As NCDs Increase in Poorer Countries, Innovative Partnerships Have Become Essential Inside View 27/09/2022 • Alison Cox, Megha Kumar & Anne Stake Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Medtronics’ Betteh Life project in Sierra Leone Infectious diseases like HIV, tuberculosis and malaria have long been the biggest public health challenges in low- and middle-income countries (LMICs) but over the past decade, non-communicable diseases (NCDs) have risen at an alarming rate. While every country faces a growing NCD burden, low- and middle-income countries are seeing the fastest increase. This epidemiological shift is largely due to increases in exposure to risk factors – urbanization, tobacco, alcohol, ultra-processed food, air pollution and a lack of physical activity – and is exacerbated by more fragile health systems. Getting NCDs under control in LMICs requires new approaches to securing funds, through innovative partnerships that can creatively leverage resources and technology for efficient and effective service delivery. ‘Betteh Lyfe’ in Sierra Leone In Africa, the Betteh Lyfe programme – a collaboration between Medtronic LABS, the Christian Health Association of Sierra Leone, and Sanofi Global Health – was launched in Sierra Leone this year. Medtronic LABS supports end-to-end care with their digital health platform, SPICE, and their team on the ground. It begins with community health workers who carry out screening for diabetes and hypertension close to people’s homes – even those living in remote areas – and referral to health facilities to begin a treatment programme. Follow-up and monitoring are community-based or via tele-counselling, making it easier for patients to adhere to treatment. This also generates real-time data that is valuable for clinical, programmatic and policy decision-making. Private sector funding helped to catalyse the programme while collaboration with the existing faith-based network made it possible to build connections with remote and marginalized communities to bring NCD diagnosis and care to their doorsteps. The total number of people living with diabetes in Africa is predicted to more than double to 55 million by 2045. Hypertension, cardiovascular diseases, cancers and mental health disorders are all on similarly steep upward trajectories. Today, 74% of all deaths are due to NCDs – with the heaviest and fastest rising burden in LMICs – and yet only 1-2% of global health funding supports NCD care. This number has stagnated since NCDs made it onto the global health agenda two decades ago. Medtronic LAB has helped to check people for hypertension in Sierra Leone. Kenya’s public-private partnership Aside from funding, the response on the ground will need to adapt to the evolving epidemiology. It requires ‘all-of-society’ partnerships, that bring together the private sector, public sector, civil society, donors, and most importantly patients themselves in designing and delivering solutions. Such partnerships are essential if we are to overcome numerous barriers to better health in LMICs, like inadequate funding, hard-to-reach services, poor adherence to treatment, and insufficient data to make informed health policy decisions. We’ve seen their effectiveness proven on the ground. A similar approach has been employed in Kenya for the last three years in a landmark public-private partnership with Medtronic LABS, the Ministry of Health, the County Government of Makueni, PATH, Novo Nordisk and Kenya Defeat Diabetes Association. This multi-sectoral model has focused on public health system strengthening. So far, it has screened 114,000 people, enrolled over 21,000 patients in Makueni County alone, and will extend to all 47 counties in Kenya by 2026. Its ethos is based on both reaching and retaining patients. Like the Betteh Lyfe program, community health workers visit people in remote areas for education, screening, follow-up, and blood pressure and blood glucose monitoring while physicians track the readings remotely through the digital health platform. Patients are kept engaged with health services as they do not have to travel prohibitively long distances to access care and begin to see improved outcomes within a year. Digitizing the health information system The program has also digitized the national diabetes and hypertension health information system from data collection all the way to aggregation into District Health Information Software (DHIS2), ensuring consistent availability of data for decision-making. As part of the commitment to work within and sustainably transform health systems for scale, the full ownership of the model, including the digital health component is being transitioned to the Ministry of Health. These examples highlight how a robust multi-sectoral partnership framework can improve access to essential NCD services, ensure optimal and efficient use of scarce resources and leverage the expertise, capacity and experience of the different partners to mount a more coordinated NCD response. Programme leadership from national and sub-national governments and aligning strategies around government priorities whilst engaging faith-based networks and other community groups can ensure sustainable, bespoke and person-centered chronic care. Rwanda’s Universal Health Coverage Rwanda is a good example of this approach. Its government has taken a strong lead in the enactment of Universal Health Coverage (UHC), which integrates NCD prevention and care whilst constructively engaging partners, civil society and the community. Here, 91% of the population is covered by health insurance, primarily the Rwanda Community Based Health Insurance (CBHI) which covers 90% of all health costs at all levels of care. This kind of financial protection, plus ambitious community screening and education programmes, helped increase the use of health services from 30.7% in 2003 to 85% in 2008. These programmes offer many translatable lessons for other countries looking to improve their health systems through multi-sectoral partnerships: the importance of government leadership, working with community organizations, leveraging community health workers to deliver NCD care, and the role of digital innovations to reach remote or marginalized populations. Building experience and evidence from bold partnerships like these will be an important contribution to supporting LMICs as they make gains towards reducing the health and economic burden of NCDs. Alison Cox Alison Cox is the Policy and Advocacy Director of the NCD Alliance. Megha Kumar Megha Kumar is Head of Global Partnerships at Medtronic LABS. Anne Stake Anne Stake is Chief Strategy & Product Officer at Medtronic LABS Image Credits: Medtronics. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. 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