Journal article
Integrating noncommunicable disease services into primary health care, Botswana
- Abstract:
- Despite the rising burden of noncommunicable diseases, access to quality decentralized noncommunicable disease services remain limited in many low- and middle-income countries. Here we describe the strategies we employed to drive the process from adaptation to national endorsement and implementation of the 2016 Botswana primary healthcare guidelines for adults. The strategies included detailed multilevel assessment with broad stakeholder inputs and in-depth analysis of local data; leveraging academic partnerships; facilitating development of supporting policy instruments; and embedding noncommunicable disease guidelines within broader primary health-care guidelines in keeping with the health ministry strategic direction. At facility level, strategies included developing a multimethod training programme for health-care providers, leveraging on the experience of provision of human immunodeficiency virus care and engaging health-care implementers early in the process. Through the strategies employed, the country’s first national primary health-care guidelines were endorsed in 2016 and a phased three-year implementation started in August 2017. In addition, provision of primary health-care delivery of noncommunicable disease services was included in the country’s 11th national development plan (2017–2023). During the guideline development process, we learnt that strong interdisciplinary skills in communication, organization, coalition building and systems thinking, and technical grasp of best-practices in low- and middle-income countries were important. Furthermore, misaligned agendas of stakeholders, exaggerated by a siloed approach to guideline development, underestimation of the importance of having policy instruments in place and coordination of the processes initially being led outside the health ministry caused delays. Our experience is relevant to other countries interested in developing and implementing guidelines for evidence-based noncommunicable disease services.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.0MB, Terms of use)
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- Publisher copy:
- 10.2471/blt.18.221424
Authors
+ National Institutes of Health
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- Funder identifier:
- http://dx.doi.org/10.13039/100000002
- Publisher:
- World Health Organization
- Journal:
- Bulletin of the World Health Organization More from this journal
- Volume:
- 97
- Issue:
- 2
- Pages:
- 142-153
- Place of publication:
- Switzerland
- Publication date:
- 2019-01-08
- Acceptance date:
- 2018-11-12
- DOI:
- EISSN:
-
1564-0604
- ISSN:
-
0042-9686
- Pmid:
-
30728620
- Language:
-
English
- Keywords:
- Pubs id:
-
969976
- Local pid:
-
pubs:969976
- Deposit date:
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2021-03-17
- ARK identifier:
Terms of use
- Copyright holder:
- NM Tapela et al.
- Copyright date:
- 2019
- Rights statement:
- © The authors; licensee World Health Organization. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
- Licence:
- CC Attribution (CC BY)
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