The Utilization of Health Service Provisions for Noncommunicable Diseases in South Asian Countries: A Systematic Review

Background Despite strengthening health systems for noncommunicable diseases (NCDs) in South Asia, low healthcare utilization (HCU) and unequal access to services remain challenges. We conducted a systematic review to explore factors affecting HCU for major NCDs (cardiovascular disease, diabetes, chronic obstructive pulmonary disease) in South Asia. We examined both service availability (supply‐side) and patients’ willingness and ability to use services (demand‐side). Additionally, we investigated the overall prevalence of HCU and the distribution between public and private healthcare systems. Method Our review included English language studies published between 2016 and August 31st, 2023, identified through a systematic search of PubMed, CINAHL Ultimate, Scopus, and Web of Science databases. We employed a combination of Joanna Briggs Institute’s convergent integrated approach, framework synthesis, and “synthesis without meta‐analysis” (SWiM) to synthesize the evidence. Result A total of 8297 articles were identified, of which 81 met the inclusion criteria. Findings showed that the top three frequently reported supply‐side determinants of HCU were wait times, quality of patient engagement with healthcare providers, and direct costs related to healthcare visits. Financial limitations, healthcare center proximity, and educational qualification emerged as the top three frequently reported demand‐side determinants of HCU among patients with NCDs. Across South Asian countries, the prevalence of HCU for NCDs varied widely. In outpatient departments, HCU ranged from 21.9% to 93.7%, while inpatient departments saw a range of 0%–61.7%. Public health facilities showed HCU prevalence between 6.9% and 69.0%, while private facilities ranged from 21.6% to 87.5%. Conclusion This review highlights the need for further research on HCU for NCDs in South Asia. This systematic review provides a foundation for researchers and policymakers to develop intervention strategies that strengthen healthcare systems for NCDs in South Asia.