Challenges and opportunities of integrating noncommunicable disease prevention into maternal health services: A qualitative study

Pregnancy provides an opportunity to assess women's health needs and engage them in appropriate healthcare services. This study explored how noncommunicable disease (NCD) prevention has been integrated into maternal health services in Vietnam and identified the barriers and facilitators influencing this process. We conducted in-depth interviews with 30 stakeholders, including policymakers, health managers, and providers in maternal healthcare services across different levels of care. Data were analyzed thematically using a conceptual framework. Recurring themes were identified and refined through discussions among investigators and technical advisors. Integrated NCD prevention and screening services were available before, during, and after pregnancy, particularly at higher-level public and private facilities, although mental health services remained limited. Limited primary healthcare capacity for maternal health and NCD prevention contributed to greater reliance on higher-level and private facilities. Most services packages relied on out-of-pocket payments rather than social health insurance coverage. Participants also identified gaps in service quality assurance, including counseling and continuity of care for women with NCDs, which may lead to inefficient service utilization and increased healthcare costs. NCD prevention services were integrated into maternal healthcare primarily at higher-level public and private facilities, whereas mental health care remained limited. Reliance on out-of-pocket payments, limited primary health care capacity, and gaps in continuity and quality of care may influence NCD prevention utilization and healthcare costs.