Redesigning primary care to tackle the global epidemic of noncommunicable disease

Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low-andmiddle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity.

Yet the health systems of low-andmiddle-income countries, historically oriented to infectious disease and often severely underfunded, are poorlypreparedforthe challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease.

We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resourceconstrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.