Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries (original) (raw)
Related papers
Lancet, 2008
The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally diff erent from acute care, relying on several features: opportunistic case fi nding for assessment of risk factors, detection of early disease, and identifi cation of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a leading role in preventing and managing chronic diseases, and these personnel need appropriate training and continuous quality assurance mechanisms. More evidence is needed about the cost-eff ectiveness of prevention and treatment strategies in primary health care. Research on scaling-up should be embedded in large-scale delivery programmes for chronic diseases with a strong emphasis on assessment.
CommentaryAfrica's chronic disease burden: from the local to the global
2010
Africa faces a double burden of infectious and chronic diseases. While infectious diseases still account for at least 69% of deaths on the continent, age specific mortality rates from chronic diseases as a whole are actually higher in sub Saharan Africa than in virtually all other regions of the world, in both men and women. Over the next ten years the continent is projected to experience the largest increase in death rates from cardiovascular disease, cancer, respiratory disease and diabetes. African health systems are weak and national investments in healthcare training and service delivery continue to prioritise infectious and parasitic diseases. There is a strong consensus that Africa faces significant challenges in chronic disease research, practice and policy. This editorial reviews eight original papers submitted to a Globalization and Health special issue themed: "Africa's chronic disease burden: local and global perspectives". The papers offer new empirical evidence and comprehensive reviews on diabetes in Tanzania, sickle cell disease in Nigeria, chronic mental illness in rural Ghana, HIV/AIDS care-giving among children in Kenya and chronic disease interventions in Ghana and Cameroon. Regional and international reviews are offered on cardiovascular risk in Africa, comorbidity between infectious and chronic diseases and cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe. We discuss insights from these papers within the contexts of medical, psychological, community and policy dimensions of chronic disease. There is an urgent need for primary and secondary interventions and for African health policymakers and governments to prioritise the development and implementation of chronic disease policies. Two gaps need critical attention. The first gap concerns the need for multidisciplinary models of research to properly inform the design of interventions. The second gap concerns understanding the processes and political economies of policy making in sub Saharan Africa. The economic impact of chronic diseases for families, health systems and governments and the relationships between national policy making and international economic and political pressures have a huge impact on the risk of chronic diseases and the ability of countries to respond to them.
Goals are Not Enough: Building Public Sector Capacity for Chronic Disease Prevention
The rising burden of non-communicable diseases (NCDs) challenges the public health sector to develop, support and implement effective interventions to reduce this global epidemic. The United Nations has responded with a global action plan that includes goals and voluntary targets for the prevention and control of NCDs. However, setting goals is not enough. To achieve meaningful outcomes, governments must act and invest to improve key enabling capacities. Political and other public sector leadership at every jurisdictional level is needed to implement health-in-allpolicies initiatives and to measure progress against set objectives, while technological and human resources for health should be developed with a focus on public health competencies. NCD surveillance and monitoring systems must be strengthened to ensure a rapid policy cycle, and public health research capacity should be built up, not only to assess the NCD challenge, but also to develop, adapt and apply new techniques and tools with the participation of decision-makers. Government and civil society partnerships are increasingly important, especially at the local level, to build multipliers, foster equity, and meet the needs of populations at risk. Given the magnitude of the NCD burden, prevention and management approaches require growth and alignment of innovative financial supports to reduce direct health expenditures and lost wages while increasing productivity. Lastly, making progress on NCDs requires a range of integrated, programmatic, health communications activities in addition to sound public policies that cross the health and non-health care sectors.
Overcoming health-systems constraints to achieve the Millennium Development Goals
Lancet, 2004
Effective interventions exist for many priority health problems in low income countries; prices are falling, and funds are increasing. However, progress towards agreed health goals remains slow. There is increasing consensus that stronger health systems are key to achieving improved health outcomes. There is much less agreement on quite how to strengthen them. Part of the challenge is to get existing and emerging knowledge about more (and less) effective strategies into practice. The evidence base also remains remarkably weak, partly because health-systems research has an image problem. The forthcoming Ministerial Summit on Health Research seeks to help define a learning agenda for health systems, so that by 2015, substantial progress will have been made to reducing the system constraints to achieving the MDGs.