The COVID-19 and NCD Syndemic: Experiences From Rwanda, the UK, and India
Frontline healthcare workers screening an individual for cardiovascular disease in Karnataka, India.

COVID-19 and non-communicable diseases (NCDs) are combining as a “syndemic” that reinforce each other and disproportionately impact the most vulnerable communities in every country during the pandemic period, said experts at a NCD Alliance panel on Thursday. 

However, primary health care workers, particularly nurses, who are the backbone of routine NCD responses have been particularly stretched during the pandemic, challenging NCD progammes. The panellists were speaking at a session on “COVID-19 and Noncommunicable Diseases: a healthcare workforce perspective.” The session focused on shared experiences and challenges of continuing care for those with NCDs in the midst of the COVID-19 pandemic in Rwanda, the United Kingdom, and India. 

Overall, people with NCDs are at an increased risk of serious COVID-19 disease and death. Approximately one fourth of the global population is estimated to have an underlying condition that increases their vulnerability to COVID-19, mostly due to NCDs. 

“In many disadvantaged communities, COVID and NCDs are experienced as what is increasingly being termed as a syndemic, a co-occurring synergistic pandemic that is interacting with and increasing socioeconomic inequalities,” said Katie Dain, CEO of the NCD Alliance. 

Noncommunicable diseases, including cardiovascular disease, hypertension and diabetes, are the world’s leading source of premature death, disease and disability, killing 15 million people annually. 

The pandemic has caused widespread disruptions in routine health services, screening, diagnosis, treatment, and palliative care for those with NCDs. Delays in diagnosis could lead to more advanced diseases and interruptions in therapies risk the wellbeing, recovery and survival of NCD patients. 

NCD diagnosis and treatment was the most frequently disrupted health service during the COVID-19 pandemic, according to a WHO survey released in June. Of the 122 countries surveyed, 39% reported that NCD-related clinical staff were deployed to provide COVID-19 relief, 46% reported a closure of population level screening programmes, and 32% reported insufficient staff to provide NCD services. 

Katie Dain, CEO of the NCD Alliance, at the media briefing on Thursday.

Said Dain: “What we can see is that COVID-19 has exposed the real damage that neglecting NCDs and cutting public health spending on health, including the health workforce, has done over many years in many countries.” 

Half of countries worldwide lack national guidelines for the prevention, early diagnosis, and treatment of the four major NCDs, cardiovascular disease, diabetes, cancer, and chronic respiratory disease. And only a third of countries can provide drug therapies and counselling services to their populations to prevent heart attacks and strokes, she said. 

“A joint approach is needed across education, training, employment, and investment in the workforce to provide integrated, people-centered care for NCDs,” said Elisabeth Iro, WHO Chief Nursing Officer. “Nurses…have a crucial role in health promotion, literacy and management of NCDs. They are key for connecting people to appropriate, timely information, services, referrals, follow-ups, and continuity of care.”

Prior to the pandemic, NCD services were already suffering from serious under-investment. The deployment of NCD healthcare workers to support the response to COVID-19 further exacerbated resource shortages.  However, there are bright spots. Examples of how health systems in Rwanda, the United Kingdom and India met those challenges creatively were showcased at the session. 

Gedeon Ngoga, a NCD nurse and educator in Rwanda.

Partnerships between hospitals and the government in Rwanda enabled a decentralized system of providing care and treatment to NCD patients during COVID-19. Private cars and ambulances were used to transport patients to the hospital for essential treatments and food was delivered to housebound people living with NCDs. 

“The integration and decentralization is one of the approaches and mechanisms to accelerate the achievement of the SDGs [Sustainable Development Goals] for universal access for all, especially for noncommunicable diseases,” said Gedeon Ngoga, NCD nurse and educator. 

United Kingdom

The disruption of NCD services and deployment of NCD clinical staff was exacerbated by a shortage of 40,000 nurses in the UK in the National Health Services at the start of the pandemic. The need for palliative and end of life care for cancer and other NCDs in community health services has doubled during COVID-19, taking a toll on an overstretched workforce.

However, one community that has benefited from increased support and care during the pandemic is homeless individuals. A programme was developed to provide hotel accommodations and health screenings, diagnosis and treatment for homeless communities, improving their NCD health profiles.


The overburdened health system in India is struggling to handle COVID-19, as the country approaches 9 million total cases. The strict lockdown enforced from March to July had far reaching consequences for people living with NCDs and their livelihoods. Many could not access essential medicines and others had to choose between buying food or insulin. This led to the rationing of insulin, which is extremely dangerous and can cause diabetic ketoacidosis. 

“Many countries today are facing the double burden…the countries are not just battling the virus, but also the overburden of NCD-related challenges,” said Apoorva Gomber, a doctor working in Delhi. “The COVID-19 crisis has opened up a window of opportunity and it is up to us to acknowledge the overburdened health system in each country and raise the urgency of ensuring equitable access to health care.”

Mobile medical service set up in Karnataka state, India to assist vulnerable populations.

Image Credits: Flickr – Trinity Care Foundation, NCD Alliance, Flickr – Trinity Care Foundation.

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