Healthcare For Non-communicable Diseases Research Articles

Women’s access to health care for non-communicable diseases in South Africa: A scoping review.

Background Non-communicable diseases (NCDs) such as obesity, hypertension (HPT), and type II diabetes (T2D) are of increasing concern in South Africa (SA), with women being more at risk. Authors conducted a scoping review to identify and map the evidence available about the barriers of access to obesity, HPT, and T2D care among women in SA. Methods Arksey and O'Malley's framework for scoping review was used. The search of the literature was completed in the Scopus, Web of Science, and PubMed databases between April and May 2022. Only studies conducted among women in SA were eligible for inclusion. Identified barriers were mapped onto Levesque’s framework of access to health care to determine which points along the chain of accessing NCD health care among women are mostly impacted. Results Seven articles were included in the review: qualitative (n=2), quantitative (n=2), mixed methods (n=2), and grey literature (n=1). The included studies reported barriers of access to HPT and T2D care only, and no study reported barriers to obesity care. Supply-side barriers included lack of knowledge about available services, physician heavy workloads, medicine stock-outs, limited availability of testing equipment, travelling long distances, long waiting times, and delayed referral. Demand-side barriers included women having low self-awareness of NCD status, concerns about confidentiality, perceived discrimination, and poverty. Conclusions The study highlighted barriers related to the availability and accessibility dimension of access to health care, indicating that care for HPT and T2D is often inaccessible, with women often unable to reach health facilities or service providers. There is a pressing need for further research on access to healthcare for obesity, T2D, and HPT for women in South Africa, particularly among women who bear a disproportionately high burden of these conditions.

Should Healthcare for NCDs Be Equated with Other Goods and Services? — Commodification of Health Care in NDCs

Healthcare services for Non-Communicable Diseases (NCDs) cannot be simply treated as tradable goods or services. The debate surrounding whether healthcare should be equated to commodities is complex, involving economic, ethical, and social considerations. While market-driven approaches can enhance innovation and efficiency, critics caution against the risks of inequality and the erosion of social solidarity. Commodification of NCD healthcare may worsen existing disparities, prioritize profit over patient well-being, and neglect prevention strategies. Balancing efficiency with equity and preventive measures is essential in managing NCDs effectively while addressing the shortcomings of a commodified healthcare system.

Cost of Care for Non-communicable Diseases: Which Types of Healthcare Providers are the Most Economical in India's Chhattisgarh State?

Non-communicable diseases (NCDs) affect a large number of people globally and their burden has been growing. Healthcare for NCDs often involves high out-of-pocket expenditure and rising costs of providing services. Financing and providing care for NCDs have become a major challenge for health systems. Despite the high burden of NCDs in India, there is little information available on the costs involved in NCD care. The study was aimed at finding out the average monthly cost of outpatient care per NCD patient. The average cost was defined as all resources spent directly by government and citizens to get a month of care for a NCD patient. The cost borne by the government on public facilities was taken into account and activity-based costing was used to apportion it to the function of providing outpatient NCD care. For robustness, time-driven activity-based costing and sensitivity analyses were also performed. The study was conducted in Chhattisgarh State and involved a household survey and a facility survey, conducted simultaneously at the end of 2022. The surveys had a sample representative of the state, covering 3500 individuals above age of 30 years and 108 health facilities. The average monthly cost per NCD patient was Indian Rupees (INR) 688 for public providers, INR 1389 for formal for-profit providers and INR 408 for informal private providers and they managed 53.5, 34.3 and 12.0% of NCD patients respectively. The disease profile of patients handled by different types of providers was similar. The average cost per patient was lowest for the primary care facilities in the public sector. The average direct cost of NCD care for government and citizens put together was substantially higher in case of formal for-profit providers compared with public facilities, even after taking into account the government subsidies to public sector. This has implications for allocative efficiency and the desired public-private provider mix in health systems.

An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia.

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.

