The fight of a lifetime: Health systems and chronic diseases
Note to our readers: This is a re-posting that first appeared in Health Affairs Blog
Here is something you don’t see too often: a room full of delegates at the World Health Organization (WHO), taking a break from discussions to practice Tai Chi. But so went proceedings at the First Global Meeting of National NCD Program Directors and Managers. The event was the first true opportunity for countries to come together and share their progress in preparation for the third High-level Meeting of the United Nations General Assembly on Non-communicable Diseases (NCDs) in 2018.
NCDs, also covered in a recent issue of Health Affairs, include illnesses such as cancer, chronic respiratory diseases, cardiovascular diseases, and diabetes, and kill up to 40 million people each year. A disproportionate amount of premature death from NCDs occurs in low-and middle-income countries (LMICs), shining a spotlight on the challenges faced by insufficiently equipped and resourced health systems.
As shown by the Tai Chi sessions in the WHO Executive Board room, physical activity and other preventative measures are critical to reducing the global prevalence of NCDs in the future. To meet the challenge of NCDs today, we must also address the lack of capacity of health systems in LMICs. As each country puts in place its own NCD programs, myself and my colleagues at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) can point to three concrete steps for building health system capacity in a substantial and sustainable manner.
- Integration and continuity of care for NCDs at the primary care level and training of health care providers
- Promotion of regulatory system strengthening
- Collection, analysis, and dissemination of relevant data
Supporting healthcare systems from their foundations
In a Johns Hopkins University report focusing on primary care, Margaret Kruk and colleagues highlight that “primary care, as the level of care provision closest to the patient and the community and focused on the whole patient rather than a single organ or disease, has a starring role in the fight against NCDs.” What if all primary health care providers were able to identify symptoms of diabetes, thereby avoiding future complications like loss of vision and amputation?
National NCDs programs need to look at addressing these diseases across the continuum of care, including risk factors, promoting adherence to treatment, and identifying co-morbidities. Implementing these strategies at the primary care level—the first port of call for people seeking health care—means reaching as many people as possible, expanding access to care in rural areas, and tailoring approaches to a specific environment.
In this endeavor, our sector finds the fusion of the public and the private to be a vital strategy — one that strikes a more optimistic note than if all sectors were to function in isolation. This is why IFPMA and its members are engaged in a number of health partnerships to strengthen health care at the primary care level and improve the training of health care workers at all levels.
Examples of these partnerships include an ongoing education program that has seen Project HOPE and Pfizer support the training of over 20,000 physicians in Egypt. Similarly, a program of the Chinese government and Bayer Healthcare active since 2007 to train local physicians across rural China so that they can address health challenges in their communities.
Regional cooperation and regulatory convergence
As stated by WHO Director-General Margaret Chan, “the UN General Assembly… found no lack of high-level government commitment to NCDs. But it witnessed, in far too many countries, a lack of capacity to act, largely because of insufficient national expertise in low- and middle-income countries.”
Another area where the need for increased capacity to act is clear is in ensuring the right regulatory and supply chain environments to provide patients with quality treatments. What if governments in different regions of the world were able to streamline the approval of medicines — so that a medicine proved safe and efficacious in Ghana could be immediately used by patients in need in Senegal?
To this end, our sector supports a number of initiatives towards regional cooperation and regulatory convergence. Last year, IFPMA hosted together with partners regulatory conferences in Africa and Asia to accelerate access to quality medicines in the region.
The data that informs the countdown to NCD targets
Results from national NCD programs will feed into a reporting system to the UN General Assembly, which five years ago set the mandate for national governments to collaborate in a global effort against NCDs. To ground high-level discussions in country realities, there is the need for improved information and surveillance systems.
NCDs are chronic diseases; as such, they require monitoring and attention for years on end, even over the course of a lifetime. What if every Ministry of Health had enough data to know which interventions were the most effective in their fight against NCDs, and what interventions could be used by other governments seeking solutions?
We see that the NCD problem is urgent, but today in many countries the supporting evidence is patchy. This is why our sector supports national governments in the collection, analysis, and dissemination of relevant data. For example, the IFPMA – PAHO Foundation partnership, launched in 2014 to assist selected countries with cancer data quality assurance, statistical analysis, and presentation of a national cancer report to inform national cancer control plans.
Something that the WHO conference has made clear is that though each country requires an approach to reducing NCDs tailored to its existing health system, as well as its geography, culture, and demographics, we have a lot to learn from each other. The conference’s innovative format—with networking sessions and interactive “work stations” to discuss themes from prevention and financing to good governance—sought solutions to the NCDs problem from all the angles. The takeaway: it is only through coherent and aligned policies and practices across countries and across sectors that we will be able to move the needle on NCDs.
As medicine and vaccine innovators, our first is role to create better health solutions through treatments. But we are aware that medicines and vaccines alone cannot solve the NCD puzzle. There is the fundamental need for health care systems and health care workers to be adequately resourced, equipped, and trained. Guided by our Framework for Action for the Prevention and Control of NCDs, IFPMA and its member companies are engaged in over 70 health partnerships with other sectors, supporting LMICs to build up their capacity to fight NCDs.
Collaborative approaches that enable people across sectors to work towards a common goal can truly transform the health of a community.
The Emthonjeni Community Centre is situated in South Africa, run by Project HOPE with support from the Lilly NCD Partnership. Patients coming to the clinic have been screened in the community and referred to the clinic because they have NCDs like hypertension and type 2 diabetes.
©Health Affairs, March 2016