Primary Care International, Oxford, UK
Primary Care International, Oxford, UK.
BMJ Glob Health. 2022 Jul;7(Suppl 5). doi: 10.1136/bmjgh-2021-007334.
Non-communicable disease (NCD) prevention and care in humanitarian contexts has been a long-neglected issue. Healthcare systems in humanitarian settings have focused heavily on communicable diseases and immediate life-saving health needs. NCDs are a significant cause of morbidity and mortality in refugee settings, however, in many situations NCD care is not well integrated into primary healthcare services. Increased risk of poorer outcomes from COVID-19 for people living with NCDs has heightened the urgency of responding to NCDs and shone a spotlight on their relative neglect in these settings. Partnering with the United Nations Refugee Agency (UNHCR) since 2014, Primary Care International has provided clinical guidance and Training of Trainer (ToT) courses on NCDs to 649 health professionals working in primary care in refugee settings in 13 countries. Approximately 2300 healthcare workers (HCW) have been reached through cascade trainings over the last 6 years. Our experience has shown that, despite fragile health services, high staff turnover and competing clinical priorities, it is possible to improve NCD knowledge, skills and practice. ToT programmes are a feasible and practical format to deliver NCD training to mixed groups of HCW (doctors, nurses, technical officers, pharmacy technicians and community health workers). Clinical guidance must be adapted to local settings while co-creating an enabling environment for health workers is essential to deliver accessible, high-quality continuity of care for NCDs. On-going support for non-clinical systems change is equally critical for sustained impact. A shared responsibility for cascade training-and commitment from local health partners-is necessary to raise NCD awareness, influence local and national policy and to meet the UNHCR's objective of facilitating access to integrated prevention and control of NCDs.
在人道主义环境中，预防和治疗非传染性疾病（NCD）一直是一个长期被忽视的问题。人道主义环境中的医疗保健系统高度关注传染病和紧急救生健康需求。然而，在难民环境中，NCD 是发病率和死亡率的一个重要原因，但在许多情况下，NCD 护理并未很好地融入初级保健服务中。患有 NCD 的人因 COVID-19 而导致更差的结果的风险增加，这使得应对 NCD 的紧迫性更加紧迫，并突显了它们在这些环境中的相对忽视。自 2014 年以来，初级保健国际一直与联合国难民署（UNHCR）合作，为在 13 个国家的难民环境中从事初级保健工作的 649 名卫生专业人员提供了 NCD 临床指导和培训师（ToT）课程。在过去的 6 年中，通过级联培训，约有 2300 名医疗保健工作者（HCW）接受了培训。我们的经验表明，尽管卫生服务脆弱、人员流动率高且临床重点不断变化，但仍有可能提高 NCD 知识、技能和实践水平。ToT 计划是向混合 HCW（医生、护士、技术官员、药剂师技术员和社区卫生工作者）提供 NCD 培训的可行且实用的格式。必须根据当地情况调整临床指导，同时为卫生工作者创造有利的环境对于提供可及、高质量的 NCD 连续性护理至关重要。为了实现持续的影响，对非临床系统变革的持续支持同样至关重要。需要承担级联培训的共同责任，并且需要当地卫生合作伙伴的承诺，以提高对 NCD 的认识、影响当地和国家政策，并实现难民署促进获得 NCD 综合预防和控制的目标。
