Pan American Health Organization · 2020
Snapshot survey of NCD service disruption across 28 American countries during May 2020 for health programme managers.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- National NCD programme managers, health service planners, clinicians and public health professionals
- Evidence
- Rapid survey of 28 PAHO Member States, May–June 2020
- Reviewed
- 21 Oct 2026 · GMJ
What this guideline says
GMJ summary
This rapid assessment, conducted 1 May–1 June 2020, surveyed 28 (80%) of PAHO Member States to document the impact of COVID-19 on noncommunicable disease (NCD) services when the Americas were the global pandemic epicentre. An estimated 220 million people in the Americas live with at least one NCD, requiring continuous care, yet this population faces heightened COVID-19 severity and mortality risk whilst health resources are diverted to pandemic response.
The survey found that 89% of countries reassigned some or all NCD staff to COVID-19 efforts (full-time or part-time), whilst NCD budgets were largely preserved. NCD outpatient services remained open but with limited access in 64% of countries; services for diabetes, dental care, and rehabilitation were most disrupted. Main disruption causes were elective care cancellation (58%), staff reallocation (50%), and patients not presenting (50%). Countries mitigated disruption through patient triage (70%), telemedicine (61%), and novel medicine dispensing strategies (57%).
Planned NCD activities were widely postponed: 57% of countries suspended NCD surveys, 43% halted screening programmes for cancer and diabetes, and 29% paused WHO HEARTS implementation. While 68% of countries included NCDs in national COVID-19 plans and 89% collected data on NCD comorbidities in COVID-19 patients, gaps remained in surveillance, telemedicine infrastructure, and continuity-of-care strategies for future health emergencies.
Key points
For clinicians — doses and thresholds as stated in the guideline
- An estimated 220 million people (one in four) in the Americas live with at least one NCD, requiring continuous essential services during the pandemic
- In 89% of countries (25/28), some or all NCD staff were reassigned to COVID-19 response either full-time or part-time, reducing personnel available for NCD management
- NCD outpatient services remained open but with limited access in 64% of countries (18/28), completely open in 25% (7/28), and closed in only two countries
- Services most disrupted were diabetes care, dental care, and rehabilitation services; main causes were elective care cancellation (58%), clinical staff reallocation (50%), and patients not presenting (50%)
- Countries maintained essential NCD services through patient triage and severity-based prioritisation (70%, 16/23), telemedicine consultations (61%, 14/23), and novel dispensing strategies for NCD medicines (57%, 13/23)
- NCD surveys were postponed in 57% of countries (16/28), public screening programmes for cancer and diabetes in 43% (12/28), and WHO HEARTS implementation in 29% (8/28)
- NCDs were included in national COVID-19 response plans in 68% of countries (19/28), with six countries reporting no inclusion; 89% (24/27) collected data on NCD comorbidities in COVID-19 patients
- NCD budgets were largely preserved, with only one country reallocating more than 50% of NCD funds to COVID-19 response
Strategies used to maintain essential NCD services during COVID-19
Table extracted from the guideline
| Strategy | Percentage of countries | Number of countries |
|---|---|---|
| Triage patients and prioritise care based on severity | 70% | 16/23 |
| Telemedicine to replace in-person consultations | 61% | 14/23 |
| Novel dispensing for NCD medicines | 57% | 13/23 |
| Redirect patients to alternate locations | 52% | 12/23 |
| Task shift | 35% | 8/23 |
| Other strategies | 5% | 1/23 |
Source: Pan American Health Organization, Rapid Assessment of service delivery for NCDs during the COVID-19 pandemic in the Americas. Reproduced in summary form.
From the guideline
Verbatim
“Almost all countries (89%, 25/28 countries) reported that some or all NCD staff are supporting COVID-19 efforts either full time or part time.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively on health systems resilience in the WHO European Region, I find this assessment particularly instructive for Georgia and neighbouring countries where NCDs account for over 90% of mortality yet pandemic preparedness often overlooks chronic disease continuity. The finding that 68% of countries included NCDs in COVID-19 plans whilst 89% reassigned NCD staff highlights a critical implementation gap we observed across Eastern Europe during 2020. For Georgian clinicians, I would emphasise the evidence that telemedicine (adopted by 61% of countries) and multi-month medicine dispensing successfully maintained care whilst reducing infection exposure—strategies we later formalised in our national programmes. The realistic caveat is that whilst this assessment validates these approaches, their effectiveness depends on pre-existing digital infrastructure, patient registries, and pharmaceutical supply chain flexibility that require investment before the next emergency, not during it.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and South Caucasus countries, this assessment provides a validated framework for monitoring NCD service continuity during health emergencies, directly applicable to national UHC programmes that include NCD management. Georgia’s established digital health infrastructure and telemedicine platforms developed since 2013 position the country well to implement the mitigation strategies identified (patient triage, remote consultations, novel medicine dispensing). National NCD programmes should prioritise: formal inclusion of NCDs in pandemic preparedness plans; standardised surveillance of NCD comorbidities in infectious disease outbreaks; training primary care staff in telemedicine protocols; and establishing multi-month medicine dispensing systems to reduce clinic visits. The finding that staff reassignment (89% of countries) was the primary disruption factor underscores the need for surge capacity planning that protects essential NCD services, particularly relevant for countries with high NCD burden and limited health workforce density in the region.
Questions this guideline answers
Quick answers
What proportion of NCD staff were reassigned to COVID-19 response in the Americas?
In 89% of countries (25/28), some or all NCD staff were reassigned to COVID-19 efforts. Specifically: 36% had some staff partially reassigned, 32% had all staff partially reassigned, 21% had some staff reassigned full-time, and 7% had all staff reassigned full-time. Only one country reported no reassignment.
Which NCD services were most frequently disrupted during the pandemic?
Services for diabetes, dental care, and rehabilitation were most commonly disrupted. Among planned activities, NCD surveys were postponed in 57% of countries, public screening programmes for cancer and diabetes in 43%, and WHO HEARTS implementation in 29%.
What strategies were most effective for maintaining NCD services during COVID-19?
The most common strategies were: triaging patients and prioritising care based on severity of condition (70% of countries), telemedicine to replace in-person consultations (61%), novel dispensing strategies for NCD medicines (57%), and redirecting patients to alternate locations (52%).
Were NCDs included in national COVID-19 response plans across the Americas?
NCDs were included in national COVID-19 plans in 68% of countries (19/28). Six countries reported not having NCDs included in their COVID-19 response plan, primarily from Mesoamerica, South America, and the Non-Latin Caribbean. Countries in South America and the Non-Latin Caribbean were more likely to include NCD services in their plans.
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Quality & accreditation
Other guidelines on this topic
- Checklist for the Management of Human Resources for Health in Response to COVID-19
- Infection prevention and control practices for care of patients in nontraditional settings with focus to the novel coronavirus (COVID-19)
- Maintaining Essential Services for People Living with Noncommunicable Diseases during COVID-19
- Post-authorization Surveillance of Medical Products during a Pandemic Emergency
- Retrofit Measures for COVID-19
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Audience
- National NCD programme managers, health service planners, clinicians and public health professionals
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Rapid survey of 28 PAHO Member States, May–June 2020
- Record history
- Created 21 Oct 2026 · updated 21 Oct 2026 · next check Apr 2027
Pan American Health Organization. Rapid Assessment of service delivery for NCDs during the COVID-19 pandemic in the Americas, 4 June 2020. Washington, D.C.: PAHO; 2020. (PAHO/NMH/NV/COVID-19/20-0024).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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