Annually, NCDs cause 41 million deaths 1. Despite efforts to alleviate NCDs, morbidity, and mortality data indicate a rising impact of NCDs in low-resource countries where 80% of deaths are due to cardiovascular diseases 1. NCDs have long-term effects further exacerbated by environmental, physical, behavioral, and genetic factors 1. In a low-income country like Uganda, the situation is particularly challenging. Overall, the prevalence of poor HRQoL in Central Uganda Luwero and Nakaseke Districts was estimated at 52% 2, a figure close to the national prevalence of 59.6% 3. Poor HRQoL exacerbates unhealthy days, limits activities, and elevates health symptoms among older persons with NCDs in these districts. This high prevalence may be linked to the substantial burden of NCDs among older persons in Central Uganda, reported at 28.5% 45. NCDs were included in PHC to foster mechanisms for better management and control of chronic diseases 4.

Health-related quality of life has been a crucial focus in public health over the last decade. HRQoL is a significant prognostic predictor used to measure and identify health problems related to physical and mental well-being dysfunctions. 6 Literature shows that older persons live longer due to increased life expectancy. However, they face enormous chronic conditions. The World Health Organization (WHO) defined HRQoL as an individual’s perception of their position in life within the context of their culture, and value systems in which they live and to their goals, expectations, standards, and concerns. Additionally, HRQoL has been conceptualized as a global tool to assess the impact of health conditions 7 and is frequently used to measure the well-being of individuals especially older persons 8. Literature indicates that HRQoL is a global phenomenon that warrants further exploration to facilitate the inauguration of mechanisms to improve older persons’ well-being 9. Assessing the HRQoL of older persons with NCDs is crucial as NCDs pose a global challenge, responsible for 63% of deaths worldwide 1. Primary health care services (PHCs) play a pivotal role in the early diagnosis, prevention, and management of NCDs and the improvement of the HRQoL of older persons globally 10. Ensuring responsive PHCs enhances accessibility, improves patient utilization and retention rates, and promotes equitable access to service delivery 11. Despite multiple studies showing the influence of PHC services on HRQoL, studies among older persons are scarce. The current study conducted a narrative literature review to ascertain the effect of PHC services on HRQoL among older persons with NCDs, providing evidence-based information to inform policy review and implementation.

The narrative review found effective PHC services to be linked to HRQoL. However, the HRQoL of older persons accessing PHC services in low- and middle-income countries was sub-optimal. Similar findings were observed 2021, where effective PHC services in both developed and developing countries were found to be associated with enhanced healthcare services and better health outcomes 22. Inadequate access to healthcare services, although previously more common in high-middle -income countries, is now increasingly affecting LMICs 21. The literature underscores the need for a collaborative approach in PHC services to enhance community access to appropriate healthcare. Along these lines, 23 posits that effective delivery of PHC services can lead to improvement in the HRQoL. However, the primary healthcare system is currently unprepared to manage the increasing burden of NCDs, as highlighted by other research findings 24. Further, a closely related study 25 observed that an independent association between PHC score and the mental health component of HRQoL exists, and an inverse association with the physical component was observed. However, the study 26 centered on comparing tools for measuring the physical and mental outcomes of the patients that influence their HRQoL.

An analysis of the effectiveness of the PHC system shows that a weak PHC system exposes older persons to poor health and increased mortality 14. Conversely, other closely related studies found that effective PHC services resulted in desirable outcomes, with improvements across all domains of HRQoL 272829. Despite improvements in HRQoL in the previous studies, Woo’s study revealed an interesting aspect: many older persons were not sure if they were taking their medications correctly 29, which raises patient safety issues that require urgent attention. A study done in India found that preparedness for comprehensive PHC care, including prevention, diagnostic interventions, treatment, and rehabilitative care for NCD patients, is sub-optimal due to critical gaps in the healthcare setting 30. This finding aligns with Baum's research, which found that a comprehensive PHC approach encompassing a wide range of health services and activities—from preventive, curative, promotional, and rehabilitative care—positively influences community health outcomes 31.

Specifically, Baum reported that effective PHC services enhance the rehabilitation of patients who suffer complications from NCDs, hence promoting HRQoL 31. Similarly, the study "Strengthening Primary Healthcare Services to Help Prevent and Control Long-term ^Chronic NCDs" confirms that a comprehensive primary healthcare strategy has been identified as an effective approach for reducing health inequities and improving community well-being 21. It emphasizes that the prevention of NCDs is possible through a primary healthcare approach, but only with strong intersectoral collaboration. This approach also enhances community access to appropriate healthcare, promoting health equity and improving HRQoL 21.

The major challenge with PHC services is identifying individuals with palliative care needs and the actual provision of palliative care itself 19. The WHO report reinforces this point, showing that 64% of the studies, including their scoping review, indicated challenges in rehabilitative care referrals by clinicians or primary healthcare workers 19. Another study revealed a discrepancy in findings, showing that despite a lack of trained workforce and adequate funds, physicians in Myanmar still provide palliative care to patients despite these challenges 32. Overall, the effectiveness of PHC services in countries like India and Sri Lanka can be attributed to better healthcare service provision and equitable access to healthcare compared to other developing countries where access to PHC services is suboptimal.

This study was a narrative literature review which has some limitations. Unlike systematic reviews, narrative reviews are more susceptible to reporting bias. However, the narrative review approach was chosen for its ability to provide comprehensive, evidence-based insights into PHC services and HRQoL, and has the potential to aid in the development of theoretical frameworks. To mitigate bias, a structured review process protocol was followed, and careful attention was given to the quality of the included articles.

Conclusively, the literature reviewed indicates that PHC services are inadequate in low-middle-income countries, and most studies have primarily focused in general on older persons, often overlooking older persons with NCDs. There is a significant knowledge gap in the provision of PHC services, making it difficult to predict their impact on HRQoL. There is a need for health policy reforms at PHC levels if the 2020 global healthy aging goal is to be met. More studies are needed to bridge the literature gap and enable better predictions of the influence of PHC services on HRQoL. Also, a methodological gap exists, as most studies included in the narrative literature review employed a cross-sectional study design and secondary data analysis (scoping review & systematic reviews) with only one study employing an RCT design and a mixed methods approach. Lastly, the literature review shows that most of the studies do not identify the specific nature and components of PHC services that contribute to the HRQoL of older persons, highlighting a need for further research.

All members actively contributed to the study. AF conceptualized the study and participated in writing, reviewing, methodology, literature search, and editing; FK participated in the review, writing, and methodology; FOM participated in editing, reviewing, and writing; and RCN participated in the editing, reviewing, and writing the manuscript.