Reorienting Primary Health Care Services for Non-Communicable Diseases: A Comparative Preparedness Assessment of Two Healthcare Networks in Malawi and Zambia

Abstract

Despite positive NCD policies in recent years, majority of Sub-Saharan African (SSA) health systems are inadequately prepared to deliver comprehensive first-line care for NCDs. Primary health care (PHC) settings in countries like Malawi and Zambia could be a doorway to effectively manage NCDs by moving away from delivering only episodic care to providing an integrated approach over time. As part of a collaborative health system strengthening project, we assessed and compared the preparedness and operational capacity of two target networks of public PHC settings in Lilongwe (Malawi) and Lusaka (Zambia) to integrate NCD services within routine service delivery. Data was collected and analyzed using validated health facility survey tools. These baseline assessments conducted between August 2018 and March 2019, also included interviews with 20 on-site health personnel and focal persons, who described existing barriers in delivering NCD services. In both countries, policy directives to decentralize disease-specific NCD services to the primary care level were initiated to meet increased demand but lacked operational guidance. In general, the assessed PHC sites were inadequately prepared to integrate NCDs into various service delivery domains, thus requiring further support. In spite of existing multi-faceted limitations, there was motivation among healthcare staff to provide NCD services.

Readiness of the primary health care units and associated factors for the management of hypertension and type II diabetes mellitus in Sidama, Ethiopia

“…However, a lower proportion of facilities have at least one type of Hydrochlorothiazide, beta-blockers, and calcium channel blockers at the lower levels of the health facilities (health centers). This finding agrees with other African countries’ reports like Cameroon, Tanzania, Zambia, Uganda, and Nigeria ( Ademe, Tebeje & Molla, 2016 ; Adinan et al, 2019 ; Shiroya et al, 2021 ; Paromita et al, 2021 ).…”

“…According to our study, facilities located in urban were 8.2 times more likely to be ready to provide HPN management than facilities located in rural. This outcome is consistent with findings from earlier Tanzanian ( Adinan et al, 2019 ), Zambian, and Malawian investigations ( Shiroya et al, 2021 ). The good reason for not providing DM and HPN at the rural health facilities could be improper supportive supervision from the nearby health offices, a little concern for NCDs, and a lack of political commitment ( Tesema et al, 2021 ; Bausch et al, 2021 ; Agunga, 2018 ).…”

The organisation of primary health care service delivery for non-communicable diseases in Nigeria: A case-study analysis

“…Being the closest entry point of the community into the formal health system, the PHC sector is best placed to reach the 'last mile population' who predominantly reside in rural areas [12]. The existence of established referral linkages between the PHC and secondary facilities is considered an enabler for the management of patient with NCDs.…”

“…[11]. The direct linkage of the PHC to communities and households positions it as the pedestal to reach the 'last mile' population who are mostly located in rural areas [12]. Despite its pivotal role in addressing access barriers, PHC attracts the least investment in the national health system [6].…”

Burden of chronic kidney diseases and underlying causes in Zambia: evidence from the global burden of disease study 2019

“…A systemic review of youth and adolescents in Africa estimate similar rates to adults with 1 in 5 impacted, yet this population is rarely screened -leading to untreated disease that progresses for years. Even though existing international hypertension guidelines have been shown effective, lack of adaptation to the Zambian setting and subsequent gaps in protocol implementation may be key drivers in poor hypertension care and resultant early-onset ESKD in Zambia [7,37,38]. Similar to our ndings, hypertension in Africa is resulting in much younger adults needing end of life care with dialysis, compared to high-income countries (HICs) [23,39].…”