Table 2 Recommended changes in the proposed integrated model of care in prototype stage

1. Screening of population

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2. Supporting peripheral health care providers in self-management of the condition

(a) Community health workers will be trained for diagnosis and treatment in the community via hiring specialists

(a) Training to community health workers in tertiary-level settings rather than taking specialists to the community

(a) Rapport building between peripheral-level health care providers and specialists so that they can reach out to specialists very easily in need of any technical support required to manage the cases

(b) All screened COPD cases will be referred to a tertiary-level health facility

(b) Mild and moderate cases should be managed at the peripheral level (health post and PHC)

Only acute cases should be referred to the secondary or tertiary care

(b) There will be no burden of cases at secondary- and tertiary-level care

3. Establishing a referral pathway

(a) No Navigator concept was introduced

(b) No involvement in secondary care (district hospital)

(a) Patients expressed the need for a patient navigator who could assist them in navigating the services at both primary and secondary/tertiary care

(b) A referral can be done to the secondary- and tertiary-level hospital (district hospital). However, a facility for the respiratory disease at a district hospital was a limitation. Severe cases should be referred directly to tertiary level

(a) Navigators can help to book an appointment and provide accompany to needy ones in a doctor's visit

(b) Strengthening of district-level hospitals will benefit the patients in terms of travel cost and time while it would also distribute loads of patients both at secondary and tertiary hospitals

This will avoid the delay of receiving emergency health services by patients

4. Community-based care

(a) No involvement of Local elected representatives and other stakeholders like the department of education, agriculture, transport, industry, media, and youth clubs

(a) Involvement of locally elected representatives and other stakeholders like the department of education, agriculture, youth clubs, who could play a valuable role in making health promotion and prevention activities like awareness on COPD, health education at school, street drama and community forums to tackle social issues at the community level. Furthermore, the department of education, agriculture, transport, and industry will develop

 Strategy to reduce pollutants from industry, transport, and agriculture

 Legislation to allow local authorities to improve air quality

 Strategy to create a supportive environment for physical exercise and meditations

(a) Awareness of COPD and tackling social issues as local leaders have social and influential power to promote change.

Meaningful engagement of different stakeholders and their interests can speed up the decision-making process, which will help to pursue purpose

Perhaps, most importantly, the local government will prioritize and address the issues of people as a whole