Oncology in Mozambique: Overview of the Diagnostic, Treatment, and Research Capacity.

Mozambique is one of the poorest countries worldwide, with nearly two thirds of the population living below the poverty line. Similarly to other less developed countries, there is a weak provision of health care for non-communicable diseases due to competing priorities with infectious diseases. Although the leading causes of death in Mozambique in 2019 were Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus and other sexually transmitted diseases and respiratory infections and tuberculosis, with increasing urbanization and westernization of lifestyles, deaths attributed to cancer are also on the rise. This review summarizes cancer burden, cancer prevention and screening, cancer care resources, and trends in cancer training and research in Mozambique, providing a background for the development of cancer care policies in the country.

Perception of Patients and Clinicians on Integration of HIV and Non- Communicable Diseases Care

The growing concerns over the prevalence of non-communicable diseases (NCDs) among individuals with HIV are widely documented. The management of patients with both NCDs and HIV is equally contested. Several studies show that nationwide and system-wide integration of HIV and NCDs care services would benefit patients. However, the effects of the HIV and NCDs care services integrations are unclear. The study therefore sought to achieve three main objectives. The study sought to determine the perceptions of patients and clinicians on the benefits of HIV and NCDs care services integrations. Secondly, the study explored whether HIV and NCDs care services integrations would cause barriers to quality access to HIV and NCDs health care. Third, the study identified the likelihood of patients’ and clinicians’ willingness to attend and work for HIV and NCDs co-existing HIV outpatient clinics. Applying a cross-sectional study design with a sample size of 480 participants, interviews were done using structured questionnaires. The study findings revealed that HIV and NCDs care services integrations improve quality of service, are cost-effective, cause crowding and workload, and enhance patients’ and clinicians’ willingness to attend the clinics. The study concluded that HIV and NCDs care services were much needed to ensure cost reduction, minimise travel from one clinic to the other and improve access to quality health care for those living with HIV and NCDs.

Women’s access to health care for non-communicable diseases in South Africa: A scoping review.

Background: Non-communicable diseases (NCDs) such as obesity, hypertension (HPT), and type II diabetes (T2D) are of increasing concern in South Africa (SA), with women being more at risk. Authors conducted a scoping review to identify and map the evidence available about the barriers of access to obesity, HPT, and T2D care among women in SA. Methods: Arksey and O'Malley's framework for scoping review was used. The search of the literature was completed in the Scopus, Web of Science, and PubMed databases between April and May 2022. Only studies conducted among women in SA were eligible for inclusion. Identified barriers were mapped onto Levesque’s framework of access to health care to determine which points along the chain of accessing NCD health care among women are mostly impacted. Results: Seven articles were included in the review: qualitative (n=2), quantitative (n=2), mixed methods (n=2), and grey literature (n=1). The included studies reported barriers of access to HPT and T2D care only, and no study reported barriers to obesity care. Supply-side barriers included lack of knowledge about available services, physician heavy workloads, medicine stock-outs, limited availability of testing equipment, unaffordable transport costs, travelling longer distances, inefficiently longer waiting times, and delayed referral. Demand-side barriers included women having low self-awareness of NCD status, concerns about confidentiality, perceived discrimination, and poverty. Conclusions: Access to HPT and T2D services is impacted from perception of need to benefitting from care. Articles included identified barriers affecting the availability and accommodation dimension of access to care, suggesting that HPT and T2D care is often unavailable or that women are unable to reach health facilities or service providers. There is need for more and better-quality research about access to NCD health care in SA, especially among women having a disproportionately high burden of obesity, T2D, and HPT.

Factors Influencing the Implementation of Remote Delivery Strategies for Non-Communicable Disease Care in Low- and Middle-Income Countries: A Narrative Review.

