Integrated approach for noncommunicable disease management in the Americas

Abstract

An overview of an integrated approach to improve noncommunicable disease (NCD) management is presented, along with tools on integrating NCD management as part of health system strengthening in the Americas. The study is based on an analysis of Pan American Health Organization/World Health Organization (PAHO/WHO) data and publicly available information on NCD care and capacity, disruptions in NCD services, and guidance on NCD management. Gaps in NCD care are highlighted, in which an estimated 43.0% of men and 28.0% of women with hypertension in Latin America remain undiagnosed; and for those with diabetes, 32.8% in Central and South America are undiagnosed. Yet, only 17/35 countries (49%) in the Americas report having evidence-based national guidelines for NCD management through a primary care approach and only 7/35 countries (20%) report provision of drug therapy, including glycaemic control for eligible persons. To improve NCD management, an integrated approach is needed to coordinate and deliver care across the levels of the health system. This includes increasing primary care capacity and competencies to address multiple chronic conditions, and integration with other complementary programs to avoid missing opportunities for NCD diagnosis and management. An integrated approach to NCD management, and implementation of available tools, should be part of rebuilding health systems after the COVID-19 pandemic.

Noncommunicable diseases in the Americas: a review of the Pan American Health Organization’s 25-year program of work

“…As countries eventually emerge from the COVID-19 pandemic, a key conclusion has been the need to transform and strengthen health systems, prioritizing NCDs, ensuring equitable access to services and integrating NCD services in the first level of care, including the use of telehealth ( 47 , 48 ). In addition, risk factor prevention and health promotion policies need to be strengthened so that more countries are on track to achieve the NCD-related SDG 2030 health goals.…”

“…The COVID-19 pandemic has disrupted services, leading to many persons missing or forgoing medical attention over the past 2 years. Therefore, the recovery effort must prioritize NCD services as a core pillar of the first level of health care and ensure integration of NCD services at the primary care level with the appropriate number of trained health care providers, expanded access to services, and good quality care to provide optimal diagnosis, treatment, and self-management support ( 48 ). Clinical protocols will also be critical to ensure optimal evidence-based care; updated, evidence-based guidelines are available through the PEN package and HEARTS package ( Table 3 ).…”

Scaling up cardiovascular disease management in primary care through HEARTS in the Americas

“…But improving CVD prevention and control will take more than standardizing hypertension treatment guidelines, promoting behavior change, training providers and ensuring essential medicines and diagnostics are available. As highlighted in the article by Luciani et al ( 4 ), transformation will be required in health system governance, and service organization and financing, so that NCDs are fully integrated throughout the health system and become a core pillar of routine primary care services. Indeed, as we look towards the post-pandemic period the focus should be on increasing capacity of the first level of care to address multiple chronic conditions, and integration with other complementary programs, such as women’s health, to strengthen diagnosis and management of NCDs.…”

Ampliación del manejo de las enfermedades cardiovasculares en la atención primaria mediante HEARTS en las Américas

“…Como se destaca en el artículo de Luciani et al . ( 4 ), se necesitará una transformación en la gobernanza del sistema de salud y en la organización y el financiamiento de los servicios, de modo que las ENT se integren plenamente en todo el sistema de salud y se conviertan en un pilar básico de los servicios sistemáticos de atención primaria. De hecho, al mirar hacia el período pospandémico, el enfoque debe centrarse en el aumento de la capacidad del primer nivel de atención a fin de atender múltiples enfermedades crónicas y la integración con otros programas complementarios, como los de la salud de la mujer, para fortalecer el diagnóstico y el manejo de las ENT.…”

“…Pero mejorar la prevención y el control de las ECV requerirá más que estandarizar las directrices de tratamiento de la hipertensión, promover el cambio de comportamiento, capacitar a los prestadores de atención de salud y asegurarse de que los medicamentos y métodos de diagnóstico esenciales estén disponibles. Como se destaca en el artículo de Luciani et al (4), se necesitará una transformación en la gobernanza del sistema de salud y en la organización y el financiamiento de los servicios, de modo que las ENT se integren plenamente en todo el sistema de salud y se conviertan en un pilar básico de los servicios sistemáticos de atención primaria. De hecho, al mirar hacia el período pospandémico, el enfoque debe centrarse en el aumento de la capacidad del primer nivel de atención a fin de 1 Directora de la Oficina Sanitaria Panamericana, Oficina Regional de la Organización Mundial de la Salud para las Américas, Washington D.C., Estados Unidos de América…”