How do we leverage infectious disease platforms to address the growing burden of noncommunicable diseases (NCDs) in low- and middle-income countries? This seminar explored approaches to integrating services for NCDs into HIV, TB, and Malaria control programming globally. This seminar has ended. We invite you to explore the information below to learn about our experiences and lessons integrating services in Ethiopia, Nigeria, and Malawi and read participants’ insights.
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Q3: What obstacles and solutions have you experienced and deployed?
Tagged: #Donors #BuyIn
December 13, 2017 at 4:13 pm #16015
While leveraging existing platforms and programs is an important strategy for addressing the rise of NCDs, it is not always easy. What challenges have you faced in your work integrating NCDs into infectious disease programs? What solutions have you used to address these challenges?
December 14, 2017 at 9:29 am #16022
Ferdinant from Cameroon asked a great question during the webinar related to John’s case study presentation:
How do you manage patient waiting time in integration, particularly in the case of malaria?
What do you think? Do you have any experiences to share with Ferdinant?
December 14, 2017 at 9:39 am #16024
Each of the three case examples shared during the webinar are funded by USAID. Was the integration of NCDs into these programs requested by the donor, or was it proposed by the programs first? How did AOR/CORs respond and support the activities?
December 14, 2017 at 9:42 am #16025
During the webinar, Melissa From Global Health Council asked:
What are ways that international NGOs can work with local NGOs to support data management and collection to then transform into evidence-based policy?
Do you have any experience with partnering to monitor and evaluate your programming? Please share!
December 14, 2017 at 10:12 am #16027
The major obstacle has been the vertical arrangement of many units within the Ministry of Health who are responsible for various technical areas. The onset of integrated projects funded by USAID and other partners has helped to bring these various units together and start looking at service provision from an integrated perspective.
Secondly the front line health workers needed capacity to be able to provide integrated services;therefore this required substantial investment in capacity building, supervision, coaching and mentoring.
December 14, 2017 at 10:20 am #16029
I am interesting in learning more about common challenges (of integrated programs) and ways of overcoming these challenges, considering the perspectives of health providers, managers, and donors.
Provider perspective – having been trained to provide multiple services (e.g. TB + diabetes screening), do staff feel overburdened and are they able to continue to provide high-quality TB services?
Manager perspective – One of the criticisms of vertical programs is that they can foster the creation of parallel systems (for finance, management, supply chain, etc.) which fail to strengthen the entire health system that is tasked with addressing other priority health issues. Is there evidence to show how these integrated programs have improved or reinforced the functioning of the health system?
Donor perspective – Often, integrated programs can distort the priorities of donors. For example. while the priority of a TB care program may be to improve TB case detection and treatment outcomes, an integrated program (e.g. TB & NCDs), may not achieve these goals as resources are spread among multiple priorities. Have there been any such issues or challenges in reporting results when funding streams can be rather vertical? Or, would you argue that the programs are achieving more by leveraging existing platforms to reduce the disease burden?
December 14, 2017 at 12:23 pm #16035
Thanks for the questions, Colin.
In response to your comment on donor perspective, I would argue that programs achieve more by leveraging existing programs and are better able to provide clients with comprehensive, coordinated care. Within the PEPFAR world, we have a long history of integrating services that are now routinely part of HIV programs and services and that we regularly report on, such as family planning, TB screening and treatment, gender-based violence screening and treatment, and more. I believe we must continually seek opportunities to maximize services to meet the needs of the patient, and that the donor community – and Ministries of Health, private sector, employers – will ultimately see the benefits and get behind the approach.
What do others think?
December 14, 2017 at 2:31 pm #16045
It is an interesting topic that you raised. What is integration, and verticality at the MoH level, health facility level, donors and the health workers? What do we really mean we say integration? These are common issues that nobody has one answer. Here is my view.
At health worker level, integration does not mean that a TB focal person trained don TB should do like diabetes testing and initiate treatment. But a doctor or a health offer or nurse diagnosing and treating TB patients should be able to know other underline causes that facilitated to progress to TB, or poor sputum conversion or worsening patient conditions. As an example TB/HIV integration is well established and the same integration can be created for diabetes. If a doctor suspects that his patient could have also DM S/he can consult the expert within the same health facility to diagnose and treat the DM patient. In conclusion a health worker should be conversant on the differential diagnosis for other disease that affect the management of his patient but not necessarily expert in every aspect of disease. The service might not be give to the patient one stop shopping in the same room by the same person but the service can be given by other experts.
The service integration for the healthy facility manager could be leveraging resources. A resource bought in one program might also serve the other. The inter-facility referrals are coordination for the manager.
At the MoH or higher level structures, there will be units or departments for infectious disease, NCD, but they should be able to have an integrated plan and budget. That saves resources, avoids duplications and creates a synergy. In my view we cannot avoid vertical structures but creating horizontal integrations are mandatory.
Donors have their own targets but at times diseases are interrelated. As an example if TB is high among DM patients, it is the donors interest to have TB screening among DM patients, that is easy. The issue is does a TB project donor allow to strengthen a DM program which is always a challenge. The strategy should be using other resources for DM program to screening TB patients for DM. It applies also the other way round that a DM patient might need a TB diagnosis then the health facility can use the donor resources.
December 15, 2017 at 10:36 am #16080
From the perspective of malaria and, to a lesser extent MNCH, the donors, PMI and the GF, are not amenable to leveraging malaria funds unless there is demonstration that the overall objective is to reduce malaria burden in the country. If it can be shown that indeed malaria services and malaria burden are being reduced by a specific activity and that this specific activity also benefits NCD control efforts, then donors (at least PMI) would be amenable to supporting the activity.
December 14, 2017 at 8:37 pm #16053
As per my personal experience working in the districts, the integration of NCDs and other infectious diseases like HIV, TB and so on can be done easily by the health workers. It is very useful and convenient for the resources limited settings however, the problem that we have encountered is that because of multi tasking of health workers, at times the quality of work is questionable. Therefore, apart from normal routine activities, a specific focal person may be appointed so that he can coordinate and carry out the activities as per the plan in a systematic and in quality. The management can also contact the focal person directly.
December 15, 2017 at 6:34 am #16071
In our case, the initial pilot project was funded by MSH, through its Innovation Challenge Fund. Subsequently, the TB screening among DM patients was included as part of the larger USAID funded project because patients with diabetes are considered key population groups in TB programs.
Introducing a new approach is always challenging. Creating adequate awareness about the importance of integrated services required a fair amount of sensitization and awareness creation efforts. Once we got to service delivery points, challenges included:
-Lack of organized clinics for diabetes care as patients were treated in several rooms
-Inadequacy of the screening tools and diagnostic tests for patients with diabetes
-Need for integrated recording and reporting tools
-High workloads in HIV clinics
-Lack of validated non-invasive screening tools for DM
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