Objectives: The COVID-19 pandemic has disrupted health care for non-communicable diseases (NCDs) and necessitated strategies to minimize contact with facilities. We aimed to examine factors influencing implementation of remote (non-facility-based) delivery approaches for people with hypertension and/or diabetes in low- and middle-income countries (LMICs), to inform NCD care delivery during health service disruption, including humanitarian crises. Methods: Our narrative review used a hermeneutic and purposive approach, including primary studies conducted in LMICs, which assessed implementation factors influencing remote NCD care delivery. Results were analyzed using the Consolidated Framework for Implementation Research. Results: Twenty-eight included studies revealed the strong influence of both internal organizational and broader contextual factors, such as community health worker policies or technological environment. Addressing patients’ specific characteristics, needs and resources was important for implementation success. Conclusion: This review highlighted the multiple, complex, interdependent factors influencing implementation of remote NCD care in LMICs. Our findings may inform actors designing NCD care delivery in contexts where facility-based access is challenging. Implementation research is needed to evaluate context-adapted e-Health, community-based, and simplified clinical management strategies to facilitate remote NCD care.

Cancer care for displaced children from Venezuela.

Venezuela, the country with the largest oil reserves, has ridden the wave of oil prices—at times becoming one of the richest countries in Latin America. During the 1960s, as the economy was booming, it attracted migrants from all over the world; around 15% of the population was foreign-born, mainly Europeans. During the 1970s and 1980s, migrants from Colombia, Argentina, Peru, Chile, and Ecuador arrived in Venezuela, fleeing from political and social unrests in their home countries. The collapse of oil prices in the 1980s, together with successive political crises and increasing corruption, led to a progressive end of wealth, a contracted economy, and inflation. In 1999, the constitution guaranteed the right to health and foresaw a decentralised system that would reduce health inequities; unfortunately, no health law was ever passed to enforce it. Instead, the health system was nationalised and became characterised by inefficiency and rampant corruption, leading to a rapid deterioration of services and massive drug shortages. In the past 10 years, Venezuela's health-care system collapsed and became one of the most expensive and inefficient systems in Latin America, with families expected to pay for more than 75% of the costs. A report on the State of Cancer Care in Venezuela, published in 2019, offered a bleak picture of the situation for adults with cancer—the country only has around 10% of the drugs needed for their adequate care. Venezuela: aid needed to ease health crisisVenezuela's health system is collapsing and experts say external assistance is needed to ease severe shortages of drugs and other medical supplies. Barbara Fraser and Hildegard Willer report. Full-Text PDF Educational attainment in displaced children with cancerSupporting the health of displaced people is a challenge shared by the health system in the location to which they are displaced, non-governmental organisations, and the international community. This challenge is magnified when the host country is struggling with violence, poverty, and an unstable government. The COVID-19 pandemic has added further strain to an already difficult situation, restricting movement both within and between countries. Since 2014, the UN High Commissioner for Refugees has rolled out capacity-building projects in countries hosting displaced people, with the aim of providing access to health care for non-communicable diseases. Full-Text PDF

Cancer care for displaced children in Lebanon.

Lebanon is a small country on the Mediterranean Sea that has been plagued for decades by civil war and internal strife, which result from regional wars and power struggles. Most of the Lebanese population has access to national governmental health-care plans, but these are inadequate to cover the costs of cancer care; therefore, non-governmental organisations (NGOs) are needed to alleviate financial barriers to care. In 2002, the Children's Cancer Institute was established at the American University of Beirut Medical Center (AUBMC; Beirut, Lebanon), as a collaboration between AUBMC, St Jude Children's Research Hospital (SJCRH; Memphis, TN, USA), the Children's Cancer Center of Lebanon Foundation (CCCL; Beirut, Lebanon), and the American Lebanese Syrian Associated Charities (ALSAC; Memphis, TN, USA). This collaboration supports programmatic growth (ie, specific projects aimed at developing medical programmes and services to optimise cancer care and delivery) at the Children's Cancer Institute, and the CCCL and ALSAC ensure that no family pays out-of-pocket expenses for cancer-directed care. Between 2002 and 2012, the Children's Cancer Institute grew to provide care for 35–40% of children with cancer in Lebanon, and consultations or specialised procedures for an additional 20–25%. Networks of paediatric oncologists across the country were established, using funded disease-specific programmes, in which enrolled patients could access centralised diagnosis, specialised surgeries, radiotherapy, and unified treatment plans in coordination with their referring oncologist. Educational attainment in displaced children with cancerSupporting the health of displaced people is a challenge shared by the health system in the location to which they are displaced, non-governmental organisations, and the international community. This challenge is magnified when the host country is struggling with violence, poverty, and an unstable government. The COVID-19 pandemic has added further strain to an already difficult situation, restricting movement both within and between countries. Since 2014, the UN High Commissioner for Refugees has rolled out capacity-building projects in countries hosting displaced people, with the aim of providing access to health care for non-communicable diseases. Full-Text PDF

