Truppa Claudia, Ansbro Éimhín, Willis Ruth, Zmeter Carla, El Khatib Aya, Roberts Bayard, Aebischer Perone Sigiriya, Perel Pablo
International Committee of the Red Cross, Beirut, Lebanon.
CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy.
Confl Health. 2023 Jul 21;17(1):35. doi: 10.1186/s13031-023-00532-x.
The Syrian crisis, followed by a financial crisis, port explosion, and COVID-19, have put enormous strain on Lebanon's health system. Syrian refugees and the vulnerable host population have a high burden of Non-communicable Diseases (NCD) morbidity and unmet mental health, psychosocial and rehabilitation needs. The International Committee of the Red Cross (ICRC) recently introduced integrated NCD services within its package of primary care in Lebanon, which includes NCD primary health care, rehabilitation, and mental health and psychosocial support services. We aimed to identify relevant outcomes for people living with NCDs from refugee and host communities in northern Lebanon, as well as to define the processes needed to achieve them through an integrated model of care. Given the complexity of the health system in which the interventions are delivered, and the limited practical guidance on integration, we considered systems thinking to be the most appropriate methodological approach.
A Theory of Change (ToC) workshop and follow-up meetings were held online by the ICRC, the London School of Hygiene and Tropical Medicine and the American University of Beirut in 2021. ToC is a participatory and iterative planning process involving key stakeholders, and seeks to understand a process of change by mapping out intermediate and long-term outcomes along hypothesised causal pathways. Participants included academics, and ICRC regional, coordination, and headquarters staff.
We identified two distinct pathways to integrated NCD primary care: a multidisciplinary service pathway and a patient and family support pathway. These were interdependent and linked via an essential social worker role and a robust information system. We also defined a list of key assumptions and interventions to achieve integration, and developed a list of monitoring indicators.
ToC is a useful tool to deconstruct the complexity of integrating NCD services. We highlight that integrated care rests on multidisciplinary and patient-centred approaches, which depend on a well-trained and resourced team, strong leadership, and adequate information systems. This paper provides the first theory-driven road map of implementation pathways, to help support the integration of NCD care for crises-affected populations in Lebanon and globally.
叙利亚危机之后，黎巴嫩又遭遇金融危机、港口爆炸以及新冠疫情，这给黎巴嫩的卫生系统带来了巨大压力。叙利亚难民以及脆弱的当地居民面临着非传染性疾病（NCD）高发的负担，且心理健康、心理社会及康复需求未得到满足。红十字国际委员会（ICRC）最近在其黎巴嫩初级保健服务包中引入了综合非传染性疾病服务，其中包括非传染性疾病初级卫生保健、康复以及心理健康和心理社会支持服务。我们旨在确定黎巴嫩北部难民和当地社区中患有非传染性疾病的人群的相关成果，并通过综合护理模式确定实现这些成果所需的流程。鉴于实施干预措施的卫生系统的复杂性以及关于整合的实践指导有限，我们认为系统思维是最合适的方法学途径。
红十字国际委员会、伦敦卫生与热带医学院和贝鲁特美国大学于2021年在线举办了一次变革理论（ToC）研讨会及后续会议。变革理论是一个涉及关键利益相关者的参与性和迭代性规划过程，旨在通过沿着假设的因果路径描绘中期和长期成果来理解变革过程。参与者包括学者以及红十字国际委员会的区域、协调和总部工作人员。
我们确定了两条不同的综合非传染性疾病初级保健途径：多学科服务途径和患者及家庭支持途径。这两条途径相互依存，并通过重要的社会工作者角色和强大的信息系统相联系。我们还定义了实现整合的关键假设和干预措施清单，并制定了监测指标清单。
变革理论是解构非传染性疾病服务整合复杂性的有用工具。我们强调，综合护理基于多学科和以患者为中心的方法，这依赖于训练有素且资源充足的团队、强有力的领导以及完善的信息系统。本文提供了首个由理论驱动的实施途径路线图，以帮助支持黎巴嫩及全球受危机影响人群的非传染性疾病护理整合。
