Organization of services for severe chronic Noncommunicable diseases at first-level hospitals in nine lower-income countries
Results from a Baseline assessment of PEN-Plus initiation
Bibliographic Data
Severe chronic noncommunicable diseases pose a significant health burden and challenges for health systems globally. This study aims to advance our understanding of the current organization of care for these conditions in low and lower-middle-income countries. The study was conducted as part of a baseline assessment of facilities prior to the initiation of the Package of Essential NCD Interventions -Plus (PEN-Plus) strategy, which is designed to enhance outpatient care for conditions including rheumatic and congenital heart disease, sickle cell disease, type 1 diabetes, severe asthma, and advanced chronic kidney disease. We employed a cross-sectional survey methodology to collect baseline data from 16 hospitals in nine LLMICs. The survey assessed the organization of common and severe NCD services, focusing on the availability and management of severe NCDs, organized into domains of integrated services. Data were analyzed using summary statistics and heatmaps to evaluate care patterns. We document gaps in the availability of services for both common and severe NCDs. We find that the majority of NCD care occurs in the general outpatient settings, with a smaller proportion provided in specialized internal medicine wards. Despite some hospitals implementing specialized clinics and teams, limitations in specialist access, variability in service fees, and inconsistent definitions of patient follow-up were prominent issues affecting patient care access and continuity. Despite the spectrum of strategies employed by these hospitals to cater to chronically and severely ill patients, notable gaps in care persist, particularly for diagnostic and treatment options that require specialist training or equipment. The sustainable decentralization of effective care for individuals with severe chronic NCDs will require integrated teams and customized systems to ensure seamless and comprehensive care through the entire care continuum—from screening and diagnosis to care linkage, ongoing management, handling of complications, uninterrupted supply of medicines and commodities and maintaining patient retention
Decentralization · Disease · Disease burden · Environmental health · Family medicine · Health care · Psychological intervention · Global Maternal and Child Health · Global Public Health Policies and Epidemiology · Healthcare Systems and Reforms · Medicine · Nursing
The Lancet NCDI Poverty Commission
Research electronic data capture (Redcap)—A metadata-driven methodology and workflow process for providing translational research informatics support
The Redcap consortium
High-quality health systems in the Sustainable Development Goals era
Addressing severe chronic NCDs across Africa
Reorienting Primary Health Care Services for Non-Communicable Diseases
| Citations per year | 1 |
|---|---|
| Citation span | 2026 - 2026 (1) |
| Highly cited | No |