Integrated Care Cascade Toolkit: an implementation guide to screening, treatment & follow-up for HIV & NCDs

Lemie Banda, Elizabeth Dunbar, Tafwirapo Chihana, Arnold Jumbe, Chiyembekezo Kachimanga, Lila Kerr, Joseph Lusaka, Bright Mailosi, Lawrence Nazimera, Basimenye Nhlema, Charles Phiri, and Emily Wroe

Click on image to access and download toolkit

The Integrated Care Cascade was developed in Neno District, Malawi over two years of collaboration between Partners In Health and the Ministry of Health (MOH).

PIH began working in Neno in 2007, and the HIV care program quickly blossomed, with active screening initiatives, treatment decentralized to all health facilities, and a robust system for tracking patients with missed appointments.3 At the end of 2014, 7,100 clients were enrolled in HIV care, representing an estimated 75% of HIV cases in the district.

Meanwhile, care for non-communicable disease (NCD) patients remained limited: case-finding was low, treatment was only available at the two hospitals, and there was no system to follow-up with missing patients. At the end of 2014, just 1% of estimated hypertension and diabetes cases were enrolled in care.

The Neno solution was to integrate care across screening, treatment and follow-up systems, leveraging the success of the HIV program to improve NCD outcomes. Through strategic leveraging of the strong HIV platform, including staff, space, and other resources, Neno was able to fully integrate NCD care. This toolkit highlight this success, including screening, treatment, and follow-up systems for our Integrated Chronic Care Clinic.

Embodied contradictions, structural power: Patient organizers in the movement for global health justice

Apoorva Gomber, Eunice Owino, Moses Echodu, Anu Gomanju, Paladie Mategeko, Lauren Brown, Jonathan D. Shaffer

Click image to access full opinion article.

The current regime of global health governance ensures three things remain true. First, it ensures that the capital allocated to systems of effective caregiving remains deeply insufficient for the health needs of the vast majority of the people in the world. Indeed, at least half the world lack access to essential health services. Second, the fragmented caregiving systems that do exist are largely governed by global institutional philanthropy and their NGOs, usually from the U.S. or Europe, and deploy a logic of “cost-effectiveness”–a race to the bottom in terms of care quality in the name of “efficiency”. Third, this regime of frag- mented charity care in impoverished regions of the Global South often dampens the political aspirations of patients, healthcare providers, and Ministry of Health planners. Sights get narrowed; expectations are reined in because budgets are assumed to be fixed. Failures of imagination combine with deep socialization for scarcity such that substantive change feels insurmountable.

Where do we find hope given this bleak picture? We, the authors, find hope in the fights waged by our fellow patient-organizers. Patient organizers are people living with disease, and those who stand in solidarity with them, who choose to build organizing campaigns and power within a broader constituency to win shared goals. They are central in driving what sociologists have called embodied health movements.

PEN-Plus – Bringing Care for Severe NCDs to the World’s Poorest Children and Young Adults

Short (6-minute) video introduces the PEN-Plus model for decentralizing integrated chronic care services for type 1 diabetes, sickle cell disease, rheumatic heart disease, and other severe NCDs that cause tens of thousands of avoidable deaths every year among the world’s poorest children and young adults. Video includes statements of support from leaders of WHO/AFRO, which has adopted a regional strategy to implement PEN-Plus continent-wide, UNICEF, WHO headquarters, the World Bank, and the Helmsley Charitable Trust.

PEN-Plus Policy Brief – Decentralizing lifesaving care for severe NCDs

8-page policy brief presents PEN-Plus as a proven model for decentralizing care and treatment for type 1 diabetes, sickle cell diseases, rheumatic and congenital heart disease, and other severe NCDs that cause hundreds of thousands of avoidable deaths every year among the world’s poorest children and young adults.

PEN-Plus: Decentralizing life-saving care for the poorest billion

This 11-minute video shows how decentralizing and integrating chronic care services for type 1 diabetes, sickle cell disease, rheumatic and congenital heart disease, and other severe NCDs has brought lifesaving care to poor rural communities in Rwanda, Malawi, and Haiti … and how this PEN-Plus model is now expanding to other lower-income countries in Africa and South Asia.


Integration of NCDI Services Policy Brief

Progressive Decentralization and Integrated Care Teams –
Keys to Bridging the Gap in Services for NCDs and Injuries

Non-communicable diseases and injuries (NCDIs) account for a large and growing proportion of the burden of disease in all World Health Organizations (WHO) regions, including in low- and lower-middle-income countries (LLMICs). Among the world’s poorest billion people, NCDIs cause almost 800,000 deaths under the age of 40 every year – more than HIV, tuberculosis, and maternal deaths combined.

Proven, cost-effective, and equitable NCDI interventions exist that could save millions of lives each year, if scaled to reach everyone in need. But in many LLMICs, these interventions are available only at referral hospitals in capital cities, which makes them inaccessible and unaffordable for the rural poor.

The key to achieving both Universal Health Coverage and Sustainable Development Goal targets for reducing mortality from NCDIs is to develop and implement strategies for progressive decentralization and integrated service delivery that can deliver these interventions, with quality, at lower levels of the health system and in rural areas.

Integration and PEN-Plus policy brief_w_CIS&Network_logos