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

5. A COMPREHENSIVE, INTEGRATED
APPROACH TO NCDs AND ROAD SAFETY
In this section, the elements of a comprehensive approach
to NCD and road safety control are considered.
It draws on the available literature, and explores
the potential for adopting shared approaches with
other conditions. The section covers the following:
• Policy approaches
• Population-level prevention
• Individual-level prevention
• Therapies – treatment, care, and rehabilitation
• Strengthening health systems
• Addressing information and health gaps
• The role of public and private employers and businesses.
5.1. Policy Approach
Improving Commitment and Response
An important starting point for action is clear government
acknowledgement of the problem and
commitment to address the issue [179]. There is evidence
of a renewed effort across Africa and within
countries to strengthen action on NCDs [54, 180-
182] since the initial commitments made during
the previous decade [53-54, 183-184]; this has not
necessarily been translated into policy or action at
country level [64, 185-186], however, and some policies
have had only mixed results or been weakened
[187-188]. On road safety, several global reports
and the Decade of Action for Road Safety [59-60,
117, 189] appear to have revitalized Africa-wide interest
with the resulting Accra Declaration in 2007
[190], a set of targets in 2009, and an African Road
Safety Plan of Action in 2011 [15, 191]. While some
progress has been made and positive examples have
emerged from some countries [181, 192-193], there
appears to be much still to do: by 2013, only 12 SSA
countries were reported as having national strategies
that set targets for reducing road deaths and injuries,
for example.
Given the range of risk factors and determinants
of NCDs and RTIs, multiple stakeholders from different
sectors within and outside government have
a contribution to make in prevention and control –
health, welfare, transport, environment, education,
agriculture, trade, urban planning, the private sector,
Civil Society Organizations (CSOs)/Non-Governmental
Organizations (NGOs), and victims of
disease and/or injury. With respect to road safety,
ministries of the interior, traffic police, transport,
education, health, emergency services as well as
private sector enterprises such as alcohol, car, and
health insurance industries need to work together.
A cross-governmental task force, steering group, or
coordinating committee of multiple stakeholders
can help achieve the broad perspective required,
but needs sufficient convening and decision-making
power to promote participation, commit resources,
and design a plan of action.
Ministries of health and public health professionals
have an important leadership role to play, but
critical mass is low, with departments understaffed,
and there are few qualified public health professionals:
over half (55 percent) of African countries, particularly
in Lusophone and Francophone areas, do
not have any postgraduate public health programme
[194]. Public health agencies or institutes can make a
critical contribution by providing technical evidence
to health authorities for decision making, and in
monitoring and evaluating NCD-related programs,
projects, and interventions, but these are not present
in all countries: the International Association
of National Public Health Institutes has members
from only 15 SSA countries. Where public health
institutes do exist, they may have had a strong focus
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