Association Between the WHO Package of Essential Non-Communicable Disease Interventions and Clinical Outcomes Among Patients With Hypertension and Diabetes in Palestine: A Comparative Cross-Sectional Study.

Background and Aims: Non-communicable diseases (NCDs), particularly hypertension and type 2 diabetes mellitus, represent a major public health burden in Palestine. The World Health Organization's Package of Essential Non-Communicable Disease Interventions (PEN) was introduced to strengthen primary healthcare services in low-resource settings. However, evidence on its association with patient-level clinical outcomes in Palestine remains limited. This study aimed to assess the association between PEN implementation and clinical outcomes, including blood pressure, glycemic control, and disease-related complications. Methods: A comparative cross-sectional study was conducted across 18 primary healthcare clinics in Hebron, Palestine, between February and May 2025. A total of 440 patients (220 receiving PEN-based care and 220 receiving conventional care) were recruited using convenience sampling. Data were collected through structured questionnaires and clinical records. Bivariate analyses were performed using Mann-Whitney Results: Patients receiving PEN-based care had lower systolic blood pressure (mean difference -2.93 mmHg; Conclusion: The PEN approach was associated with modest improvements in clinical outcomes, reduced complications, and enhanced healthcare utilization among patients with hypertension and diabetes in primary care settings. However, given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Further longitudinal and experimental studies are required to confirm these findings and evaluate long-term impact.