supply chains to ensure access to essential medicines and diagnostic technologies, and (3) investment in robust health information systems [35][36][37].…”

Capacity of Palestinian primary health care system to prevent and control of non‐communicable diseases in Gaza Strip, Palestine: A capacity assessment analysis based on adapted WHO‐PEN tool

“…These indices were compared to an agreed cutoff at 70%, as it was used in many previous studies in different countries. 13,19 Which meaning that a center or governorate index below 70% was considered as "not ready" to prevent and control of NCDs at that level. Fisher's exact test was used to assess differences in basic equipment, essential services, diagnostic capacity, counseling services and essential medicines availability by governorate.…”

“…were not unique to Palestine, similar studies were conducted in other countries and remarkable deficiencies were found in health system infrastructure, workforce, surveillance, planning, policy, and management. 13,[19][20][21] In term of essential medicines, readiness index demonstrated that there was severe shortage in medicines required for prevention and control of NCDs in all governorates and none of the surveyed governorates had scored a mean index higher than the 70% cut off. In addition, among the 35 essential drugs, only aspirin and sodium chloride infusion were available in almost all PHCs.…”

“…The WHO developed package of essential NCDs interventions (WHO‐PEN) for primary health care system in low‐resource settings, the WHO‐PEN is the minimum standard for NCDs to strengthen national capacity to integrate and scale up care of NCDs in primary health care in low resource settings 13 . In 2013, the Palestinian Ministry of Health (MOH), introduced the WHO‐PEN in primary health care 14 .…”

“…12 The WHO developed package of essential NCDs interventions (WHO-PEN) for primary health care system in low-resource settings, the WHO-PEN is the minimum standard for NCDs to strengthen national capacity to integrate and scale up care of NCDs in primary health care in low resource settings. 13 In 2013, the Palestinian Ministry of Health (MOH), introduced the WHO-PEN in primary health care. 14 The introduction of the WHO-PEN approach, including the training of employees, adapting record-keeping and the health information system, and support supervision, has delegated most NCDs management responsibilities to general physicians and nurses working in primary health care centers (PHCs).…”