Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries
Abstract Background Noncommunicable diseases (NCDs) and mental health conditions represent a growing proportion of disease burden in low- and middle-income countries (LMICs). While past efforts have identified interventions to be delivered across health system levels to address this burden, the chal...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09072-9 |
| _version_ | 1811171848739618816 |
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| author | Alma J. Adler Laura Drown Chantelle Boudreaux Matthew M. Coates Andrew Marx Oyetayo Akala Temo Waqanivalu Hongyi Xu Gene Bukhman |
| author_facet | Alma J. Adler Laura Drown Chantelle Boudreaux Matthew M. Coates Andrew Marx Oyetayo Akala Temo Waqanivalu Hongyi Xu Gene Bukhman |
| author_sort | Alma J. Adler |
| collection | DOAJ |
| description | Abstract Background Noncommunicable diseases (NCDs) and mental health conditions represent a growing proportion of disease burden in low- and middle-income countries (LMICs). While past efforts have identified interventions to be delivered across health system levels to address this burden, the challenge remains of how to deliver heterogenous interventions in resource-constrained settings. One possible solution is the Integration of interventions within existing care delivery models. This study reviews and summarizes published literature on models of integrated NCD and mental health care in LMICs. Methods We searched Pubmed, African Index Medicus and reference lists to conduct a scoping review of studies describing an integrated model of NCD or neuropsychiatric conditions (NPs) implemented in a LMIC. Conditions of interest were grouped into common and severe NCDs and NPs. We identified domains of interest and types of service integration, conducting a narrative synthesis of study types. Studies were screened and characteristics were extracted for all relevant studies. Results are reported using PRISMA-ScR. Results Our search yielded 5004 studies, we included 219 models of integration from 188 studies. Most studies were conducted in middle-income countries, with the majority in sub-Saharan Africa. Health services were offered across all health system levels, with most models implemented at health centers. Common NCDs (including type 2 diabetes and hypertension) were most frequently addressed by these models, followed by common NPs (including depression and anxiety). Conditions and/or services were often integrated into existing primary healthcare, HIV, maternal and child health programs. Services provided for conditions of interest varied and frequency of these services differed across health system levels. Many models demonstrated decentralization of services to lower health system levels, and task shifting to lower cadre providers. Conclusions While integrated service design is a promising method to achieve ambitious global goals, little is known about what works, when, and why. This review characterizing care integration programs is an initial step toward developing a structured study of care integration. |
| first_indexed | 2024-04-10T17:20:59Z |
| format | Article |
| id | doaj.art-d9f5c63e9c5446868287b5ec6c83f25d |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-10T17:20:59Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-d9f5c63e9c5446868287b5ec6c83f25d2023-02-05T12:07:48ZengBMCBMC Health Services Research1472-69632023-01-0123111410.1186/s12913-023-09072-9Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countriesAlma J. Adler0Laura Drown1Chantelle Boudreaux2Matthew M. Coates3Andrew Marx4Oyetayo Akala5Temo Waqanivalu6Hongyi Xu7Gene Bukhman8Division of Global Health Equity, Department of Medicine, Brigham and Women’s HospitalDivision of Global Health Equity, Department of Medicine, Brigham and Women’s HospitalDivision of Global Health Equity, Department of Medicine, Brigham and Women’s HospitalDivision of Global Health Equity, Department of Medicine, Brigham and Women’s HospitalProgram in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical SchoolNoncommunicable Diseases Department, World Health OrganizationNoncommunicable Diseases Department, World Health OrganizationNoncommunicable Diseases Department, World Health OrganizationDivision of Global Health Equity, Department of Medicine, Brigham and Women’s HospitalAbstract Background Noncommunicable diseases (NCDs) and mental health conditions represent a growing proportion of disease burden in low- and middle-income countries (LMICs). While past efforts have identified interventions to be delivered across health system levels to address this burden, the challenge remains of how to deliver heterogenous interventions in resource-constrained settings. One possible solution is the Integration of interventions within existing care delivery models. This study reviews and summarizes published literature on models of integrated NCD and mental health care in LMICs. Methods We searched Pubmed, African Index Medicus and reference lists to conduct a scoping review of studies describing an integrated model of NCD or neuropsychiatric conditions (NPs) implemented in a LMIC. Conditions of interest were grouped into common and severe NCDs and NPs. We identified domains of interest and types of service integration, conducting a narrative synthesis of study types. Studies were screened and characteristics were extracted for all relevant studies. Results are reported using PRISMA-ScR. Results Our search yielded 5004 studies, we included 219 models of integration from 188 studies. Most studies were conducted in middle-income countries, with the majority in sub-Saharan Africa. Health services were offered across all health system levels, with most models implemented at health centers. Common NCDs (including type 2 diabetes and hypertension) were most frequently addressed by these models, followed by common NPs (including depression and anxiety). Conditions and/or services were often integrated into existing primary healthcare, HIV, maternal and child health programs. Services provided for conditions of interest varied and frequency of these services differed across health system levels. Many models demonstrated decentralization of services to lower health system levels, and task shifting to lower cadre providers. Conclusions While integrated service design is a promising method to achieve ambitious global goals, little is known about what works, when, and why. This review characterizing care integration programs is an initial step toward developing a structured study of care integration.https://doi.org/10.1186/s12913-023-09072-9Noncommunicable diseasesMental healthLow- and middle-income countriesIntegration scienceService deliverySystematic review |
| spellingShingle | Alma J. Adler Laura Drown Chantelle Boudreaux Matthew M. Coates Andrew Marx Oyetayo Akala Temo Waqanivalu Hongyi Xu Gene Bukhman Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries BMC Health Services Research Noncommunicable diseases Mental health Low- and middle-income countries Integration science Service delivery Systematic review |
| title | Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries |
| title_full | Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries |
| title_fullStr | Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries |
| title_full_unstemmed | Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries |
| title_short | Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries |
| title_sort | understanding integrated service delivery a scoping review of models for noncommunicable disease and mental health interventions in low and middle income countries |
| topic | Noncommunicable diseases Mental health Low- and middle-income countries Integration science Service delivery Systematic review |
| url | https://doi.org/10.1186/s12913-023-09072-9 |
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