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

34 The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa
4.3. Development Rationale
The rising burden of NCDs threatens to reverse the
gains already made on MDGs, especially those relating
to poverty, education, and child and maternal
health [129, 168-169]. There are many examples of
links between NCDs, child mortality, and infectious
diseases and the general well-being of households:
illness can reduce household earnings and ability
to provide for and educate children; disability of
an adult may mean a child (probably a girl) staying
home from school to provide care; tobacco and alcohol
use-related illness, cost of health care, and death
of the main wage earner can propel a family into
poverty [163, 170].
There are co-benefits for health from actions to
address climate change, and vice versa; for example,
through increasing walking and cycling. An improved
understanding of the relationship between
NCDs, RTI, and climate change could enable improved
policy formulation to the common benefit of
these issues [171-172].
Developing policies for NCD prevention and control
requires a better understanding of the processes
and political economies of policy making in Africa,
in particular the relationships between national policy
making and international economic and political
pressures as well as the extent to which the health
MDGs and aid architecture supports (or not) an
NCD agenda for Africa [129, 173].
There has been a call for including NCDs in new
international development goals, especially given the
close associations among NCDs, infectious diseases,
and maternal and child health, and to encourage
some rethinking of the relative allocations of health
development assistance and delivery approaches
[161, 174]. Although funding to developing countries
for NCDs grew more than sixfold during the
period 2001-2008, it still comprised less than 3 percent
of overall, global development assistance for
health in 2007 – a similarly disproportionate, small
amount, relative to the NCD contribution to DALYs
[175]. This imbalance is highlighted in Table 7.
In order to re-position NCDs within health and
development agendas, a different approach and
view may be needed. It may be helpful to reframe
the debate at country level to emphasize the societal
(rather than individual) determinants of disease,
and the inter-relationship with poverty and
development [176]. Distribution of resources could
be made on the basis of avoidable mortality, health
effects, or broad care needs rather than disease or
category. For example, an analysis of Tanzanian
health data according to chronicity and mortality
found that for the majority of the population older
than five years, the burden of disease, irrespective of
etiology, would require a health system that could
provide long-term care and management [177].
Resources could be mobilized through an inclusive
approach that links closely with global health and
development agendas, allowing emerging strategic
and political opportunities to be seized and built
upon, with better coordination of efforts among
global actors [176-178].
Table 7: ODA Funding for Health and Disease Areas per 2008 DALY
2008 DALYs
LMIC (million)
Health Development
Assistance 2007
Funding per
DALY
HIV, TB, Malaria 264 US$6,315 million US$23.9
NCDs 646 US$503 million US$0.78
All conditions 1,338 US$22,013 million US$16.4
Source: [175]