Health systems strengthening and the need for a systems approach: Lessons from PATH’s work to sustainably improve noncommunicable disease care

A vast array of interventions and technologies exist to cure disease and prolong life, yet gaps in health outcomes continue to widen, particularly for those living with NCDs. No single intervention or technology has the capacity to overcome population-wide challenges, which is why strong health systems are essential to achieving universal, equitable access to quality and timely care. PATH’s approach to strengthening service delivery is a unique example of how co-creating with local partners as well as through upfront investment in people generates health solutions for NCDs that are readily adopted, locally owned, and sustainably scaled.

As not all primary health care delivery provides equal access to prevention, diagnostics, and treatment for NCDs, PATH works with national and local governments to transform primary health care to better serve people’s needs throughout their life. To do this well, PATH builds health workforce capacity to support NCD care in primary care facilities, partners with community health workers and volunteers to provide follow-up and support, and leverages digital health innovations to increase demand for services as well as access to affordable care for diabetes and hypertension by bringing diagnostic services closer to communities, such as in the case of the Communities for Healthy Vietnam project. Increasing the availability of NCD services at the primary care level is a key pillar of PATH’s approach, because regular interactions with primary care providers can identify risk factors for NCDs and help prevent the development of serious illness. By changing how people with NCDs experience care delivery, PATH is enabling a transformation in both demand and supply of services, thus enriching the care experience for both patients and practitioners.

Recognizing that primary health care is the face of a national health system, PATH also works to strengthen its backbone through supply chain management. Not only does a reliable supply chain enable countries to meet demand for medicines and associated health products, but they also safeguard a country’s investment in health commodities, which is often lacking for NCDs. PATH strengthens supply chains by working closely with health authorities and providing them resources to identify and address challenges. To do this, PATH undertakes diagnostic assessments to identify strengths and inefficiencies in national supply chains, including tracking stockouts and price mark-ups. These provide a thorough overview for countries to understand which actions to take to strengthen commodity security. These assessments are essential as countries work towards universal health coverage and transition into more sustainable financing for NCD commodities.

Lastly, PATH’s approach enables countries to use data to guide their decision-making. A key example of this is their pioneering digital technology which collates and visualizes the sub-national NCD burden, national NCD initiatives, implementers, and funders — the NCD Navigator. The Navigator is fundamental in providing evidence that helps countries to allocate resources efficiently and to coordinate stakeholders effectively. Beyond decision-making, having these types of data enables health systems to really question what key gaps exist in service delivery and for whom.

In addition to the three areas of PATH’s systems approach, PATH adapts its programs to each country’s specific context, thus ensuring the acceptability of technologies and tools while encouraging local ownership. This continuous engagement over time allows projects to become embedded at national level, creating a rigorous approach to implementation, coordination, and stakeholder engagement.

PATH’s approach offers lessons on how health systems can be strengthened to support NCD care, in turn revealing the multiple low-hanging fruits for NCD action. The tenets of PATH’s work: primary health care, supply chain management, data-driven decision-making and working with local partners showcase that sustainable change is possible and feasible. PATH’s success stories in national scale-up demonstrate that siloed approaches are not the only options available for NCDs. Instead, having a simplified proof-of-concept pilot, compounded by long-term funding is deeply transformative for systems-wide change.