Strengthening primary health care through integration of non-communicable disease services: Insights from the abundant health model in Vietnam

Vietnam is aging rapidly, leading to a substantial rise in morbidity and mortality associated with non-communicable diseases (NCDs). Despite the Government's 2015 NCD care and management guidelines, there was no practical implementation. From 2018 to 2020, the Abundant Health (AH) model was introduced to enhance the screening and management of hypertension and diabetes at community health stations (CHSs). This study explores the potential for scaling up this model to other provinces in Vietnam and identifying structural enabling factors and challenges based on the model's lessons learned.The study was conducted in five provinces of Vietnam, using a mixed methods approach of desk review, focus group discussions, key informant interviews, and a survey. Intervention feasibility and acceptability were evaluated using the framework developed by Gadke et al., with a scale of 5 points indicating the highest rating for upscaling the AH model. The sample comprised 164 healthcare providers, 5 group discussions, and 14 focus group discussions. The overall statistical value for Cronbach's alpha was 0.87, the factor analysis identified 4 factors, and the scale is appropriate for evaluation.The AH model received high average scores for relevance (4.25 over 3 items) and acceptability (4.24 over 4 items). However, feasibility (including suitability and affordability) obtained a lower score (3.65 over 7 items), with primary concerns regarding the availability of local funding for activities (3.04) and the adequacy of equipment and medicines at CHSs (3.08). Enabling factors for delivering quality NCD services at the primary level included strong government commitment to NCD management at the grassroots health level and high community demand for quality NCD management and continuum services. The most significant barriers identified were the scarcity of physicians at CHSs and high staff turnover.The AH model, which encompasses screening, management, and treatment of hypertension and diabetes at CHSs, has demonstrated feasibility and potential for upscaling in Vietnam. Moreover, this model can be adopted in other low- and middle-income countries.