Estrategia para la Prestación de Servicios de Salud en el Abordaje de las Enfermedades Crónicas No Transmisibles Priorizadas en el Primer Nivel de Atención

Objectives

Strengthen first-level prevention, diagnosis, treatment, rehabilitation and long-term follow-up for prioritised non-communicable diseases, particularly hypertension and type 2 diabetes mellitus, within Honduras’s Integrated Health Service Networks. The strategy seeks to reduce morbidity and mortality, improve quality of life, close coverage gaps, and ensure equitable, comprehensive, continuous and quality care for defined populations.[1][2][3][4][5][6]

• Standardise processes and procedures for organising first-level care for hypertension and type 2 diabetes mellitus, using current clinical protocols and a service portfolio spanning prevention, diagnosis, risk stratification, treatment, referral and follow-up.[2][7][8][9]
• Reduce common risk factors for non-communicable diseases, including tobacco use, harmful alcohol consumption, physical inactivity and unhealthy diets, through multisectoral policies, community action and health promotion.[1][10][7]
• Strengthen primary health care as the National Health System entry point, coordinating the continuum from health promotion and prevention to treatment, rehabilitation and continuity of care.[11][5][12]
• Develop Integrated Health Service Networks’ facility structure, governance, workforce, information systems, care coordination, financial allocation and incentives.[4][13]
• Ensure minimum service conditions across human resources, equipment, infrastructure, medicines, laboratories, information systems, administration, financing, referral systems and community work.[14][15][16][17][18]
• Promote community participation and intersectoral action that address social determinants of health and reflect territorial, intercultural, gender and local-context considerations.[11][19][10]
• Improve clinical outcomes through integrated management at diagnosis, regular comprehensive care, protocol-based consultations, immediate referral where indicated, blood-pressure control and glycaemic control.[8][20][9]

Implementation

Implementation uses a multi-level model led by the Secretariat of Health, Health Regions, Integrated Health Service Network coordinating and governance bodies, and first-level health establishments. It combines family health teams, standardised protocols, community-based activities, referral and counter-referral, quality improvement, information management, workforce development and annual operational planning.[2][21][22][23][6][24]

• Establish an operational, administrative and governance body for each Integrated Health Service Network, with responsibility for integrated planning, financing, operations, performance oversight, evaluation, control and accountability.[21]
• Organise care through multidisciplinary Family Health Teams, strengthened primary-care establishments and polyclinics, with defined roles, community service agendas, screening, user clubs, health fairs, rehabilitation and prolonged follow-up.[12][21][25][10][7][26]
• Apply hypertension and type 2 diabetes protocols through screening of adults, risk assessment, clinical and laboratory diagnosis, pharmacological and non-pharmacological management, counselling, treatment-adherence support and timely referral.[7][8][20][27]
• Operate the National Referral and Response System to connect care levels, coordinate appointments and transport, document referrals and responses, use telehealth where appropriate, and support continuity of diagnosis, treatment, follow-up and rehabilitation.[19][28][18][29][30]
• Map and inspect facilities’ infrastructure, biomedical equipment, laboratory capacity and workforce to identify gaps, plan improvements and support compliance with authorisation and licensing standards.[13][31][32][29]
• Maintain level-appropriate medicines, supplies, diagnostic capacity and laboratory networks, using stock management, quarterly needs consolidation, redistribution based on consumption and need, and preventive and corrective maintenance.[16][17][18][32][33][34][35]
• Develop workforce capacity through needs assessments, annual training plans, cascade training, supportive supervision, clinical discussions and continuing professional development.[31]
• Engage community leaders, health promoters, intersectoral committees and local actors in health education, volunteer networks, healthy-lifestyle activities, identification of new users and prevention initiatives.[21][7][26][36][34]
• Use integrated information systems to maintain user records, monitor care, analyse population health, harmonise provider data and support surveillance, planning, risk management and decision-making.[11][12][27][37]
• Monitor implementation through continuous quality-improvement standards covering inputs, processes and outcomes, including medicine and supply availability, trained staff, registration, screening, referrals, quarterly care, annual consultations, blood-pressure control and glycaemic control.[26][38][8][20][27][9]
• Assess network integration using an evaluation tool covering operational, administrative and governance capacity; scores of at least 60% indicate a network tending towards administrative and operational sustainability.[39][13]
• Plan annually by defining objectives, targets and indicators, translating these into management commitments, calculating required resources, preparing budget proposals and reporting progress quarterly. Potential complementary financing may include municipalities, private companies, non-governmental organisations and external cooperation.[24]
• Coordinate financing and investment planning across central, regional and network levels, including external-cooperation projects, while recognising that the available material provides no quantified overall budget, costing methodology, funding gap or monetary allocation.[23][40][31][24]

