Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius

Abstract

Background: The objectives of the study reported in this paper were: (a) to score the coverage of core NCD population-based interventions and individual services in Mauritius; (b) to analyse and score the presence of 15 common health system challenges that impede delivery of core NCD interventions and services in Mauritius; and (c) to provide policy recommendations for Mauritius to address health system barriers to delivery of NCD interventions and services. Methods: The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically scoring coverage of NCD interventions and assessing health system challenges for improving NCD outcomes. The assessment used qualitative research design approach. Results: Of the 24 core population-based interventions for addressing key NCD risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. The top five health system challenges hampering scale-up of coverage of population-based NCD interventions in Mauritius were inadequate interagency cooperation; limited application of explicit priority setting approaches; inadequate change management; sub-optimal distribution and mix human resources; insufficient population empowerment; and insufficient political commitment. The top five challenges had average scores of between 3.1 (interagency cooperation) and 2.4 (distribution and mix of human resources). The top five health system challenges constraining expansion in coverage of individual NCD services were limited integration of evidence into practice; limited use of explicit priority-setting approaches; inadequate application of information and technology solutions; insufficient population empowerment; and sub-optimal distribution and mix of human resources. The top five challenges for individual interventions had mean scores varying between 2.6 (integration of evidence into practice) and 1.7 (distribution and mix of human resources).Conclusions: Mauritius needs to increase its domestic general government investments into the national health system and requisite multi-sectoral action to address the priority health system challenges with a view of bridging the existing gaps in coverage of NCD population-based interventions and individual services.

Noncommunicable Diseases Prevention Policies and Their Implementation in Africa: A Systematic Review

“…Mendeley Desktop reference management was used to identify duplication and data management. After removing duplications, checking the eligibility of full-text articles, applying exclusion criteria, and screening, 21 papers met the inclusion criteria [10,12,13,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43].…”

“…A mere three studies measured policy implementation on the four major NCD risk factors such as tobacco use, harmful alcohol use, unhealthy dietary practice, and physical inactivity [ 35 , 36 , 39 ]. Three studies considered opportunities and challenges to implementing NCD policy to combat the developing burden of NCDs [ 12 , 37 , 40 ]. Most of the studies considered WHO-endorsed policy strategies branded as “best buys” and a global action plan to prevent NCDs 2013–2020 in their NCD policy analysis.…”

Improving equity in the distribution and financing of health services in Mauritius, a small island state with deeply rooted welfare state standards

“…PHC needs to be better designed to meet the needs of the poor. 18 An assessment of health systems performance in Mauritius revealed that inefficiency inherent to the PHC in Mauritius hampers provision of preventive services, early diagnosis and treatment for those living with NCDs. 44 Several dysfunctions with the referral system were also flagged.…”

“…36 A significant proportion of OOP spending is linked to the purchase of pharmaceuticals from the private sector as there is a general wrong perception that generic drugs in the public sector are substandard. 18 Generic medicines in the private sector are generally sold at 4.87 times their international reference price. Furthermore, innovator brand medicines are generally sold at 10.25 times their international reference price.…”

Progress towards Achieving the Recommendations of the Commission on Ending Childhood Obesity: A Comprehensive Review and Analysis of Current Policies, Actions and Implementation Gaps in Thailand

“…Five key factors that were evident as especially influential factors for success or failure of policy implementation were selected as criteria for analysis. These five criteria were: policy comprehensiveness [22,23]; coverage [24,25]; monitoring and evaluation mechanism [14,26]; multi-sectoral collaboration [14,25,27]; and coherence [14,[28][29][30]. Overall, the analysis of each policy or action resulted in their categorization into one or other of three levels: high, H (having at least three criteria rated as high level and no criteria as low level); moderate, M (having at least two criteria rated as high level); low, L (having less than two criteria rated as high level) according to a consensus among stakeholders.…”