Procurement and supply management activities are fundamental to consistent and reliable access to essential medicines and health products. To reduce the impact of CVD, action needs to be taken to improve prevention, diagnosis, care and management of CVD diseases. Affordable essential medicines and t...echnologies to manage CVD disease must be available where and when they are required. Medicines and technologies need to be managed appropriately to ensure that the correct medicines are selected, procured in the right quantities, distributed to facilities in a timely manner, and handled and stored in a way that maintains their quality. This needs to be backed up by policies that enable sufficient quantities to be procured in order to reduce cost inefficiencies, ensure the reliability and security of the distribution system, and encourage the appropriate use of these health products. In order to avoid stock-outs and the disruption of treatment, all related activities need to be conducted in a timely manner, with performance continually monitored, and prompt action taken in response to problems that may arise. Additionally, medication must be dispensed correctly and used rationally by the healthcare provider and patient alike. The purpose of this guide is to explain the necessary steps.
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Many low-resource settings have a shortage of physicians and health workers. (1) In order to provide patient-centred continuous care more effectively, primary care systems can include team-based care strategies in their clinic workflows and protocols. Team-based care uses multidisciplinary teams (wh...ich may involve new staff, or the shifting of tasks among existing staff). Teams can include patients themselves, primary care physicians, and other allied health professionals, such as nurses, pharmacists, counsellors, social workers, nutritionists, community health workers, or others. Teams reduce the burden on physicians by utilizing the skills of trained health workers. Strong evidence shows that team-based care is effective in improving hypertension control among patients in a cost-effective way. (2) Some amount of task shifting/team-based care is already taking place in many settings; this module provides further guidance on how to maximize this approach for greater impact.
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Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
Monitoring is the on-going collection, management ...and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
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HEARTS provides a set of locally adaptable tools for strengthening the
management of CVD in primary health care.
HEARTS is designed to enhance implementation of WHO PEN by providing:
• operational guidance on further integrating CVD management
• technical guidance on evaluating the impact of... CVD care on patient outcomes.
For countries not using WHO PEN, CVD management can still be integrated into
primary health care. The process of implementing HEARTS will vary, depending
on country context, and may require a significant reorienting and strengthening
of the health system. At some sites, existing CVD management services may be
reoriented toward a risk-based approach, while other sites may adopt a public
health approach, strengthening management of particular risk factors such as
hypertension. Whether or not introducing CVD management into primary care is a
new intervention, successful implementation will require engagement with national and local health planners, managers, service providers, and other stakeholders.
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USAID funded/ Primary Health Care Project in Iraq (PHCPI) in cooperation with Iraqi Ministry of Health (MOH) aims to promote Primary Health Care (PHC) services provided by Primary Health Care Clinics (PHCCs) in Iraq in order to achieve the development goal in enhancing the PHC provision system throu...gh achieving the following results: First: Enhancing management and operations systems, which support clinical care. Second: Improving the quality of the delivered PHC according to quality standards. Third: Enhancing and expanding local community participation and partnership in PHC. Maintaining the medical & service devices in the hospitals and health clinics besides making them function according to the adapted standard specifications, lead to providing most efficient medical services for people and accomplish the purposes for which they were invented. Maintenance and repair of facilities and infrastructure, and keeping them safe and clean are also of the important approaches for the results referred to in (first) and (second) above. This can be achieved through enhancing and developing facilities, and medical & service devices management. This guideline seeks to develop work mechanism for engineers, technicians and the PHCCs’ facilities and medical & service equipment maintenance workers; clarify the concept of maintenance, its importance and classifications in health area, its planning and implementation, the tasks and duties of other directorates and departments of the Ministry in relation to all kinds of maintenance. Add to that preparing documents and forms, which are used in documenting and monitoring the steps required to be accomplished in the maintenance of PHCCs’ facilities and medical & service equipment, for the equipment to perform the best possible services for people and get their satisfaction.
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The Lancet Global Health January 24, 2022
What are the FP and CAC competencies?
Through the clear articulation of the family planning and comprehensive abortion care (FP and CAC) competencies for the primary health care workforce, the aim is to advance improvements in FP and CAC service delivery by aligning health worker education approach...es with population health needs and health system demands.
