Corrina Moucheraud (
Health Aff (Millwood). 2018 Aug;37(8):1321-1330. doi: 10.1377/hlthaff.2018.0151.
The growing burden of noncommunicable diseases (NCDs) may pose challenges for resource-limited health systems. This study used standardized, nationally representative data from Service Provision Assessments conducted in 2013-15 and the Service Availability and Readiness Assessment methodology to examine NCD service availability and readiness in Bangladesh, Haiti, Malawi, Nepal, and Tanzania. Both service availability and readiness were found to be very low: Very few facilities were fully "ready" to provide any one NCD service. Shortages of trained health workers and essential medicines were critical limitations to readiness. Rural and free facilities had lower availability and readiness, which may present access barriers. Policy makers should draw on decades of experience with global health initiatives to close these service gaps through the training of health workers on NCD screening and treatment, engaging the private sector on NCDs, and ensuring access to NCD medicines. Such efforts must be attentive to distributional equity and the multiple dimensions of care quality.
非传染性疾病（NCD）负担不断增加，可能给资源有限的卫生系统带来挑战。本研究利用 2013-15 年开展的服务提供情况评估的标准化、全国代表性数据以及服务提供情况和准备情况评估方法，考察了孟加拉国、海地、马拉维、尼泊尔和坦桑尼亚的 NCD 服务提供情况和准备情况。结果发现，这两个方面都非常薄弱：只有极少数机构完全“有准备”提供任何一项 NCD 服务。卫生工作者和基本药物短缺是准备工作的重大限制。农村和免费机构的服务提供情况和准备情况较差，这可能构成获取服务的障碍。决策者应该借鉴全球卫生倡议数十年来的经验，通过培训卫生工作者进行 NCD 筛查和治疗、让私营部门参与 NCD 工作以及确保 NCD 药物的获取，来填补这些服务空白。这些努力必须关注分配公平和护理质量的多个方面。
