FROM SILOES TO SYNERGIES:

Integrating noncommunicable disease prevention and care into global health initiatives and universal health coverage

Policy Research Report

About the REPORT

This report, commissioned by the NCD Alliance to The George Institute for Global Health and supported by the Helmsley Charitable Trust, focuses on priority populations addressed by global health initiative programming.

It draws attention to the scale and nature of unmet need for NCD services, identifying what has been learnt from past efforts at expanding or integrating health care services. Through analyses of data from an online survey, interviews, and a targeted literature review, it brokers knowledge by showcasing examples of where global health financing mechanisms have supported the provision of cost-effective NCD prevention and care services, and in so doing, supported progress towards UHC. It demonstrates that there are ways to effectively support NCD service provision through global health programming, and that these will vary in different contexts.

Report Chapters

The Case for Integration of Noncommunicable Diseases

From Siloes to Synergies

Possibilities for Integration –
Ways Forward

The Case for Integration of Noncommunicable Diseases

Introduction

The Case for Integration of Noncommunicable Diseases

NCDs in global health priority areas

Priority populations in LMICs targeted by global health initiatives are generally at increased risk for NCDs, when compared to the general population

The Case for Integration of Noncommunicable Diseases

Barriers to integration of cost-effective NCD services with global health initiatives

In the online survey conducted as part of the research process for this report, we asked respondents for examples of NCD service integration efforts, their perceptions regarding the success of such initiatives, and if unsuccessful, their perceived barriers to success. Our thematic analysis of the stakeholder responses identified three sets of issues impacting on the success of past efforts: resistance to new ways of working; problems in health system organisation and capacity; and limitations in design for equity, scale and sustainability of integration efforts.

From Siloes to Synergies

Improved population health outcomes

Most of the documentation about examples of where NCD services have been incorporated into disease-specific programmes focuses on process and implementation outcomes, rather than clinical and population health endpoints.28 However, findings from some studies demonstrate the potential impact on health outcomes, as described below.

From Siloes to Synergies

Improved equity of access

The degree to which NCD service integration helps to further health equity goals in LMICs is largely dependent on the features of the system in which service integration is taking place, including the ability of that system to reach the underserved.34 The potential for COVID-19 to exacerbate existing inequities in health underscores the need for heightened attention to efforts to reduce inequities at all levels.

From Siloes to Synergies

Cost-effectiveness

Data that are able to help countries identify the optimal and most cost-effective way of preventing and managing NCDs and other chronic conditions as part of UHC are scant. Even fewer data consider this issue within the national context of existing priority populations or disease-specific programmes.

From Siloes to Synergies

User satisfaction and trust in health services

Integrated services have been found to increase user satisfaction with health services across diverse contexts.32 34 37 38 Where diseases are potentially stigmatising (such as HIV or leprosy), integration into general health services has been widely accepted by unaffected clients and welcomed by those affected by these conditions.

Possibilities for Integration – Ways Forward

Strengthening relationships across health priorities and communities

Overcoming entrenched ways of working, particularly where these have met with success in galvanising support in the past, requires a concerted effort. The case studies, illustrate that strong relationships across different communities are essential to the success of integration efforts.

Possibilities for Integration – Ways Forward

Identifying ways to strengthen local health systems

Health systems worldwide are not well designed to deal effectively and efficiently with the range of health conditions that people present with, particularly those conditions that can be detected early and managed cost-effectively with appropriate screening and early intervention at primary health care level. Addressing underlying health system weaknesses is essential for UHC and for better NCD service integration. The literature review, and survey identified enablers for success of integration initiatives that were particularly relevant to this goal.

Possibilities for Integration – Ways Forward

Embedding whole-of-person care at all levels in programme design

A strong theme from the online survey responses and the case studies, was that the design of programmes needs to be consistent with a vision of integrated, people-centred health systems.

Conclusions and Recommendations

Annex