Editorial by Clément Meda & Guda Obse Amarech
(participants in the ITM short course on health policy & phd–students)
Strengthening of health care systems in low- and middle-income countries (LMICs) is still not sufficiently taking into account the Non-Communicable disease (NCD) challenge. Indeed, there are several countries which do not have programmes related to NCDs. Public health in sub-Saharan Africahas neglected non-communicable diseases; there is no emphasis on the control of the problems. Moreover, data on NCD are rare and tend to be hospital-based, if they exist at all. This reflection aims to highlight the increasing problem of NCDs in LMICs and the need for urgent and comprehensive action.
Among NCDs, cardiovascular diseases (CVD), diabetes, cancer and chronic pulmonary diseases are the most common ones. Their burden is affecting countries worldwide but a growing trend can also be noticed in developing countries. It is even projected that the burden of non-communicable diseases will overtake that of communicable diseases by 2030. It is found that 80% of global mortality from only one of the non-communicable diseases, CVD, occurs in LMICs.
Several studies are only now revealing that NCD is a rising problem in the African context. A study on the prevalence of hypertension and determinants of blood pressure in four SSA populations (rural Nigeria and Kenya, and urban Namibia and Tanzania) shows that NCDs are becoming a major burden in Africa. It was found that the age-standardized prevalence of hypertension was 17.3%-26.2 % in rural settings and 35.9-40.1% in urban settings. Equally important, the prevalence of hypertension in Namibia Windhoek was 32% which is similar to the prevalence of hypertension in adults in the US. Respondents with low socioeconomic status had higher blood pressure. Moreover, the treatment of hypertension is insufficient and is not proportional to severity – instead, it depends on financial means. Respondents with health insurance controlled their hypertension problem better than uninsured ones. This may also explain why people with low socio-economic status had higher blood pressure; they cannot treat it in time due to financial and other problems and as a result, their problem gets worse.
Despite the UN high-level meeting on NCDs in 2011 and the global buzz about health-systems strengthening which emphasizes the importance of NCDs, no (or little) action is taken against chronic diseases, at least in terms of a comprehensive health system response. Moreover, several studies showed that focusing only on infectious diseases is a source of inequity in the health system. There is, for example, a clear relationship between tuberculosis and smoking. Another study showed a relationship between tuberculosis and diabetes. Diabetes could worsen the mortality rate among tuberculosis patients and TB and lung disease programmes goals might thus not be achieved due to a failure to take into account the link with diabetes.
The scope of the NCD challenge and its increasingly devastating impact in SSA call for urgent action. To tackle the emerging epidemic of NCDs, health system strengthening is urgently needed. There is a need of increased focus and understanding on the dimensions of health systems in order to address the challenge of chronic diseases. Preventive strategies must take into account the growing trend of risk factors correlated to these diseases.