Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study

Nair, Divya; Thekkur, Pruthu; Fernando, Manoj; Kumar, Ajay M. V.; Satyanarayana, Srinath; Chandraratne, Nadeeka; Chandrasiri, Amila; Attygalle, Deepika Eranjanie; Higashi, Hideki; Bandara, Jayasundara; Berger, Selma Dar; Harries, Anthony D.

doi:10.3390/healthcare11020202

Open AccessArticle

Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study

by

Divya Nair

^1,†

,

Pruthu Thekkur

^1,*,†

,

Manoj Fernando

^2,†

,

Ajay M. V. Kumar

^1,3,4

,

Srinath Satyanarayana

^1,3

,

Nadeeka Chandraratne

^5,6,

Amila Chandrasiri

⁵,

Deepika Eranjanie Attygalle

⁷,

Hideki Higashi

⁷,

Jayasundara Bandara

⁸,

Selma Dar Berger

¹ and

Anthony D. Harries

^1,9

¹

Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France

²

Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Anuradhapura 50300, Sri Lanka

³

The Union-South East Asia (USEA) Office, New Delhi 110016, India

⁴

Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore 575018, India

⁵

The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka

⁶

Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka

⁷

The World Bank, Colombo 00300, Sri Lanka

⁸

Project Management Unit, Primary Health Care System Strengthening Project (PSSP), Colombo 00300, Sri Lanka

⁹

Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Healthcare 2023, 11(2), 202; https://doi.org/10.3390/healthcare11020202

Submission received: 3 November 2022 / Revised: 27 December 2022 / Accepted: 5 January 2023 / Published: 9 January 2023

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Abstract

The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0–23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.

Keywords: noncommunicable diseases; screening; continuity of patient care; perspectives; primary healthcare; health system; operational research

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MDPI and ACS Style

Nair, D.; Thekkur, P.; Fernando, M.; Kumar, A.M.V.; Satyanarayana, S.; Chandraratne, N.; Chandrasiri, A.; Attygalle, D.E.; Higashi, H.; Bandara, J.; et al. Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study. Healthcare 2023, 11, 202. https://doi.org/10.3390/healthcare11020202

AMA Style

Nair D, Thekkur P, Fernando M, Kumar AMV, Satyanarayana S, Chandraratne N, Chandrasiri A, Attygalle DE, Higashi H, Bandara J, et al. Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study. Healthcare. 2023; 11(2):202. https://doi.org/10.3390/healthcare11020202

Chicago/Turabian Style

Nair, Divya, Pruthu Thekkur, Manoj Fernando, Ajay M. V. Kumar, Srinath Satyanarayana, Nadeeka Chandraratne, Amila Chandrasiri, Deepika Eranjanie Attygalle, Hideki Higashi, Jayasundara Bandara, and et al. 2023. "Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study" Healthcare 11, no. 2: 202. https://doi.org/10.3390/healthcare11020202

APA Style

Nair, D., Thekkur, P., Fernando, M., Kumar, A. M. V., Satyanarayana, S., Chandraratne, N., Chandrasiri, A., Attygalle, D. E., Higashi, H., Bandara, J., Berger, S. D., & Harries, A. D. (2023). Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study. Healthcare, 11(2), 202. https://doi.org/10.3390/healthcare11020202

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Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study

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