Prioritizing noncommunicable diseases in the Americas region in the era of COVID-19

Luciani, Silvana; Agurto, Irene; Caixeta, Roberta; Hennis, Anselm

doi:10.26633/rpsp.2022.83

Cited by 13 publications

(11 citation statements)

References 15 publications

(8 reference statements)

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“…59–61 Studies emphasized challenges in coordinating evidence-based responses, managing scarce resources, and confronting healthcare inequities exacerbated by the pandemic. 62–66 Significant regional disparities in health workforce availability were also reported. 67 Delays and inconsistencies in healthcare guidelines and policies were reported in Mexico during the initial pandemic stages.…”

Section: Resultsmentioning

confidence: 99%

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

Ogungbe,

Jabakhanji,

Mehta

et al. 2024

Preprint

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Summary Background The COVID-19 pandemic disrupted care for non-communicable diseases globally. This study synthesizes evidence on disruptions to primary care, focusing on hypertension and diabetes care and mitigation approaches taken during the pandemic in Latin America and the Caribbean (LAC). Methods We conducted a scoping review, searching nine electronic databases for studies from January 2020 to December 2022 on COVID-19-related primary care disruptions and interventions, including studies on hospital-based interventions given their relevance to the pandemic response in LAC. We adapted the Primary Health Care Performance Initiative framework to develop our search strategy and synthesize data. For studies reporting interventions, we included studies conducted outside of LAC. Findings Of 33,510 references screened, 388 studies were included (259 reported disruptions in LAC, 61 interventions in LAC, 63 interventions outside LAC, and five interventions from countries within and outside LAC), with three-quarters presenting data from Brazil, Argentina, Mexico, and Peru; few studies focused on rural areas. Additionally, the few studies that adequately quantified care disruptions reported a reduction in hypertension and diabetes control during the pandemic (e.g., hypertension control rate decreased from 68% to 55% in Mexico). Frequently reported causes of disruption included burnout and mental health challenges among healthcare workers (with disproportionate effects by type of worker), reduced medication supplies, and reduced frequency of clinic visits by patients (e.g., due to financial constraints). The most reported interventions included remote care strategies (e.g., smartphone applications, virtual meeting platforms) and mental health programs for healthcare workers. Remote care strategies were deemed feasible for care delivery, triaging, and clinical support for non-physicians. Patients were generally satisfied with telemedicine, whereas providers had mixed perceptions. Robust evidence on the effectiveness of remote care strategies for diabetes and hypertension care was unavailable in LAC. Interpretation Hypertension and diabetes control appeared to worsen in LAC during the pandemic. Major reported causes of care disruptions were workforce issues, reduced medication supply, and changes in patient perceptions of seeking and receiving primary healthcare. Remote care strategies were feasible for various purposes and were well received by patients. However, the lack of data on intervention effectiveness underscores the importance of strengthening research capacity to generate robust evidence during future pandemics. Developing resilient healthcare systems able to provide care for hypertension and diabetes during future pandemics will depend on investment in the healthcare workforce, medical supply chain, health data and research infrastructure, and technology readiness.

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Section: Resultsmentioning

confidence: 99%

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

Ogungbe,

Jabakhanji,

Mehta

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…As a way forward, the Americas region has charted a path for creating more resilient health services, which includes strengthening primary care and increasing financial investments in health systems 30. And as COVID-19 cases continue to decline and health services resume to capacity, the public health priority now needs to be on improving the equitable access to NCD diagnosis and treatment in primary care, which includes updating NCD guidelines, training multidisciplinary healthcare teams, increasing access to essential NCD medicines and technologies, improving self-management support, among others 31. With regard to NCD medicines and technologies, governments in the Americas region can use the PAHO Strategic Fund which offers a useful mechanism for pooled procurement of quality assured essential NCD medicines and technologies, and was successfully deployed in government responses to COVID-19, and other health priorities 32…”

Section: Discussionmentioning

confidence: 99%

What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region

et al. 2023

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ObjectiveThis article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic.SettingInformation on public sector primary care services for NCDs, and related technical inputs from 35 countries in the Americas region are provided.ParticipantsAll Ministry of Health officials managing a national NCD programme, from a WHO Member State in the Americas region, were included throughout this study. Government health officials from countries that are not WHO Member States were excluded.Outcome measuresThe availability of evidence-based NCD guidelines, essential NCD medicines and basic technologies in primary care, cardiovascular disease risk stratification, cancer screening and palliative care services were measured in 2019, 2020 and 2021. NCD service interruptions, reassignments of NCD staff during the COVID-19 pandemic and mitigation strategies to reduce disruptions for NCD services were measured in 2020 and 2021.ResultsMore than 50% of countries reported a lack of comprehensive package of NCD guidelines, essential medicines and related service inputs. Extensive disruptions in NCD services resulted from the pandemic, with only 12/35 countries (34%), reporting that outpatient NCD services were functioning normally. Ministry of Health staff were largely redirected to work on the COVID-19 response, either full time or partially, reducing the human resources available for NCD services. Six of 24 countries (25%) reported stock out of essential NCD medicines and/or diagnostics at health facilities which affected service continuity. Mitigation strategies to ensure continuity of care for people with NCDs were deployed in many countries and included triaging patients, telemedicine and teleconsultations, and electronic prescriptions and other novel prescribing practices.ConclusionsThe findings from this regional survey suggest significant and sustained disruptions, affecting all countries regardless of the country’s level of investments in healthcare or NCD burden.

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“…Moreover, COVID-19 and its health consequences [ 68 ] – including sequelae – deep social inequalities and food insecurity – more incident in highly impoverished areas (for example, RRMs) – mental health problems, and the progressive growth of chronic degenerative diseases [ 64 ], some related to the aging population [ 66 ], should pressure the demand for specialized care.…”

Section: Discussionmentioning

confidence: 99%

Challenges to the provision of specialized care in remote rural municipalities in Brazil

Nunes

Santos

Carneiro

et al. 2022

BMC Health Serv Res

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This case study analyses the challenges to providing specialized care in Brazilian remote rural municipalities (RRM). Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). We identified that the distance between municipalities is a limiting factor for access and that significant care gaps contribute to different organizational arrangements for providing and accessing specialized care. Physicians in all the RRMs offer specialized care by direct disbursement to users or sale of procedures to managers periodically, compromising municipal and household budgets. Health regions do not meet the demand for specialized care and exacerbate the need for extensive travel. RRM managers face additional challenges for the provision of specialized care regarding the financing, implementation of cooperative arrangements, and the provision of care articulated in networks to achieve comprehensive care, seeking solutions to the locoregional specificities.

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Prioritizing noncommunicable diseases in the Americas region in the era of COVID-19

Cited by 13 publications

References 15 publications

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region

Challenges to the provision of specialized care in remote rural municipalities in Brazil

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