Care cascades: a priority indicator to monitor NCD service coverage and strengthen PHC

A care cascade is a simple model of the sequential steps of care that a patient would ideally undertake after becoming ill. An indicator that reveals the proportion of people successfully diagnosed, being treated and in good control of their Non-communicable diseases (NCD) (e.g. diabetes) could potentially tell us more about the overall performance of the health system.

The potential use of care cascades to monitor the success of health systems in meeting needs for NCD care emerged as a key message at a recent workshop organised by the universities of Lausanne and Erasmus Rotterdam together with the World Health Organization. NCD care cascades have considerable potential as indicators, and it would be positive to see this agenda further developed by the global community of policy makers and researchers. These indicators not only tell us about effective NCD service coverage levels and the extent to which the current health system is providing quality Primary health care (PHC), they also highlight general health system problems that need fixing. For example, a high proportion of people who are undiagnosed with hypertension could point to issues of service coverage as well as health seeking behaviours, which are influenced by health literacy and trust in providers. Integrated, people-centered care and affordable medicines are also likely to be crucial at each step of the cascade. 

Benchmarking and tracking progress in NCD care cascade indicators could be a feasible way to monitor the effectiveness of policy and health system reforms (both within and across countries). Importantly, many countries have started to monitor NCD care cascades as part of their national plans and programmes.  Please refer to the original featured article here by Callum Brindley for further reading.

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