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

8 The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa
Both NCDs and RTIs are receiving global attention.
The United Nations (UN) High-level meeting
on NCD Prevention and Control in September 2011
was only the second time that disease has been highlighted
in this way, the first being AIDS a decade
earlier [8]. The year 2011 also marked the beginning
of the UN Decade of Action for Road Safety 2011-
2020 [4]. At the World Health Assembly in May
2012, Member States agreed to adopt a global target
of “25 by 25” – for a 25 percent reduction in premature
mortality 2 from NCDs by 2025 [9]. They also
placed a new Global Action Plan and Monitoring
Framework for NCDs under consideration [10-11].
NCDs and RTIs are largely preventable causes of
premature mortality and morbidity and a package
of cost-effective measures has been identified [12-
13]. It has been estimated that implementing a core
package of ‘best buys’ for NCDs would cost less than
US$1 per day in low-income countries, and less than
US$3 per day in middle-income countries – with
three dollars expected in return for every dollar invested
in NCDs [14]. Achieving a 50 percent reduction
in RTI fatalities in Africa by 2020 would save an
estimated one million lives and 10 million serious
injuries, with an estimated social benefit of around
US$340 billion [15].
NCDs and RTIs are a hidden yet growing health
challenge for Africa. The report aims for a broader
understanding of NCDs and RTIs within Africa’s
health and development context, and explores
shared drivers and potential integrated solutions. It
essentially seeks to answer four questions:
(1) How is the growing burden of NCDs and RTIs
changing the epidemiology of SSA?
(2) What determines and drives this burden, and
what are the commonalities with communicable
diseases?
(3) What is the rationale for public intervention?
(4) How could resource-constrained governments
approach NCD prevention and treatment and
road safety in a comprehensive, effective, and
efficient way?
2 ‘Premature mortality’ in this context refers to mortality between the
ages of 30 and 70 years of age due to cardiovascular disease, cancer,
diabetes or chronic respiratory disease.
The challenge presents risks for an already resource-constrained
situation: how to respond in a
way that does not further deepen any divide between
communicable and NCDs, or add new vertical programs
that are potentially in competition for scarce
resources, but which instead could capitalize on the
commonalities among disease groups, in causation,
co-morbidity, and care.
Development is multi-dimensional – social, economic,
environmental – and the challenges, and
their solutions, are interlinked [6]. To sustain and
increase growth in an inclusive and equitable way,
Africa’s governments need to adopt long-term development
strategies, increasing investments in
high-quality education, health, and infrastructure.
To the same end, they must find ways of addressing
the threat posed by NCDs and RTIs which build on
existing resources and experience and take account
of the many commonalities between communicable
diseases, NCDs, maternal and child health, and development.
This report is not a World Bank policy paper nor
is it an academic review of the literature. Instead,
it seeks to stimulate new ways of thinking and approaches
to health and development, specifically to
tackling NCDs and RTIs, within the context of SSA.
It is grounded in evidence and in practical experience,
drawing upon a broad and extensive review of
the data and literature and benefitting from the insights
and experience of policymakers, analysts, and
managers in the field. 3
While the report is comprehensive, it is intentionally
not prescriptive. It systematically considers a
range of functions (prevention, treatment, care) and
systems that cut across disease categories to highlight
what can be done. To find what has been done
and works, it harvests from evidence and examples
from within and beyond SSA. It deliberately stops
short of advocating what countries should do in the
belief that more tailored, country-led approaches
need to follow that take account of individual country
need, capacity, and context.
The report is intended for policymakers and technical
staff at the national and international level,
3 See Acknowledgements section, for list of experts consulted.