Availability and readiness of primary healthcare facilities for the management of non-communicable diseases in different districts of Punjab, Pakistan

Abstract

IntroductionNon-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care.MethodologyThis is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs.ResultsThere was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level.ConclusionThis study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC).

Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey

“…Previous small-scale investigations in Afghanistan [29], Bangladesh [30], and Nepal [31] found that health facilities weren't ready to provide CVD-related services. Other LMICs [19][20][21] have found that they are facing similar difficulties. Health facilities' lack of readiness in all three countries may be due to inadequate funding raised through domestic and international channels and a lack of political importance [32] given to combating non-communicable disease.…”

“…The explanatory variables were chosen based on two criteria: (1) they were available in the SPA survey of the countries under investigation [24-26] and (2) previous research [14,[17][18][19][20][21] had established them as important determinants of readiness of health facilities to provide CVD services. The following variables were considered: facility location, managing authority, facility type, external sources of revenue, quality assurance activities, routine management meetings, external supervision, user fees, presence of trained health provider at facility 24 hours with duty schedule or present on-call, feedback on clients' opinions, health facilities' ability to perform diagnosis and/or treatment, and number of CVD care providers who had received in-service training in cardiovascular disease services during the 24 months before the survey.…”

“…A few studies carried out in several LMICs, including South Asian nations, found low readiness to offer services for noncommunicable diseases like diabetes [10][11][12], hypertension [13][14][15] and chronic respiratory diseases [14,16,17]. There is, however, a dearth of research on CVD readiness and related factors in LMICs [14,[17][18][19][20][21][22]. However, most earlier studies on the availability of CVD care in low-resource settings relied on proxy measures made up of generic inputs like the number of healthcare workers and hospital beds [22], or were restricted to local or regional samples [19][20][21].…”

“…There is, however, a dearth of research on CVD readiness and related factors in LMICs [14,[17][18][19][20][21][22]. However, most earlier studies on the availability of CVD care in low-resource settings relied on proxy measures made up of generic inputs like the number of healthcare workers and hospital beds [22], or were restricted to local or regional samples [19][20][21]. The results may be skewed because most earlier studies in this area used small sample sizes, unrepresentative samples, or didn't use a consistent measurement tool to gauge readiness.…”

Enhancing the health supply chain for non-communicable diseases management in Rwanda: A qualitative exploration of the perceptions from policy implementers.

“…Unfortunately, the availability of NCD medicines and nutrition products to individual patients remains inadequate in LMICs. This lack of access increases the risk of undermining the effectiveness of healthcare services and hinders progress toward achieving target 3.8 of the Sustainable Development Goals (SDGs), which is related to attaining Universal Health Coverage (UHC) (3,5,6).…”