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

72 The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa
conditions, and NCDs; for example, evidence for
common causes; shared underlying social conditions;
interacting co-morbidities; as well as common
solutions such as vaccination, standardized
syndromic protocols, and care models. Many of
the measures needed for strengthening health systems
cut across disease categories, and there are
opportunities for NCDs and RTIs to benefit from
the lessons and initiatives of interventions for HIV/
AIDS, TB, and maternal health, for example, and
vice versa. Thus, the report concludes that there
is likely to be added value in capitalizing on the
shared challenges, drivers, and potential solutions
across the different disease categories, with broader
health-systems strengthening measures, and that
there is already evidence of this taking place and
being effective.
Globalization, rapid urbanization, population
growth, and ageing are contributing to the burden
of disease in SSA, as NCDs and RTIs emerge from
the shadows. The response to NCDs and RTIs in SSA
needs to avoid establishing yet another set of vertical
programs in competition for scarce resources.
As the evidence shows, divisions between disease
categories, or between so-called vertical and horizontal
programs, are to some extent artificial, and
may not be optimal for Africa at this stage of its
health development. Opportunities for integration
can arise out of synergies between targeted interventions,
necessity, or desirability [493]. Consideration
of NCDs and/or RTIs within broader development
initiatives could, for example, mean mitigating the
impact of road infrastructure, buildings, and urban
design on safe and active travel, by building in from
the start ways of keeping pedestrians and cyclists
safe and for managing speed. Or it could mean designing
programs to maximize benefit and minimize
harm in terms of NCD and RTI outcomes, such as
ensuring that infant feeding programs and conditional
cash transfer programs are not designed in
such a way that they worsen NCD outcomes.
It should also be possible to continue ongoing efforts
to strengthen health systems in ways that enable
the benefits to be shared – this report has included
examples of how improvements for NCD care can
‘piggy-back’ onto other existing efforts at little additional
cost, such as extending chronic care delivery
to span a spectrum of diseases with similar care
needs, or for palliative care to reach beyond AIDS,
or for demographic and other health surveys to be
expanded to incorporate measurement of NCDs and
their risk factors. Finally, there are a number of NCD
interventions that are not only cost-effective but also
potentially resource-generating and beneficial for
dealing with other diseases, such as putting in place
and enforcing a strong regulatory and fiscal framework
for tobacco and alcohol including the raising
of prices. In making this happen, and facilitating it,
there are roles not just for politicians and policymakers
within countries but also at the regional and
international level. There is also work for researchers
in furthering the evidence base on the integration of
health programs, the integration of health concerns
into other development interventions, and in different
country contexts.
In conclusion, it should be clear that controlling
NCDs and RTIs are key public health issues in Africa.
Ensuring an effective response, however, is a particularly
difficult challenge in countries facing a double
or triple burden of disease with a low national income
level and weak health care systems. As argued
here, and fully consistent with the health improvement
and poverty alleviation objectives of World
Bank work in the health sector [494-495], efforts to
address this challenge effectively in Africa should be
part of broader multisectoral effort, including health
system strengthening programs and activities, that
need to be supported by national governments, public
and private employers and businesses, civil society,
and the international community over the short
and medium terms. It is expected therefore that this
report will contribute to advance the discussion on
this topic in Africa and beyond in the years to come.