Integrating noncommunicable disease care in a public primary health care facility in North Lebanon: A qualitative study of implementation in a humanitarian crisis

Integrated care for non-communicable diseases (NCDs) may enhance care delivery, clinical impact, user-satisfaction, and access. However, evidence on integrated NCD care in humanitarian settings remains scarce. This qualitative study accompanied the first year of implementation (March 2023 to March 2024) of an integrated care programme at an International Committee of the Red Cross (ICRC)-supported, Ministry of Public Health-affiliated primary healthcare centre (PHC) in North Lebanon. A preceding theory of change (TOC) workshop on combining NCD PHC, mental health and psychosocial support (MPHSS), and rehabilitation services, identified two interdependent pathways to integrated NCD care: the multidisciplinary service pathway and the patient/family support pathway. The REAIM PRISM implementation science framework guided the study design, analysis and reporting. We interviewed service users and ICRC/PHC staff and analysed interview data alongside programme documentation using a joint thematic and constructive grounded theory approach. Overall, integrated care was feasible despite contextual challenges, including economic crisis, job losses, regional tensions, and insufficient NCD financing. A key overarching theme emerged: staff-related human values, motivation, and work ethic driving action amid personal and professional adversity. Implementation narratives described assimilating new processes, adapting to contextual challenges, and resolving process-oriented problems. In the first year, interventions under the TOC's multidisciplinary pathway-such as training, streamlined processes, and improved data systems-were prioritized, notably incorporating MHPSS and diabetic foot screening, while interventions in the patient empowerment pathway were not yet implemented. PHC NCD care remained the entry point for integrated care with unidirectional referrals to collocated services. Most service users reported no change in their clinic experience; however, many positively noted improvements in programme quality, respect, and trust. Limited awareness or demand for MHPSS services was observed. Strengthening bidirectional referrals, multidisciplinary meetings, patient and caregiver empowerment, and promotion of self-care may address unmet needs and promote uptake of MHPSS and rehabilitation services.