Beaglehole 2008 Improving mangement NCDs PHC

Title Improving the prevention and management of chronic disease in low-income and middle-income countries: A priority for Primary Health Care
Format publication
Authors Beaglehole, R., Epping-Jordan, J., Patel, V., Chopra, M., Ebrahim, S., Kidd, M., Haines, A.
Journal Name (if applicable) Lancet
Date Published 2008
Open Access Y/N no
Hard copy PDF Available Y/N yes
Link http://dx.doi.org/10.1016/S0140-6736(08)61404-X
Abstract The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally diff erent from acute care, relying on several features: opportunistic case fi nding for assessment of risk factors, detection of early disease, and identifi cation of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a leading role in preventing and managing chronic diseases, and these personnel need appropriate training and continuous quality assurance mechanisms. More evidence is needed about the cost-eff ectiveness of prevention and treatment strategies in primary health care. Research on scaling-up should be embedded in large-scale delivery programmes for chronic diseases with a strong emphasis on assessment.