将非传染性疾病和心理健康纳入初级卫生保健：数字化团队护理如何改善护理途径（英）2025

© 2025 International Bank for Reconstruction and Development / The World Bank location-dot1818 H Street NW,Washington DC 20433phone202-473-1000globewww.worldbank.org This work is a product of the staff of The World Bank with external contributions. The findings, interpretations,and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of ExecutiveDirectors, or the governments they represent. The World Bank does not guarantee the accuracy, completeness, or currency of the data included in this work and doesnot assume responsibility for any errors, omissions, or discrepancies in the information, or liability with respect to the useof or failure to use the information, methods, processes, or conclusions set forth. The boundaries, colors, denominations,and other information shown on any map in this work do not imply any judgment on the part of The World Bankconcerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be construed or considered to be a limitation upon or waiver of the privileges andimmunities of The World Bank, all of which are specifically reserved. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge,this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications,The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; envelopepubrights@worldbank.org Suggested citation: BenDor, Amanda, Ogutu, Jacklynne, Sichel, Amarynth, Muthee, Tonny, Haas, Sherri, Hulse, Matthew,and Habib, Ali. Integrating NCD and Mental Health into Primary Health Care: How Digitally Enabled Team-Based CareImproves Pathways to Care. Washington, DC: World Bank. License: Creative Commons Attribution CC BY-SA 4.0. I N T R O D U C T I O N Noncommunicable diseases (NCDs)—including hypertension, diabetes, cardiovascular diseases, and cancers—arethe leading causes of death globally. In 2021, these conditions accounted for approximately 43 million deaths,with 73% occurring in low- and middle-income countries (LMICs).1Of those, 1.97 million deaths were in low-incomecountries, 12.2 million in lower-middle-income countries, and 17.6 million in upper-middle-income countries.2Sustainable Development Goal 3.4 calls for a one-third reduction in premature mortality from NCDs throughprevention and treatment and to promote mental health and well-being. Integrating NCD and mental health services into primary health care (PHC) models offers a promising strategyfor increasing individuals’ knowledge of their health status and prevention measures, and improving the continuityand quality of care. Integration within PHC is cost-effective through early detection and the reduction of the needfor more expensive treatment.3The importance of addressing NCDs through PHC is crucial to the World Bank’sgoal ofreaching 1.5 billion people with quality and affordable health services by 2030. The chronic nature of many NCDs requires long-term and often lifelong monitoring and care. As NCDs become anincreasingly pressing public health concern, many governments are prioritizing prevention, early detection, accuratediagnosis, and long-term management plans. A person-centered approach to NCD care and treatment ensures that care iscatered to the individual—not the disease. Given that many NCDs coexist and share risk factors, this is critical to address thegrowing burden of NCDs and mental health. However, health systems in many LMICs continue to face barriers, includinghealth workforce shortages, limited access to essential medicines and diagnostics, underfunded health systems, andfragmented intersectoral collaboration—all of which undermine efforts to deliver integrated, patient-centered care.4 Digital technologies present an opportunity to overcome many of these systemic challenges.By improvingcare coordination, facilitating efficient referrals, supporting clinical decision-making, and empoweringpatients in the self-management of their conditions, digital tools can support integrated screening andservice delivery across the NCD and mental health care continuum. This brief examines the potential for digital health to address some of these challenges to increase preventionknowledge and screening, connect individuals with the health system specifically at the PHC level, and facilitateperson-centered care using a team-based approach. The World Bank’sDigital Transformation for Person-CenteredNCD and Mental Health Care: A Practical Primerprovides more information on how digital technologies can beharnessed across the health care cascade.5 ߹Box 1: Defining Team-Based Care Team-based care constitutes a people-centered approach to health services: Multipl