Table 1

List of adaptations and their examples*

AdaptationDescriptionExamples
Facility-level administrative and engineering controlsChanges were made in all five settings to the way staff were working: isolating persons from the hazard through organisational, physical and/or mechanical means.

  • Adapting waiting bays to ensure social distancing

  • Allocating more staff for NCD care

  • Expanding stable patient review periods—from 1 month to 2 months

  • Strengthening infection, prevention, control measures

  • Setting up contingency/preparedness plans

  • Provision of PPE to all staff

  • Avoid long waiting times for patients visiting clinics (spread clinic hours)

  • Designated areas/days for PLWNCDs

  • Activation of appointment systems

Triaging to identify prioritiesPatients were screened upon their first contact with the healthcare system in all five settings. The triaging process has helped to identify priorities, individuals who have suspected or confirmed COVID-19, and control the transmission.

  • Screening to identify PLWNCDs (patients with NCDs were identified as high-risk group)

  • NCD yellow cards (to protect clients with NCDs)

  • Placing a sustainable system with high index of suspicion

Changes in delivery of clinical careChanges to prescribing practices have played a pivotal role in all settings during the pandemic. It was shown that programmes have extended the validity of prescriptions issued from 1 month to 2 or 3 months for medication supply of patients with NCD (for stable patients). The frequency of NCD consultations was reduced for stable patients in order to prevent the local transmissions of COVID-19.

  • Allocating more staff for NCD care

  • Designated nurse

  • Working with referral hospitals to adjust follow-ups

  • Implementing telemedicine

  • Halting all non-medical emergency referrals to tertiary facilities

  • Extended prescriptions

Expanded scope of responsibility for existing community health workers (CHWs) networkThere is evidence from all five countries that CHWs are well positioned to play a key role in the community-level fight against the pandemic. The CHWs were required to perform pandemic-related activities and provide critical care services to bridge the gap between health facilities and patients with NCD.

  • Screening at community and health facility level

  • Public health information strategies were developed and adopted for PLWNCDs and their families

  • House visits (when permissions are granted)

  • Delivery of medications and other supplies

  • Mentoring individual patient compliance

  • Integrated outreaches

  • *Data included in this table were generated from FGDs and the online survey.

  • FGDs, focus group discussions; NCD, non-communicable disease; PLWNCDs, people living with NCDs; PPE, personal protective equipment.