Understanding the role and organization of health workers delivering non-communicable disease management in primary care in low- and middle-income countries: a scoping review.

Abstract

Non-communicable diseases are responsible for three-fourths of annual deaths worldwide and disproportionately affect individuals living in low- and middle-income countries. As populations age and the burden of chronic diseases rises, the role of the health workforce becomes increasingly vital in ensuring equitable access to prevention, early detection, and appropriate treatment. This study aims to review and synthesize the existing knowledge on the role and organization of health workers in managing non-communicable diseases in primary care in low- and middle-income countries. We followed the PRISMA-SCR guidelines and conducted a scoping review in the MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases. We included studies that addressed a non-communicable disease, specified the health workers involved, and reported on models of care for chronic disease management. These studies were published in English. We identified 175 articles. One hundred twenty-five (71%) highlighted the role of multidisciplinary teams, and 41 (23%) discussed optimizing roles within teams for the management of non-communicable diseases in primary care. Multidisciplinary teams often included generalist physicians, nurses, and community health workers. Optimizing roles within teams involves redistributing tasks from doctors to nurses or community health workers and from nurses to community health workers. Multidisciplinary teams and optimizing health workers' roles within teams are important in delivering non-communicable disease management. Multidisciplinary teams typically included generalist physicians, nurses, and community health workers, while additional non-physician health workers depended on the most prevalent health conditions being addressed in the community served. Optimizing the roles of health workers provides opportunities to redistribute responsibilities to deliver more comprehensive care.