The Challenge of Non-Communicable Diseases and Road Traffic ...

An Overview 5
disability from RTI can throw a family further into
poverty. Health systems are particularly challenged
by care of chronic conditions which require a complex
response over an extended time period. While
medicines, such as insulin for diabetes, are essential
in NCD prevention and treatment, their quality,
safety and effective use are not assured and they
make up a substantial part of the direct costs of care
for chronic diseases. Evidence shows that availability
may be worse for medicines for chronic diseases
than for acute diseases, and that under-funding,
poor planning, and inefficient procurement, supply,
storage and distribution systems within the public
sector may exacerbate the problem. Health service
delivery systems in low- and middle-income countries
(LMIC) are typically more suited to providing
episodic care for acute conditions; models for delivery
of care for chronic conditions may be unfamiliar
and hindered by shortcomings of the system.
Some of the potential solutions would benefit all
disease groups. Universal health coverage aims to
ensure that everyone has access to effective health
services when needed, without incurring financial
hardship; some countries have made significant
progress in developing financial systems towards
this goal. Shifting from originator medicines to generic
products could achieve substantial savings
without loss of quality, and a GAVI-like capacity at
the regional or global level could usefully negotiate,
make bulk purchases, and distribute vaccines, medicines
and test kits. A health care delivery system
that has been designed to decentralize and integrate
chronic care across health care provider boundaries
can span a spectrum of diseases with similar care
needs, assisted by simplified protocols and treatment
plans. Decision support tools for health-care
professionals can improve their adherence to guidelines,
standardized case management and patients’
outcomes. Performance-based funding can be used
to incentivize providers towards public health goals,
and more efficient use of resources with reductions
in waste, errors and corruption could help gain
‘more health for the money’. Innovative strategies to
expand health system capacity include ‘task-shifting’
in clinical settings so that appropriate tasks are delegated
to the lowest cadre of health worker with the
ability to perform the task effectively – and even to
people with the condition themselves. Finally, the
application of ICT in health (eHealth), for example
through telemedicine and distance learning, has
the potential to facilitate better health care delivery
in situations where health services and human resources
for health are scarce.
Some of these solutions have already been developed
or implemented by other disease groups, and
NCDs and RTIs can benefit from this work. For
example, many existing programs, such as TB control,
aim to strengthen primary care in low-resource
countries; there are opportunities for improvemed
NCD care to ‘piggy-back’ existing efforts, by integrating
services when an individual is seen by a
health worker. There is broad experience in implementing
chronic care models for HIV/AIDS in Africa,
and this may be transferable to NCDs. Systems
for communicable diseases can be adapted, and existing
health surveys and surveillance instruments
can be expanded to measure NCDs and their risk
factors. Rather than pursuing separate solutions,
therefore, there are opportunities for initiatives to
share resources and benefits.
(v) Revisit governance for health
Weak governance impedes work to improve health
systems effectiveness and health outcomes generally.
With the greater emphasis on prevention and the
recognition that many of the solutions for NCDs and
RTIs lie outside of the health sector, broad partnerships
across a range of sectors are needed. Political
will, active civil society organizations, and research
support are all significant contributors to success.
Furthermore, underlying social determinants such
as inequitable distribution of power, money and
other resources have implications for prevention and
care strategies, and both health and non-health sectors
have roles to play in addressing these. There is
an opportunity to revisit the roles and terms of reference
of Ministries of Health to allow them to play
an oversight role of coordinating actions from other
sectors to deliver health outcomes. There are encouraging
signs, for example with civil society organizations
emerging to hold governments to account, and
increased recognition that population health is not
the outcome of a single ministry but requires a wide
range of actors and a synergetic set of policies.