NCD Care Continuum and Opportunities for Action within Health Reform in Ukraine
Ukraine is amid a comprehensive health sector reform to transform the current unaffordable and inefficient system into a modern, more efficient, and affordable one. The country’s health system is not addressing non-communicable diseases (NCD) and c...
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| Language: | English |
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World Bank, Washington, DC
2021
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| Online Access: | http://documents.worldbank.org/curated/en/311091621216694793/NCD-Care-Continuum-and-Opportunities-for-Action-within-Health-Reform-in-Ukraine http://hdl.handle.net/10986/35587 |
| Summary: | Ukraine is amid a comprehensive health
sector reform to transform the current unaffordable and
inefficient system into a modern, more efficient, and
affordable one. The country’s health system is not
addressing non-communicable diseases (NCD) and chronic
conditions effectively, and NCD-related health outcomes
compare relatively poorly to countries with a similar level
of health financing. The paper analyzed the continuum of
care for four conditions (hypertension, diabetes, breast,
and cervical cancer) using the cascade framework as an
analytical tool and programmatic data from two regions of
Ukraine (Lviv and Poltava). It draws on global evidence of
good and cost-efficient practices and includes the findings
from guided discussions with Ukrainian health care planners,
administrators, and providers. The analysis found
significant gaps in detection, treatment monitoring, and
treatment adherence in hypertension care (the largest
breakpoints were blood pressure monitoring and achieving
treatment targets) and similarly in diabetes care
(underdiagnosis, inappropriate or incomplete treatment
monitoring, sub-optimal treatment success). In breast cancer
care, there was inadequate screening coverage among eligible
women, post-screening losses, and a lack of documentation
regarding treatment outcomes. In cervical cancer care, the
screening intervals for covered women were short, creating
inefficiencies, while many women were not screened despite
program eligibility, and there was also a lack of long-term
monitoring of women who had undergone treatment. The authors
discuss the methodological approach of analyzing routine
medical records and cancer registry data and triangulating
data across multiple data sources. Important lessons and
policy implications include the need to revise sequence of
services, focus on follow up and retention in care, develop
systems for managing risk factors, and strengthen the
monitoring and data recording of NCD cases. Improved NCD
care would save lives, reduce disability, save resources in
health care, and reduce the impact of NCDs on individuals
and society. |
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