Will NCDs gain traction at the World Health Assembly?

The 67th World Health Assembly is happening this week in Geneva, and one of the key issues on the agenda is noncommunicable diseases.

NCDs — cardiovascular disease, cancer, diabetes and chronic respiratory disease — result in more than 36 million deaths each year, and 80 percent of these occur in low- and middle-income countries. In Africa, deaths from NCDs are expected to outpace those stemming from infectious, maternal, prenatal and nutritious diseases by 2030.

The World Economic Forum estimates NCDs can cost the global economy more than $30 trillion — or 48 percent of the world's gross domestic product in 2010 — in the next two decades.

But perhaps because the development community is more focused on addressing health issues covered by the Millennium Development Goals — HIV and AIDS, malaria, tuberculosis, and maternal and child health — funding to prevent the spread of NCDs has been minuscule. The latest available sectoral data on development assistance for health indicate NCDs received $377 million, or just 1.2 percent of health funding, in 2011. While this represented a 4.6 percent increase from 2010 allocations, it pales in comparison to what other subsectors are receiving. Development assistance for HIV and AIDS, for instance, is 20 times higher than that for NCDs.

NCDs — which are caused by either genetic or lifestyle factors — are preventable and less costly to combat. According to the World Health Organization, cost-effective interventions in low-income countries would only amount to 4 percent of current global health funding. That figure drops to 2 percent in lower-middle-income countries and 1 percent in upper-middle-income nations.

Collaboration: 'The only way to go'

Community-level outreach is one of the most effective low-cost interventions to prevent and control NCDs. And to implement such programs effectively, partnerships and a multistakeholder approach are vital.

"No one organization has the solution," Dr. Ayham Alomari, senior health officer for community health and noncommunicable diseases at the International Federation of Red Cross and Red Crescent Societies, told Devex.

To change the behavior of members of at-risk communities and encourage them to adopt healthy lifestyles, Alomari said the environment plays a very critical role. By "walking the talk," volunteers can help communities understand the risks associated with unhealthy habits and the benefits of healthy living. The academic community, meanwhile, can provide empirical data on which community-level approaches work, how, why and where.

For many of these health issues, collaboration "is the only way to go," Mario Ottiglio, public affairs and global health policy director at the International Federation of Pharmaceutical Manufacturers & Associations, affirmed. With NCDs, one has to go beyond the health dimensions and look at the messaging and marketing as well.

IFPMA is an international group based in Geneva, Switzerland. Its members include R&D companies and national pharmaceutical associations in developed and developing countries.

"You can't escape the way of partnerships because there are too many interlinked dimensions [in addressing NCDs]," Ottiglio told Devex. "You can conceivably have a partnership between the food sector, the government [and the information technology] industry, and you will have a stake for everybody there."

Last year, IFPMA forged a two-year partnership with the IFRC, which entailed having to design a behavioral change-based toolkit for community-based outreach. The toolkit aims to promote four healthy habits — eat healthy, be physically active, reduce alcohol intake and quit smoking — as a way to prevent and control NCDs.

IFPMA provided in-kind and modest financial contributions to kick-start the program and make sure the basics the volunteers will need are in place. The group is also helping with the messaging and advocacy, according to Ottiglio.

"The plan in the future," Alomari said, is for IFPMA to "be the bridge between IFRC and the private sector." IFPMA will identify potential partnerships and develop the framework for collaboration.

"Our member companies have been traditionally involved in this field," Ottiglio said. "One-quarter of our partnerships focus on NCDs." At present, IFPMA members have been involved in building capacity, raising awareness, devising strategies to facilitate access to medicines, and strengthening and securing the supply chain.

IFPMA and IFRC have trained volunteers in 20 countries in Asia and the Pacific and 13 in Europe, and are planning to conduct training in some 40 countries in the Americas and Africa by the end of the year. Volunteers in the initial 33 countries are now ready to implement the "4 Healthy Habits" initiative, which will be formally launched at a side event on the first day of the World Health Assembly.

Beyond financing and behavior change

Changing the behavior of communities is a key challenge the "4 Healthy Habits" initiative aims to address.

"[The] key for the success of the program is the uptake at the local level, in the sense that those that will be trained will be proactive and can explain the value of the program to the community. Messaging is key," Ottiglio stressed.

But there are key concerns surrounding NCD prevention that are beyond the scope of the initiative. Among these, Alomari noted, is the need to have legislation that can help promote healthy behavior.

"The challenge is for countries to adopt and enforce clear policies that work," Alomari said.

Financing is an issue as well. Early diagnosis is a vital component of preventing deaths from NCDs. But diagnosis is a problem in communities where health centers are ill-equipped or do not have the necessary equipment at all.

Alomari is hopeful global spending on NCDs will pick up in 2016, after the end of the MDG period. And some developments support this optimistic view.

At last year's meeting, the World Health Assembly approved a 20.5 percent increase in WHO's 2014-2015 budget for noncommunicable diseases — from $264 million to $318 million. This is in stark contrast to the $72 million cut in the allocation for infectious diseases. In 2013, WHO also released a $940.3 million, eight-year action plan to prevent and control NCDs.

Alomari is hoping for more than increased financing for NCDs at this year's World Health Assembly.

"We would want to see that NCD prevention would be included in the agenda of donors and policy makers. We would like to see there is a fund and promotion of community health workforce, including volunteers, as integral components of the health system. See more practical, easy-to-use toolkits and learn from them. We would like to see more programs in the field happening."

Devex is in Geneva to cover the 67th World Health Assembly. Check back in the next few days to see video interviews and more of our coverage from Switzerland. Join the Devex community and gain access to more in-depth analysis, breaking news and business advice — and a host of other services — on international development, humanitarian aid and global health.

source: www.devex.com