Assessing and improving primary health care models for Non-Communicable Disease management in two complex emergencies

The IRC conducted a study describing Non-Communicable Disease (NCD) services in acute crises, looking at Southeast Syria and North Kivu, DRC. There are few research studies on non-communicable diseases being undertaken in primary care settings affected by conflict. However, the activities and operations were severely limited in both contexts due to emergencies, impacting data collection and results. 

The main objectives were to:

1. describe primary care models to manage NCDs and challenges to patient access and delivery of care by healthcare workers in acute crises, and identify opportunities for improvement;
2. assess the feasibility of health facilities collecting and analyzing cohort clinical data to describe the burden of disease, programmatic indicators, defaulting and treatment outcomes; and
3. investigate feasibility of enhanced adherence strategy (basic patient monitoring, cohort reporting and analysis, and community outreach) to improve adherence to care and rational planning. Additionally, a secondary objective was to produce cohort clinical data to describe the burden of disease, programmatic indicators, defaulting and treatment outcomes. 

The results indicated that NCD care in both settings tended to be medication-focused due to the acute lack of resources and large burden of disease (Syria) and lack of developed clinical capacity (DRC). It also demonstrated that cohort monitoring was feasible and useful for the monthly review of cases and outcomes and demonstrated gaps in the continuum of care for NCDs. The cohort clinical data indicated for both settings that the largest proportion of patients were registered with hypertension, high proportions (27-43%) of displaced patients were registered, and the majority of patients (58-76%) missed at least one monthly appointment, although those lost to follow-up (missing 3 months consecutively) were the minority (42%). Finally, despite reinforcement of the continuum of care using the NCD model (e.g. through health facilities, CHWs, and home management), acute civil conflict and health emergencies destabilized access and operations of NCD programs.