Table 3.

Recommendation for future kit use

Recommendation	Rational/description
Establishing/strengthening a systematic process for predeployment needs prior to shipping future kits	To ensure the kit is relevant and necessary to the local context, designing specific tools/forms could support decisions to distribute the WHO-NCDKs or halt further orders if needs were found to be limited
Establishing/strengthening monitoring and evaluation (M&E) systems	Provision of standardised M&E tools such as logs, frameworks and forms could support effective utilisation of the kit and provide insight on regional burden of NCDs as well as the QoC provided. This would address a significant gap in NCD data collection and help to increase visibility and understanding of the burden of NCDs
Strengthening collaboration and communication between stakeholders	Future collaborations must consider local/national and humanitarian efforts; multiple stakeholders were found to support guidelines development and field staff tend to follow national guidance. A quicker delivery process is required to ensure efficacy of the kit. It is recommended to incorporate the WHO-NCDK deployment system via a common distribution channel and ensure communications with facility/staff focal personnel
Assigning relevant WHO standard emergency health kits according to local capacity and need	Revise the IEHK and reduce its NCD content and aim to use it in settings with low NCD burden, low apparent burden and/or places with little capacity to manage NCDs; reserving the WHO-NCDK for higher burden areas (where the infrastructure and capacity to manage these conditions are better established) and also avoid wasted medicines
Reviewing the WHO Non-Communicable Diseases Kit (NCDK) content	Observations from previous and current WHO-NCDK evidence demonstrated a need to review its content and modular design. It is suggested to be flexible about the specific items to be included, as well as their quantities, strengths and dosage forms as required locally. It would be ideal to organise the WHO-NCDK items by level of service delivery, regional NCD burden, and by considering the capacity and training of HCWs in each service delivery level in accordance with local practices and guidance followed
Reframing the WHO-NCDK contents into further subcategories	The WHO-NCDK modules could be reframed by separating out medicines and supplies into further subcategories by the NCD type, for example, cardiovascular disease submodule. Considerations for a minimum package of essential mental health services at PHC level should also be made and rolled with comprehensive training in the future
Capacity strengthening of healthcare workers (HCWs)	The past and present evaluations have revealed several gaps in NCD training; as such, trainings should be implemented before or concurrently with the deployment of the WHO-NCDK, including periodic refreshers to guarantee HCWs are comfortable and competent in using the kit. Solutions to improve local staff retention must be factored in policies to ensure revenue on the investment of organisational efforts around training
Ensuring the model of non-communicable disease (NCD) service integration is defined prior to the deployment of commodities	Establishing a separate NCD clinic is expected to improve the quality of services as health counselling, patient education and record-keeping practices are likely to be improved when provided systematically. Provision of up-to-date resources, materials and guidance to facilitate patient awareness
Improving patient registries and records	Improving registries, patient records including good documentation practices to record disease biomarkers (patient tracking systems) to enable assessment of patient outcomes. Systems for capturing real-world evidence through health information and patient record systems are highly recommended to further explore the kit effectiveness from patient perspectives; to further understand the social circumstances, environmental and physical influences, behaviours and the quality of medical care provided
Ensuring quality of service delivery	When deploying the WHO-NCDK, it is crucial to ensure availability of guidelines and protocols adopted to the local context, with systematic, aligned M&E procedures to evaluate patient outcomes
Development of an essential medicine list for NCDs at the PHC level	To facilitate the transition into normal supply chain channels in the future, the establishment of an essential medicine list for NCDs at the PHC level with connections to existing national guidance and training is strongly recommended
Ensuring the continuity of relevant COVID-19 adaptations	Strategies that were used to modify/adapt care during the COVID-19 pandemic to ensure continuity of care when services were interrupted must be maintained. It is important to sustain and not abandon some of these adaptations, such as remote consultations and follow-ups, triaging to improve safety of care for patients, prescribing practices and the expanded role of community health workers

IEHK, Interagency Emergency Health Kit; PHC, primary healthcare.