Integrating care for non-communicable diseases into routine HIV services: key considerations for policy design in sub-Saharan Africa

There is great interest for integrating care for non-communicable diseases (NCDs) into routine HIV services in sub-Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population.The authors summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. It is emphasized key considerations that can guide integrated care ...

Context matters: a qualitative study of the practicalities and dilemmas of delivering integrated chronic care within primary and secondary care settings in a rural Malawian district

With the increasing double burden of communicable and non-communicable diseases (NCDs) in sub-Saharan Africa, health systems require new approaches to organise and deliver services for patients requiring long-term care. There is increasing recognition of the need to integrate health services, with evidence supporting integration of HIV and NCD services through the reorganisation of health system inputs, across system levels. This study investigates current practices of delivering and implementing integrated care for chronically-ill patients in rural Malawi, focusing on the primary level.

Human-centered design as a guide to intervention planning for non communicable diseases: the BIGPIC study from Western Kenya

Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated early in intervention design. Human-centered design (HCD) is a methodology that can be used to engage stakeholders in intervention design and evaluation to tailor-make interventions to meet their specific needs.

'They are inconveniencing us' - exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: perspectives from patients and clinicians in the Free State Province, South Africa.

Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood.Treatment interruption appears to be the culmination of poor health literacy of patients and inadequate health education provided by clinicians. Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care.

Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana

Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving ‘Health for All.’ The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana’s flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services.

This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved.

Giving patients a voice: implementing patient and public involvement to strengthen research in sub-Saharan Africa

Patient and public involvement (PPI) is recognised as a valuable tool in improving the quality and relevance of research. Defined as "research being carried out "with" or "by" members of the public rather than "to", "about" or "for" them", PPI is a method of involving patients and the public in the design, conduct and dissemination of research and services that affect them, providing for a more democratic approach and patient empowerment.

Non-communicable diseases in sub-Saharan Africa: a scoping review of large cohort studies

Non-communicable diseases (NCDs) cause a large and growing burden of morbidity and mortality in sub-Saharan Africa. Prospective cohort studies are key to study multiple risk factors and chronic diseases and are crucial to our understanding of the burden, aetiology and prognosis of NCDs in SSA. The aim of this study was to identify the level of research output on NCDs and their risk factors collected by cohorts in SSA.

A conceptual framework for capacity strengthening of health research in conflict: the case of the Middle East and North Africa region

In conflict settings, research capacities have often been de-prioritized as resources are diverted to emergency needs, such as addressing elevated morbidity, mortality and health system challenges directly and/or indirectly associated to war. This has had an adverse long-term impact in such protracted conflicts such as those found in the Middle East and North Africa region (MENA), where research knowledge and skills have often been compromised. This paper proposes a conceptual framework for health research capacity strengthening that adapts existing models and frameworks in low- and middle-income countries and uses the knowledge of the MENA context to contextualise them for ...

Towards Integrated People-centered Maternal, Newborn, and Child Health Care in Mali

The World Health Organization (WHO), through its Framework on integrated people-centred health services adopted by Member States in 2016, has called for a fundamental shift in the way health services are funded, managed, and delivered.

In Mali, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has been working with the Ministry of Health since 2013 to contribute to reducing maternal, neonatal, and child mortality and morbidity. As part of ASSIST’s larger partnership with WHO to contribute to the development of IPCHS in different contexts and settings to promote learning, the project proposed to conduct a pilot ...

End-line Assessment of Integrated People-Centered Health Services in Nelson Mandela Metro Municipality, Eastern Cape Province, South Africa

Since 2013, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has been working closely with the South African Department of Health (DOH) and its partners in five provinces to accelerate the reduction of morbidity and mortality through improving access, utilization, and satisfaction with essential HIV services. Drawing on its partnership with the World Health Organization (WHO) Service Delivery and Safety Department to promote people-centered care as an essential pillar of health service quality, ASSIST secured support from the USAID Office of Health Systems to pilot WHO’s global framework on integrated people-centered health services (IPCHS) in the ...