CHALLENGES AND OPPORTUNITIES IN DELIVERING NON-COMMUNICABLE DISEASE SERVICES THROUGH PRIMARY HEALTHCARE SYSTEMS

Abstract

Background

In low-resource settings, the growing burden of non-communicable diseases (NCDs) is increasingly difficult to manage, largely due to weaknesses within the existing health system. Despite the critical need for effective service delivery, there remains limited understanding of the systemic barriers and potential enablers related to organizing NCD care. This study aims to explore the health system-level challenges and possible opportunities in delivering services for four key NCDs i.e., cervical cancer, diabetes, cardiovascular disease, and chronic respiratory conditions, at the primary healthcare (PHC) level.

Study design: exploratory qualitative design.

Duration and place of study: This study was conducted in Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi from December 2023 to December 2024

Methods

This study adopted a qualitative research approach to explore the issues in depth. Data collection involved 10 in-depth interviews with local healthcare providers, 10 key informant interviews with facility-level managers and service providers, and 10 focus group discussions held with members of the community. Thematic analysis was conducted using the health system dynamics framework as a guiding structure. To enhance the credibility of the findings, data from different methods and sources were triangulated for validation.

Results

The delivery of NCD services at the PHC level was shaped by multiple systemic challenges. Key issues included the absence of standardized treatment guidelines and clinical protocols, limited oversight of informal and profit-driven private healthcare providers, fragmented health information systems with inadequate record-keeping, and poor coordination among various healthcare actors and service platforms. Additional barriers included weak referral systems, insufficient access to essential medicines, diagnostics, and logistical support, along with a shortage of trained healthcare personnel. On the other hand, several strengths and opportunities were also identified. These included the presence of national policy documents focused on NCDs, an extensive network of healthcare facilities and frontline workers, and a growing public demand for NCD-related services.

Conclusion

Although there is significant potential to strengthen NCD service delivery at the PHC level, persistent health system challenges continue to hinder effective organization and implementation. Addressing these systemic gaps is essential to ensure the delivery of quality NCD care and to respond more effectively to the growing burden of NCDs within PHC settings.