Optimizing Intermittent Catheterization Following Spinal Cord Injury: A Narrative Review Using the WHO Health System...

This narrative review examines intermittent catheterization (IC) for individuals with spinal cord injury (SCI) from a health systems perspective. Although IC is considered the preferred standard of care for neurogenic bladder after SCI, its long-term effectiveness depends on healthcare systems' ability to provide integrated, sustainable, and patient-centered care. The review explores system-level challenges and strategies to optimize IC delivery using the World Health Organization (WHO) Health System Building Blocks framework.

A structured literature search was conducted across CINAHL, MEDLINE, PubMed, Scopus, ScienceDirect, and Google Scholar for studies published between January 2015 and June 2026. Relevant evidence addressing clinical outcomes, healthcare delivery, workforce capacity, access to catheter technologies, financing, and governance was synthesized using the WHO Health System Building Blocks framework. Key studies informing the review are summarized in Table 1.

Significant systemic barriers to effective IC implementation remain despite strong clinical evidence supporting its use. Key challenges included limited access to catheter supplies, inadequate workforce training, fragmented follow-up services, and inconsistent patient education. Across the reviewed literature, service delivery, workforce capacity, and access to essential technologies emerged as the most influential determinants of successful IC implementation and long-term adherence. The findings further indicated that successful IC delivery depends on the interaction and integration of multiple health system domains rather than any single component in isolation.

Optimizing IC outcomes in SCI requires stronger health systems that support coordinated, accessible, and sustainable care. Integrating IC services into broader health system strengthening initiatives may reduce preventable complications, improve quality of life (QoL), and support Sustainable Development Goal 3 (SDG 3) on health and well-being.