This document, which describes these competencies in detail, is intended to:
be a foundational tool to be adopted and adapted by educators and regulators for FP and CAC providers (students) with a pre-service training pathway of at least 12 months;
describe competencies that are relevant to current and future health practice;
enable widespread use of the competencies not only for curriculum development for pre-service education, but also for in-service education, regulation, qualifications, quality assurance, personal development, performance evaluation, recruitment, management and career progression;
focus on the core functions of FP and CAC providers within broader efforts towards achieving universal health coverage
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This document, Programme and curriculum development guide, presents a systematic approach to developing programmes and curricula for implementation of the family planning (FP) and comprehensive abortion care (CAC) competencies,and the theory behind the approach. Specifically, the aim is for effectiv...e implementation of these competencies in the context of pre-service education and training, post-graduate studies and continuing professional development (CPD). This guide is designed for programme and curriculum developers who are preparing or revising formal education and training programmes and curricula for the FP and CAC workforce.
This guide proposes a new FP and CAC Educational Design Model for programme and curriculum development. This model can support competency-based education (CBE) for current and future FP and CAC services, with a pre-service training pathway of at least 12 months, and can also support in-service training. CBE provides the most effective means to orient educational programmes and curricula towards effective health services that meet population health needs, and this Educational Design Model provides a guide for linking the competencies required to provide a range of health services
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Unpreparedness of health professionals to address non-communicable diseases (NCD) at peripheral health facilities is a critical health system challenge in Mozambique. To address this weakness and decentralize NCD care, training of the primary care workforce is needed. We describe our experience in t...he design and implementation of a cascade training of trainers (ToT) intervention to strengthen the prevention and control of cardiovascular disease.
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The COVID-19 pandemic has brought the need for well-functioning primary health care (PHC) into sharp focus. PHC is the best platform for providing basic health interventions (including effective management of non-communicable diseases) and essential public health functions. PHC is widely recognised ...as a key component of all high-performing health systems and is an essential foundation of universal health coverage
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Over one third of all deaths in Kenya in 2019 were attributed to NCDs (Vos et al., 2020). The four major NCDs – CVDs, cancer,
diabetes and chronic respiratory diseases – accounted for 57% of these deaths. Furthermore, the direct and indirect economic
impact of NCDs is significant- Kenya is sai...d to have lost Ksh 230 billion or 3.4% of its gross domestic product in 2016 from rising
NCD-related medical costs and indirect productivity losses. At the household level, an estimated decrease of 28.6% in income
due to NCDs was reported in 2007 (Mwai & Muriithi, 2016; Mensah et al., 2020). Therefore, preventing and managing NCDs are
significant public health and economic priorities.
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The OpenWHO course titled "Interventions for Noncommunicable Diseases in Primary Health Care" provides guidance on screening, detection, diagnosis, and management of major noncommunicable diseases (NCDs) such as cardiovascular diseases, type 2 diabetes, chronic respiratory diseases (asthma and chron...ic obstructive pulmonary disease), and early cancer detection within primary health care settings. It emphasizes delivering high-impact essential NCD interventions through a primary healthcare approach to enhance early detection and timely treatment. This course is part of the SEARO NCD PEN-HEARTS series, which includes four courses aimed at enabling learners to plan and deliver NCD services effectively.
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An integrated approach is particularly important for low-resource settings for efficient use of limited resources. The course contents will include risk factors, clinical course, guidance and protocols for diagnosis, management and referral as needed for NCDs in PHC. SEARO NCD PEN-HEARTS is a series... of four courses with the other three courses focusing on Hearts of NCD: an integrated approach to management of NCDs in PHC, diabetic foot care and palliative care that will enable the learner to plan and deliver NCD services.
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The "WHO Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care" provides a set of cost-effective, evidence-based interventions to address noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers. Designed ...for implementation in primary healthcare settings, especially in low-resource environments, the package includes protocols for screening, diagnosis, treatment, and management of these diseases. The document emphasizes an integrated approach, supporting universal health coverage by empowering healthcare workers with practical tools to improve NCD care. It aims to reduce premature mortality from NCDs and enhance global health equity.
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Effective implementation of WHO PEN, combined with other very cost effective population-wide interventions, will help even resource constrained settings to attain the global voluntary targets related to reduction of premature mortality and preventionof heart attacks and strokes.
Mugisha et al. Int J Ment Health Syst (2017) 11:7 DOI 10.1186/s13033-016-0114-2