2024-10-09-世界卫生组织-Evaluation_of_adoption_of_people_centred_NCD_service_delivery_within_primary_health_care_in_WHO_South-East_Asia_Region,_2014–2021_327页_9mb

Summary of "Evaluation of adoption of people centred NCD service delivery within primary health care in WHO South-East Asia Region 2014-2021"

Core Content

This report evaluates the adoption of people-centred non-communicable disease (NCD) service delivery within primary health care (PHC) in the WHO South-East Asia Region (SEARO) from 2014 to 2021. It aims to document regional progress, identify challenges, and provide recommendations for enhancing the effectiveness and sustainability of NCD services.

Main Objectives

1. To document regional progress in adopting and expanding access to people-centred NCD services within PHC, including achievements, innovations, and key challenges.
2. To provide recommendations for sustaining gains, accelerating action, and innovating to achieve the impact targets of the WHO Thirteenth General Programme of Work (GPW13) and the Sustainable Development Goals (SDGs), particularly the reduction of NCD-related premature mortality by 33% by 2030.

Key Findings

1. Governance of People-Centred NCD Service Delivery

• WHO's normative guidance supported governance reforms for NCD service delivery in PHC.
• Countries adopted tailored approaches to align NCD services with existing health systems, human resources, and administrative structures.
• The WHO STEPS surveys helped align multilateral investments with specific NCD needs.
• Reforms in health insurance, procurement, access to medicines, and prevention were evident, with some countries implementing wide-scale systemic changes.

2. Delivery of People-Centred NCD Services

• Primary health care reforms focused on NCD services have acted as a major force multiplier.
• Countries used different strategies: some focused on population-level screening, while others improved human resources and prioritized urban areas.
• Despite progress, challenges such as political transitions, the impact of the COVID-19 pandemic, and integration of technological tools hindered implementation.
• Coverage gaps persist, especially for vulnerable populations and remote areas. Medicine availability and cost remain significant constraints.

3. Community Participation

• Community participation is linked to governance structures but remains nascent in most countries.
• Institutionalized systems for community engagement range from national health assemblies to local outreach mechanisms.
• There is a clear need for reforms to enhance community involvement in decision-making and to increase public awareness of NCD risks through counseling and education.

Conclusions

• Member States have demonstrated strong commitments to NCD management at the primary level.
• There has been increased momentum and technical support from WHO.
• The Region should now focus on operationalizing, adapting, and implementing guidance.
• Strengthening community engagement is critical to mainstreaming people-centred NCD care at the PHC level.

Recommendations

A. Governance

1. Sustain Momentum: WHO SEARO should continue to support Member States in utilizing and adapting NCD tools like PEN, STEPS, HEARTS, and MSAP, with a focus on governance enablers and drivers.
2. Enhance Integration: Support Country Offices to integrate NCD services into Health Systems Strengthening (HSS) reforms and deverticalization of PHC, aligning with local contexts and existing health system architecture.

B. Service Delivery

1. Develop Strategies: Support Country Offices to develop service delivery strategies based on existing contexts, reform pathways, and innovations.
2. Provide Guidance: Offer core orientation and implementation support for PHC-level NCD reforms, including training for government actors and ensuring free access to medicines.
3. Monitor and Assess: Conduct monitoring and assessment to identify gaps in population and service coverage, and optimize strategies to address equity and efficiency challenges.
4. Enhance Knowledge: Strengthen regionwide knowledge generation, management, and translation on NCDs, supporting health information systems with purpose-driven, disaggregated data.

C. Community Participation

1. Expand Evidence Base: Build a regional evidence base on national and subnational community initiatives and platforms.
2. Advocate Inclusion: Promote the involvement of disadvantaged and marginalized groups, as well as people living with NCDs, in the development, design, and evaluation of NCD policies and programs.

Key Information

• NCDs: Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are priorities in the SEARO.
• Prevalence: Hypertension affects a quarter of the adult population, and diabetes affects every twelfth adult.
• Economic Burden: NCDs account for 4–6% of GDP in most Member States.
• Triple Billion Goals: One billion more people benefiting from universal health coverage is a key goal under GPW13.
• Colombo Declaration: Adopted in 2016, it emphasizes accelerating NCD service delivery through a people-centred PHC approach.
• PEN (Package of Essential NCD Interventions): Promoted as a model for integrating NCD services since 2010, with Bhutan and Sri Lanka as early adopters.
• Tools and Frameworks: The evaluation used the WHO Integrated People-Centred Health Services Framework, Primary Health Care Operational Framework, Health Systems Building Blocks Framework, and Health Systems Strengthening Evaluation framework.
• Data Collection: Mixed methods were used, including documentary reviews, stakeholder mapping, in-person missions, and analysis of secondary data from STEPS and other surveys.
• Challenges: Political changes, the pandemic, and integration of technology are major barriers. Coverage gaps and medicine availability remain critical issues.

Structure of the Report

• Introduction: Sets the context and outlines the scope and purpose.
• Objectives: Defines the evaluation goals.
• Methods: Describes the sequential mixed-methods approach and conceptual framework.
• Findings: Divided into three domains: governance, service delivery, and community participation.
• Conclusions: Summarizes the current status and regional trends.
• Recommendations: Proposes actions for WHO SEARO and Member States.
• Annexures: Include timelines, country deep dives, and document review summaries.

This evaluation underscores the importance of a people-centred approach in PHC for effective NCD management and highlights the need for continued support, innovation, and community engagement to meet global and regional health targets.