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Integrating non-communicable disease care in humanitarian settings: an operational guide

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PURPOSE AND SCOPE

The purpose of this document is to serve as an operational guide for public health staff of humanitarian organizations providing healthcare in humanitarian settings in order to ensure that care for persons with noncommunicable disease is included and integrated within the primary health care services.

This document describes the rationale and guiding principles for addressing NCDs in a humanitarian context and provides operational guidance for addressing NCDs through an integrated approach at primary health care level. The guidance applies to all types of humanitarian settings and covers the initial acute and ongoing response phases.

The priority NCDs targeted are diabetes, hypertension, cardiovascular disease, asthma and Chronic Obstructive Pulmonary Disease (COPD). Mental Health and many neurological conditions are not included in the scope of this guidance but covered under the mhGAP Humanitarian Intervention Guide (WHO and UNHCR Mental Health Gap Action Programme MhGAP Humanitarian Intervention Guide - see under programmatic Guidance).

The document does not provide clinical guidance on the management of NCDs but clinical guidelines and resources that may be useful include:

⊲ National clinical guidelines (if available)
⊲ PEN-Humanitarian (open source)
⊲ MSF clinical guides
⊲ UNHCR-Primary Care International field guides

RATIONALE

The NCD burden is increasing globally in all age groups and in all regions of the world. In 2015, 71.3% (39.8 million) of global deaths were due to NCDs. Almost three quarters of these deaths and 82% of premature deaths (before the age of 70 years of age) occur in low-and-middle income countries (LMICs). LMICs will also see the highest increase in NCD burden in the coming years.

In addition to being disproportionally affected by NCDs, LMICs also share the highest burden of humanitarian crises. Importantly, due to an increased average duration of displacement (average 26 years in 2015), the humanitarian community has increasingly needed to address NCD care in its operations.

NCD management in general is difficult and humanitarian settings add to this challenge due to a variety of factors. The diversity of challenges includes the varied demographics of the populations affected, the different types of humanitarian crises, as well as the breadth of NCD diseases and presentations. Recent changes in humanitarian emergencies such as conflicts occurring in higher income countries, the increasing number of protracted crises, multiple crises occurring within the same country, and more people being internally displaced (IDP) compared to refugees, impact the type of response needed. Displaced people are more likely to be housed in urban areas rather than camp settings. Furthermore, increased urbanization and population density means that natural disasters are impacting far larger populations.

Any humanitarian emergency is likely to cause disruption to the provision of health services for those with NCDs, due to the damage or destruction of health facilities, limited access to health personnel, medication and supply unavailability, and difficulties in physically accessing health facilities (e.g. damaged roads, transportation networks, or security constraints).

Responses to NCD care needs in these challenging emergency contexts have so far lacked standardization, as well as suffered from a lack of an evidence base to inform the response and adapted guidance.

This document aims to address the gap in operational guidance for NCD care in humanitarian settings by providing a framework for public health programme managers to ensure that care for NCDs is included and mainstreamed in humanitarian responses.

HOW TO USE THIS GUIDE

This document presents an overarching framework for ensuring integration of NCD care in humanitarian health responses outlining the key considerations for NCDs to be included in the needs assessment through to planning, implementation and monitoring of a response. It highlights prioritization of actions in the acute phase, defined as the first 6 months of a response, and considerations for the ongoing response phase beyond the first 6 months.