Barriers and facilitators to integrating non-communicable disease care within primary healthcare systems in low-resource countries: a systematic review

BACKGROUND: Non-communicable diseases (NCDs) are a leading cause of mortality worldwide, disproportionately affecting low-resource countries. Integrating NCD care into primary healthcare (PHC) systems through a systems approach is critical for achieving universal health coverage. However, the barriers and facilitators to this integration in low-resource countries remain inadequately understood. OBJECTIVES: This systematic review explores the barriers and facilitators to integrating NCD care within PHC systems in low-resource countries, providing actionable insights to strengthen health systems and improve NCD care delivery. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted searching six databases, including PubMed, Scopus, Web of Science, Embase, EBSCOhost, and Cochrane Library, complemented by grey literature searches. Studies published from 2016 onward that examined the integration of NCD care into PHC systems using a systems approach were included. Data were synthesized thematically, and the quality of studies was assessed using established appraisal tools. RESULTS: A total of 23 studies met the inclusion criteria. Key barriers included insufficient healthcare workforce capacity, inadequate infrastructure, limited access to essential medicines, and fragmented governance. Patient-related challenges, such as low awareness and cultural barriers, further impeded integration. Facilitators included task shifting to community health workers, strong policy frameworks, financial incentives, health information systems and community engagement. CONCLUSIONS: Integrating NCD services into PHC systems in low-resource settings necessitates a comprehensive systems approach that addresses structural and contextual barriers while leveraging existing facilitators. Policy and programmatic efforts should focus on workforce training, infrastructure development, governance strengthening, and community-centered strategies. These findings provide a roadmap for advancing health system strengthening and achieving equitable NCD care delivery in low-resource settings.