Table 1 Recommendation for future kit use

Establishing a systematic process for pre-deployment needs prior to shipping future kits

To ensure that the kit is relevant and necessary to the local context, gathering information about the emergency situation and working closely with relevant organizations and stakeholders, including the MoH, is essential. This collaborative approach can help to identify the specific needs of the community and support a decision to halt further orders if needs are found to be limited.

Establishing and/or strengthening M&E systems

The provision of M&E tools such as logs and the use of barcode scanners on medicines could support effective utilization of the kit (e.g., pharmacy managers using mobile applications with barcode scanners). However, service implementation may face challenges such as technical issues, lack of training/resources, or resistance to change. Careful assessment and stakeholder collaboration can mitigate these barriers for optimal M&E tool usage.

Work around the push-based supply chain system

Future deployments must take into account that pull-based supply chain systems are generally preferred over push-based systems; multiple donors were found to support facilities with the same medicines. A quicker delivery process is required to ensure efficacy of the kit. It is recommended to incorporate the NCDK deployment system via a common distribution channel (chain). In South Sudan, for instance, it can be done through the Central Medical Store or by utilizing the supply chain of key partners like the Health Pooled Fund (HPF) or United Nations Children’s Fund (UNICEF) for World Bank Project supported sites.

Assigning relevant WHO standard emergency health kits according to local capacity and need

It is suggested to revise the IEHK and reduce its NCD content and aim to utilize it in settings with low NCD burden, low apparent burden and/or places with little capacity to manage NCDs; reserving the NCDK for higher burden areas where the infrastructure and capacity to manage these conditions are better established. However, it is important to acknowledge that not all emergency responses may have access to the NCDK, and in such cases, having adequate NCD medicines in the IEHK can be useful. The IEHK and NCDK should be seen as complementary tools assigned based on local need.

Reviewing the NCDK content

Observations from previous and current assessments of the NCDK suggest a need to review its content. It is recommended to introduce flexibility around the items included in the kit, as well as their quantities and strengths, to align with the BPHS, local essential medicine lists, and tailored to local needs. It would be ideal to organize the NCDK material by level of service delivery, taking into account the capacity and training of HCWs at each level and in accordance with local practices and guidelines.

Reframing the NCDK contents into further sub-categories

It is suggested that the NCDK modules could be reframed by separating out medicines and supplies into further sub-categories by disease (e.g., cardiovascular disease sub-module etc.). Country-specific contexts and needs must be considered to ensure that the sub-categories are recognized and relevant. Considerations for a minimum package of essential mental health services at PHC level should also be made and rolled with comprehensive trainings in the future.

Capacity strengthening of HCWs

The past and present assessments have revealed several gaps in NCD training. As a result, trainings should be implemented before or concurrentlywith the deployment of the NCDK, including periodic refreshers to guarantee HCWs are comfortable and competent in utilizing the kit.

Ensuring the model of NCD service integration is defined prior the deployment of commodities

It is important to note that the approach to NCD service integration may vary depending on the healthcare system and context of each country. Therefore, the model of NCD service integration should be tailored to the specific needs and resources of each country’s health system. For example, setting up a separate NCD clinic is likely to improve the quality of services as health counseling, patient education, and record keeping practices are likely to be improved when provided systematically.

Ensuring quality of service delivery

When deploying the NCDK, it is crucial to ensure availability of guidelines and protocols adopted to the local context accompany the kits at the time of deployment. These resources must be made readily accessible to HCWs to ensure proper utilization of the kits, with systems in place to monitor adherence to them. Furthermore, it is highly recommended to establish systems for capturing health information and patient records before or during the deployment process to ensure that these records are accurately documented and maintained.

Development of an essential medicine list for NCDs at the PHC level

While many essential medicines for NCDs may already be included in the existing national list of medicines, establishing a separate essential medicine list for NCDs at the PHC level can help to ensure that these medicines are readily available in PHC settings and facilitate transition into normal supply chain channels in the future. Moreover, by connecting this list to existing national guidance and training programs, HCWs can be better equipped to properly prescribe and administer these medicines, which can ultimately contribute to better health outcomes for patients with NCDs.