Educational attainment in displaced children with cancer.

Supporting the health of displaced people is a challenge shared by the health system in the location to which they are displaced, non-governmental organisations, and the international community. This challenge is magnified when the host country is struggling with violence, poverty, and an unstable government. The COVID-19 pandemic has added further strain to an already difficult situation, restricting movement both within and between countries. Since 2014, the UN High Commissioner for Refugees has rolled out capacity-building projects in countries hosting displaced people, with the aim of providing access to health care for non-communicable diseases.

Noncommunicable Disease Service Utilization among Expatriate Patients in Thailand: An Analysis of Hospital Service Data, 2014–2018

Global morbidity associated with noncommunicable diseases (NCDs) has increased over the years. In Thailand, NCDs are among the most prevalent of all health problems, and affect both Thai citizens and non-Thai residents, such as expatriates. Key barriers to NCD health service utilization among expatriates include cultural and language differences. This study aimed to describe the situation and factors associated with NCD service utilizations among expatriate patients in Thailand. We employed a cross-sectional study design and used the service records of public hospitals from the Ministry of Public Health (MOPH) during the fiscal years 2014–2018. The focus of this study was on expatriates or those who had stayed in Thailand for at least three months. The results showed that, after 2014, there was an increasing trend in NCD service utilizations among expatriate patients for both outpatient (OP) and inpatient (IP) care. For OP care, Cambodia, Laos PDR, Myanmar, and Vietnam (CLMV) expatriates had fewer odds of NCD service utilization, relative to non-CLMV expatriates (p-value < 0.001). For IP care, males tended to have greater odds of NCD service utilization compared with females (AdjOR = 1.35, 95% CI = 1.05–1.74, p-value = 0.019). Increasing age showed a significant association with NCD service utilization. In addition, there was a growing trend of the NCD prevalence amongst expatriate patients. This issue points to a need for prompt public health actions if Thailand aims to have all people on its soil protected with universal health coverage for their well-being, as stipulated in the Sustainable Development Goals. Future studies that aim to collect primary evidence of expatriates at the household level should be conducted. Additional research on other societal factors that may help provide a better insight into access to healthcare for NCDs, such as socioeconomic status, beliefs, and attitudes, should be conducted.

The Global Breast Cancer Initiative: a strategic collaboration to strengthen health care for non-communicable diseases

The worldwide burden of cancer is substantial and growing. More than one in six deaths globally are due to cancer, with 19 million new cancer cases and 10 million new cancer deaths in 2020.1 The public health response has been insufficient to control the disease burden, with many low-income and middle-income countries having inadequate capacity to provide high-quality and accessible cancer programmes. This deficient response threatens public health, economic growth, and achievement of the UN Sustainable Development Goals.

