Health system readiness for non-communicable diseases at the primary care level: a systematic review

Abstract

Objective: To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs).

Design: Systematic review.

Data sources: Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice.

Eligibility criteria: Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs).

Data extraction and synthesis: Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework.

Results: Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research.

Conclusion: The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.

Keywords: primary care; public health; social medicine.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart for study inclusion.

Figure 2

Number of published studies that investigated the primary healthcare system’s readiness between January 1984 and July 2021, broken down by NCD type, NCD focus and WHO region. AFR, African Region; AMR, Region of the Americas; CRD, chronic respiratory diseases; CVD, cardiovascular diseases; DM, diabetes mellitus; EUR, European Region; HIS, health information system; HF, health financing; HSD, health service delivery; HTN, hypertension; HW, health workforce; L&G, leadership and governance; MI, mental Illness; MPK&T, medical products, knowledge and technologies; NCDs, non-communicable diseasesSEAR, South East-Asian Region; WPR, Western Pacific Region.