Training of health staff will help eliminate diseases
Non-communicable diseases (NCDs) have emerged as the leading cause of death and disability worldwide. According to WHO, they kill 41 million people each year (71 per cent of all deaths) globally. Further, each year, over 15 million people die from NCDs between the ages of 30 and 69, with 85 per cent of the “premature” deaths occurring in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths (17.9 million people) annually, followed by cancers (9.3 million), respiratory diseases (4.1 million) and diabetes (1.5 million). The four account for over 80 per cent of all premature NCDs deaths. Tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets all increase the risk of dying from an NCD.
NCDs also threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing premature deaths from NCDs by a third by 2030. Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products and have limited access to quality health services.
Detection, screening and treatment, as well as palliative care, are key components of the response to NCDs. Unfortunately, health care facilities in Less Developed Countries are often lacking basic diagnostic tools. Some NCDs symptoms also manifest very late, making early diagnosis difficult. The inability to diagnose early or well enough means patients end up spending more and having complicated cases.
Lack of adequately trained primary care physicians, for delivering evidence-based care at primary care, is a major hurdle controlling the NCD epidemic. In addition, the number of specialists is also insufficient in Less Developed Countries due to limited training opportunities. There is, therefore, an urgent need to train primary care physicians in evidence-based NCD management to provide screening, diagnosis, management and follow-up services of uncomplicated cases at primary care.
Attention and investments from multiple stakeholders across several key areas—from awareness to prevention and diagnosis to treatment—are needed, as well as recognition of the existing gaps and imbalances.
As WHO recommends, the response to NCDs requires concerted action at the level of policy, health systems, community action and individual behaviours. Since the determinants of risk are driven by many social forces, a comprehensive policy response is necessary, involving several sectors.
Tobacco control, for example, requires higher taxes on all products, a ban on advertising, effective health warnings, and smoke-free public and workplaces. Promotion of healthy diets would need availability of fruit, vegetables and healthy oils at affordable prices and reduction of salt, sugar and saturated fats, in processed foods.
The role of capacity building of healthcare personnel cannot be overstated. A recent study published in the BMC Health Services Research Journal found that a large-scale capacity building intervention improved primary health care professionals’ knowledge, skills and clinical practice on NCD risk detection and reduction. The study is titled Capacity building of health care professionals to perform inter-professional management of non-communicable diseases in primary care.
Whereas the fight against NCDs calls for political commitment, this fight cannot be conducted in isolation. Like many other global development challenges, building strong health systems to tackle NCDs and achieving UHC will require a coordinated and sustained effort from all stakeholders.
— The writer is the Cluster Head, Novartis East Africa Cluster
