Integrated Care and the Long Tail of Endemic NCDs and Injuries
Rebecca E. Rollins / Partners In Health
Clinical Officer Atupere Phiri evaluates an elderly stroke victim during a home visit in a village near Nsambe Hospital, Malawi.
Through integrated service delivery strategies and decentralization across the health system, it is possible to feasibly and efficiently provide quality care for noncommunicable diseases and injuries among the poorest billion people.
The challenge of the long tail
The PIH Guide to Chronic Care Integration for Endemic NCDs
This graph shows a rank order of modeled causes of death and disability in Rwanda in 2004, using 2008 data from the World Health Organization. Communicable, maternal, nutritional, and neonatal condition are in yellow. NCDs and Injuries are in yellow. Because Rwanda has taken an integrated approach to health sector planning, over the last ten years the country has made great strides in reducing the burden of disease due to both the major killers as well as NCDs and injuries.
Among the poorest, there is no single noncommunicable disease or kind of injury that is responsible for as much death and disability as one of the major infectious diseases. Taken together, however, their impact is nearly as large. This long tail of noncommunicable conditions requires a more deliberately integrated kind of planning to achieve equivalent population health impact.
Designing equitable NCD treatment that cuts across diseases and connects to existing health programs requires 1) leveraging existing resources, 2) progressively decentralizing services, and 3) identifying an optimal group of service clustering for a given facility. Decentralized strategies are needed to provide NCD and injury care as close to the patient as possible. All levels of the health system, from referral centers to the community are essential to an equitable and effective response.
Strong examples of leadership in clinical design include:
- The Toolkit for Outpatient Care for Severe, Chronic, NCDs at First-Level Hospitals (2017) has assembled materials for training and program operation, based on PIH’s work in Rwanda and Malawi. Sections are included on implementation & work planning, baseline assessment, clinical guideline development, training & mentorship, progressive decentralization, medical informatics, and monitoring & evaluation.
- The PIH Guide to Chronic Care Integration for Endemic NCDs (2011), based on Partners In Health’s experiences in Rwanda. This 329-page book provides a framework for long-tail clinical design and gives in-depth guidance on chronic care integration strategies.
- Global health and economic visionaries Jim Yong Kim, Paul Farmer, and Michael E. Porter present their case for Redefining Global Health Delivery in a seminal Lancet article that proposes integrating care across disease verticals.
- The Rwanda Human Resources for Health program will have a major impact on NCDs and injuries. It also is an example of good long-tail clinical design, addressing gaps in clusters of interventions at referral, provincial, and district hospitals.
The NCD Synergies project is seeking out inspiring and successful service delivery models which are bringing quality NCD and injury treatment closer to the patients who need it.