Opinion
Eliminating NCDs Calls for Training of Healthcare Providers and Early Diagnosis

By Anthony Mwangi
Non-communicable diseases (NCDs) have emerged as the leading cause of death and disability worldwide. According to the World Health Organization (WHO), NCDs kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Further, each year, more than 15 million people die from a NCD between the ages of 30 and 69 years, with 85 percent of these “premature” deaths occurring in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million). These four groups of diseases account for over 80 per cent of all premature NCD deaths. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from an NCD.
NCDs also threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing premature deaths from NCDs by one-third by 2030. Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products and have limited access to health services.
Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs. Unfortunately, health care facilities in Less Developed Countries are often lacking basic diagnostic tools. Some NCD symptoms also manifest very late, making early diagnosis difficult. The inability to diagnose early or well enough means that patients end up spending more and having complicated cases.
Lack of adequately trained primary care physicians, for delivering evidence-based care at primary care, is a major hurdle controlling this NCD epidemic. In addition, the number of specialists is also insufficient in Less Developed Countries due to limited training opportunities. There is therefore an urgent need to train primary care physicians in evidence based NCD management to provide services such as screening, diagnosis, management and follow-up of uncomplicated cases at primary care.
Novartis led the way in 2020 when it partnered with the University of Nairobi and the Heart Centre to ease the suffering of patients with heart conditions across the country and to help Kenyans towards the attainment of UHC. Apart from donating 30 echo cardiograms, Novartis also enabled a total of 120 doctors to be trained in cardiac diagnosis. Earlier in 2016, Novartis partnered with the Kenya Red Cross Society (KRCS) to train health workers, community volunteers and scale up screening at community and facility level for NCDs over a period of three years. The partnership also enabled KRCS to purchase the Novartis Access portfolio to improve access to NCD prevention, treatment, care and support.
Due to the scope and complexity of the problem, however, attention and investments from multiple stakeholders across several key areas — from awareness to prevention, and diagnosis to treatment — are needed, as well as recognition of the existing gaps and imbalances.
As WHO recommends, the response to NCDs, therefore, requires concerted action at the level of policy, health systems, community action, and individual behaviours. Since the determinants of risk are driven by many social forces, including social inequalities that expose vulnerable segments of society to greater risks and reduced access to health promoting programmes, screening, and medical care, a comprehensive policy response is necessary, involving several sectors such as agriculture, food processing, urban design and transport, commerce, education, and communication.
Tobacco control, for example, requires higher taxes on all tobacco products, a ban on tobacco advertising, effective health warnings, and smoke-free public and workplaces. Promotion of healthy diets would need availability of fruit, vegetables, and healthy oils at affordable prices and reduction of salt, sugar, and saturated fats, in processed foods.
The role of capacity building of healthcare personnel cannot be overstated. A recent study published in the BMC Health Services Research Journal found that a large-scale capacity building intervention improved primary health care professionals’ knowledge, skills and clinical practice on NCD risk detection and reduction. The study is titled Capacity building of health care professionals to perform inter-professional management of non-communicable diseases in primary care.
Whereas the fight against NCDs calls for political commitment, this fight cannot be conducted in isolation. Like many other global development challenges, building strong health systems to tackle NCDs and achieving Universal Health Care will require a coordinated and sustained effort from businesses, NGOs, local authorities, and civil society.
The writer is the Cluster Head- Novartis East Africa Cluster
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