Team-based primary health care for non-communicable diseases: complexities in South India

Chronic non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases, have reached epidemic proportions worldwide. Health systems, especially those in low- and middle-income countries, such as India, struggle to deliver quality chronic care. A reorganization of healthcare service delivery is needed to strengthen care for chronic conditions. In this study, we evaluated the implementation of a package of tailored interventions to reorganize care, which were identified following a detailed analysis of gaps in delivering quality NCD care at the primary care level in India. Interventions included a redesign of the workflow at primary care clinics, a redistribution of tasks, the introduction of patient information records and the involvement of community health workers in the follow-up of patients with NCDs. An experimental case study design was chosen to study the implementation of the quality improvement measures. Three public primary care facilities in rural South India were selected. Qualitative methods were used to gain an in-depth understanding of the implementation process and outcomes of implementation. Observations, field notes and semi-structured interviews with staff at these facilities (n = 15) were thematically analysed to identify contextual factors that influenced implementation. Only one of the primary health centres implemented all components of the intervention by the end of 9 months. The main barriers to implementation were hierarchical arrangements that inhibited team-based care, the amount of time required for counselling and staff transfers. Team cohesion, additional staff and staff motivation seem to have facilitated implementation. This quality improvement research highlights the importance of building relational leadership to enable team-based care at primary care clinics in India. Redesigned organization of care and task redistribution is important solutions to deliver quality chronic care. However, implementing these will require capacity building of local primary care teams.

What influenced provision of non-communicable disease healthcare in the Syrian conflict, from policy to implementation? A qualitative study

BackgroundThere has been increasing focus on tackling the growing burden of non-communicable diseases (NCD) in crisis settings. The complex and protracted crisis in Syria is unfolding against a background of increasing NCD burden. This study investigated factors influencing implementation of NCD healthcare in Syria.MethodsThis is a qualitative study, whereby semi-structured interviews were conducted with fourteen humanitarian health staff working on NCD healthcare in Syria.ResultsChallenges to NCD care implementation were reflected at several stages, from planning services through to healthcare delivery. There was a lack of information on unmet population need; little consensus among humanitarian actors regarding an appropriate health service package; and no clear approach for prioritising public health interventions. The main challenges to service delivery identified by participants were conflict-related insecurity and disruption to infrastructure, hampering continuity of chronic illness care. Collaboration was a key factor which influenced implementation at all stages.ConclusionsThe historical context, the conflict situation, and the characteristics of health actors and their relationships, all impacted provision of NCD care. These factors influenced each other, so that the social views and values (of individuals and organisations), as well as politics and relationships, interacted with the physical environment and security situation. Infrastructure damage has implications for wider healthcare across Syria, and NCD care requires an innovative approach to improve continuity of care. There is a need for a transparent approach to resource allocation, which may be generalisable to the wider humanitarian health sector.

Access to non-communicable disease health care among non-camp Syrian refugees in northern Jordan

Access to non-communicable disease health care among non-camp Syrian refugees in northern Jordan

A cross-sectional study to identify the factors associated with utilisation of healthcare for non-communicable diseases in a southern part of India

Background: In India, non-communicable diseases (NCDs) are a serious threat to human resources, as the recent data suggests that one in four Indians are at a risk of dying of NCDs before they reach 70 years of age. Healthcare utilisation is a major policy issue to tackle the threat of non-communicable diseases. Objective: The aim of this study was to identify the factors and build a regression model that shows how the various factors affect health care service utilisation for non-communicable diseases across rural and urban households of Udupi taluk, Karnataka. Materials and Methods: A cross-sectional study was done to study the objective. Two-stage cluster sampling technique was used in both rural and urban areas. Thirty villages and 30 urban wards of Udupi taluk were selected by the probability proportional to size (PPS) technique. Result: On univariate analysis, the factors found to be significant (p-value < 0.05) were the residence; health insurance; health care provider preference; income; education; waiting time; and distance to the health centre. To adjust for confounders, a multivariable analysis was done with binomial logistic regression which found that health insurance and distance to the health centre were the significant factors that affect outpatient health care utilization for NCD patients in Udupi taluk. Conclusion: The results of this study show that it is important to concentrate on health insurance for access to health care for chronic diseases and strengthen the primary health care system. The main focus should be on insuring the vulnerable population and concentrate on the primary care of NCDs treatment.