Monitoring & Evaluation

Monitoring and evaluation are organised through a multi-level system spanning the Secretariat of Health, Health Regions, Integrated Health Service Network coordinating teams and health establishments. It combines service-quality standards, network-performance assessment, surveillance, routine information management, supportive supervision and management commitments for prioritised non-communicable diseases, particularly hypertension and type 2 diabetes mellitus.[28][40][6][24]

• Measure network integration using an assessment tool covering operational, administrative and governance capacity. Scores range from 25% to 100%, and a score of at least 60% indicates a network tending towards administrative and operational sustainability and improved health outcomes.[39][13]
• Monitor morbidity and mortality from priority non-communicable diseases, avoidable hospitalisations, service production, efficiency, user satisfaction, adverse events, user safety and service-production costs. Include these measures in network management commitments with targets and expected achievements for defined periods, and use results in planning, control, management and financing.[28]
• Apply continuous quality-improvement standards for hypertension and type 2 diabetes protocols, structured as input, process and outcome standards. Hypertension measures include availability of supplies and medicines, staff training, operation of an information subsystem, registration of newly diagnosed users and blood-pressure control among treated users.[26][38][20]
• Measure type 2 diabetes care through indicators for comprehensive management at diagnosis, quarterly quality care, at least four protocol-based consultations annually, immediate referral when criteria are met and glycaemic control among users receiving treatment.[9]
• Monitor facility readiness by mapping infrastructure, biomedical and technological equipment, laboratory capacity and health personnel, and by using primary-care establishment inspections to identify gaps for planning and budgeting.[13]
• Use information systems to maintain user records, support continuity of care, monitor specialist waiting lists and collect and analyse clinical-care data. The strategic level is responsible for defining the national indicator monitoring and evaluation system for policies, plans and programmes addressing priority non-communicable diseases.[11][12][27][40]
• Conduct surveillance, health analyses, profiles and projections to inform prevention, control, risk management and assessment of health-system performance. Regional leadership is expected to analyse population health information, assess intervention impact and introduce corrective and preventive action when objectives are not met.[6][37]
• Report quarterly on health-establishment operational-plan targets and on network management commitments. Network teams also consolidate and present referral-system information monthly, while health establishments submit monthly referral reports.[30][24]
• Strengthen accountability through governance bodies responsible for performance oversight, operational control, evaluation of health outcomes, integrated planning, financing and accountability. Management-support functions also include internal audit, transparency and accountability.[21][40]

The extract does not provide a single consolidated indicator dictionary, uniform data-collection protocol, independent evaluation mechanism or formal sanctions for non-compliance. Some reporting frequencies are specified, notably monthly referral reporting, quarterly progress reporting and quarterly consolidation of medicines and supplies needs, but wider reporting timetables are not consistently defined.[31][33][30][24]

Costing & Financing

Financing is embedded in annual operational planning, network governance and investment planning for priority non-communicable disease services, but the available material provides no total implementation budget, monetary allocation, unit cost, quantified funding gap or economic assumption.[14][23][24]

• Prepare annual operational plans and associated budget proposals for priority non-communicable disease activities. Health establishments are expected to calculate resources required for planned activities, while network coordinating teams coordinate the budgeting process.[24]
• Allocate and harmonise financial resources through senior leadership, which is responsible for proposing allocations for expanded priority-disease coverage and aligning resources from different health-system funding sources.[23]
• Manage financing through each Integrated Health Service Network governance body, which is financed by its own network and is responsible for health-financing management alongside planning, operations, control, evaluation and accountability.[21]
• Mobilise complementary financing from municipalities, private companies, non-governmental organisations and external cooperation, in addition to health-sector funding.[24]
• Plan investments in infrastructure, laboratory capacity and biomedical equipment through national funds, external cooperation, intersectoral arrangements and local resource mobilisation. Regional authorities are expected to identify investment needs, funding sources, financed services and results.[31][32][29][34]
• Support budget execution and control, particularly investment related to priority non-communicable diseases, and plan medicines, supplies, equipment, staffing, laboratory services and facility improvements according to identified needs.[22][40][33]
• Recognise potential efficiency and household-cost benefits from telehealth, including reduced unnecessary travel, lower out-of-pocket expenditure, shorter waiting lists and improved access for hard-to-reach populations.[5][12][28]

Required resources include medicines, supplies, laboratory reagents, biomedical equipment, information technology, transport, telehealth capacity, maintenance and a multidisciplinary workforce, but no associated monetary values are specified. Administration and financing are included among the facility standards used to assess implementation.[14][16][17][18][36][34][35]