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

An Overview 45
financing and external financing that is allocated
to specific interventions rather than to systems
strengthening [286].
Community-Based Interventions
The community, whether defined socially or spatially,
can be a good hub for health promotion in Africa, as
elsewhere [277]. Community-based demonstration
projects for CVD prevention have been shown to be
effective in achieving reduced rates of CVD and risk
factors, and given the common risk-factor approach
these have been expanded to focus to NCD prevention
[287-288]. The approach is based on low-cost lifestyle
modifications and community participation and is
generalizable, with the general principles the same regardless
of the degree of development of the country
[289-290]. Table 10 summarizes the main components
of a community-based intervention program.
Any demonstration project to pilot and evaluate
the approach in a country context should work
closely with national policy makers throughout, with
a view to scaling-up and country-wide dissemination.
Shifting from project to program and ensuring
sustainability can be challenging, requiring investment
in the skills and capacity of community-based
organizations and public health systems during a
phased transition [291].
A Focus on Determinants
Programs need to take into account social determinants
– the causes underlying causes – which influence
risk factors and behaviors; for example, gender
norms have implications for health prevention and
care strategies in Africa [130, 295]. The discussion
on burden of disease in Section 2 highlighted clear
variations in the risk factors between women and
men; thus policies, interventions, and monitoring of
impact need to be gender sensitive. Both the health
and non-health sectors have roles to play in improving
day-to-day living conditions and addressing
the inequitable distribution of power, money, and
resources so that people have greater health opportunities
[296]. Investing in early child development
and compulsory education at primary and secondary
levels can have strong returns, and comprehensive
and universal social protection strategies would
support a level of income for healthy living [128].
Helping people change their behaviors can be difficult,
and needs to take account of the challenges
that face people and understanding what motivates
and influences their behaviors and choices [297].
Successful NCD preventive interventions do make
it feasible for people, including those in poverty,
to adopt healthier lifestyles. Making the healthier
choice the easier choice can be achieved through the
TABLE 10: Components of a Community-Based Program for NCD Prevention
Diagnosis
Planning
Communication
Interventions
Health-Supporting
Environments
Evaluation
A good understanding of the community’s needs, practices, beliefs and priorities, developed in
close collaboration with the community itself
Carefully planned activities that take account of the community context, including primary health
care services, voluntary organizations, food shops, restaurants, work sites and schools, that link
with any existing strategies for identifying and targeting people at high risk, and which build
upon the existing skills and resources within the community
Messages and interactions to provide information and reinforce behavior change, using the most
effective channels (media, peer-to-peer, opinion leaders, and so forth)
Equipping practitioners with the necessary skills and competencies to carry out cost-effective
interventions, ensuring the community is exposed to an effective dose of the intervention
Working with community organizations and sectors such as education, transport, environment,
and spatial planning to help change social and physical environments to make them more healthsupporting
and conducive to health and healthy life-styles
Monitoring the change process and evaluating the interventions and program objectively and in
terms of the community’s perceptions, and including an economic component in the evaluation
where possible; disseminating results so that other communities can benefit
Source: Authors, adapted from [275, 292-294]