Call for Women Health Workers to Share Experiences of Sexual Harassment and Violence 23/09/2022 Megha Kaveri Two women healthcare workers caring for an infant. A significant number of women health care workers are being driven from the professional because of sexual harassment, and Women in Global Health (WGH) collecting their testimonies. There are no laws against sexual harassment at workplace in over 50 countries, and WGH has called for a ‘change at all levels’ of the ecosystem. The organisation recently announced their research project, “HealthToo”, to document testimonies of sexual exploitation, abuse and harassment (SEAH) experienced by women health care workers across the globe. WGH will be accepting testimonies from women healthcare workers till 30 November, and intends to publish the data and findings by December. The intention of the project is to address the gap in the data of SEAH across the world and draw attention to the issue that has caused several women to leave the workforce. Women constitute around 70% of the global health care workforce and that the workforce is already short-staffed. Dr Ann Keeling, a senior fellow at WGH, said that the lack of comparable data and consistency in the terminology used prompted this project to take shape. “When you try and chart this, you can’t get any consistent picture and what isn’t visible in data is easy to ignore. So there is this very widespread denial about the extent of this among policymakers,” she told Health Policy Watch. “This is the time now to use women’s testimonies as data and get a platform out there where we can lock these stories, so that this will no longer be invisible.” The testimonies collected from women healthcare workers will be made public on the WGH website. “We are aiming to have a geographic representation of testimonies on the website,” said Dr Kalkidan Lakew, a policy associate at WGH. “We do not want to concentrate on a specific country but want to show that this happens everywhere – high income country, low income country, hospitals, organisations and NGOs,” she said. Pointing to the International Labour Organization (ILO)’s convention on violence and harassment, referred to as C190, the researchers said that the end goal is to get as many countries as possible to sign up to the convention. The convention, which has been ratified by 20 countries and is in force in eight, defines violence and harassment at the workplace and encourages countries to set up their own legislative framework to address SEAH at the workplace. “ILO’s C190 defines what harassment and violence is and recognises it as a human rights abuse. So, for the first time we actually have a framework that every country can sign up to,” Keeling explained, adding that a “change is needed at all levels of the ecosystem.” Image Credits: Photo by Mufid Majnun on Unsplash. Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” WHO Unveils ‘Invisible Numbers’ of the NCD Crisis as Leaders Meet at United Nations 21/09/2022 Stefan Anderson The majority of Africans with high blood pressure are unaware of their condition. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis. The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday. The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway. “Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.” NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere. “This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.” Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.” Air pollution not fully represented as an NCD risk factor in database Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both. Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”. Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data. However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO. The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity. When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. A rich country problem? The data can be misleading However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past. “The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.” “There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.” A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions. While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average. But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically. In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations. Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it. As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. “If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. Underinvestment, lack of treatment facilities In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey. About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes. Diabetes, cardiovascular disease and their uneven risks Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region. In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%. Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000. “Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi. Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe. “Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.” “NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.” SDG goal out of reach? Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third. If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030. “There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.” According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years. “The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised. ‘It isn’t that simple’ “It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.” With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. “Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. “I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year. “In our time,” Afuko-Addo said, “this will be our legacy.” Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck: this is urgent.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO. Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Uganda Prepares New Ebola Vaccine Clinical Trial as Cases Rise to Seven 23/09/2022 Paul Adepoju Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven. Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health. Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter. On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said. Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district. He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine. Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks. This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda. Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.” WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.” Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing. “We are also delivering medical supplies to support the care of patients,” he added. Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit The race to test new Ebola vaccines There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported. Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis. “We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.” Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines. This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda. The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process. “So we have three critical elements ready, moving fast,” said Henao-Restrepo. “If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.” Image Credits: WHO/Matt Taylor. At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” WHO Unveils ‘Invisible Numbers’ of the NCD Crisis as Leaders Meet at United Nations 21/09/2022 Stefan Anderson The majority of Africans with high blood pressure are unaware of their condition. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis. The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday. The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway. “Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.” NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere. “This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.” Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.” Air pollution not fully represented as an NCD risk factor in database Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both. Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”. Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data. However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO. The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity. When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. A rich country problem? The data can be misleading However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past. “The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.” “There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.” A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions. While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average. But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically. In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations. Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it. As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. “If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. Underinvestment, lack of treatment facilities In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey. About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes. Diabetes, cardiovascular disease and their uneven risks Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region. In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%. Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000. “Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi. Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe. “Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.” “NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.” SDG goal out of reach? Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third. If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030. “There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.” According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years. “The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised. ‘It isn’t that simple’ “It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.” With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. “Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. “I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year. “In our time,” Afuko-Addo said, “this will be our legacy.” Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck: this is urgent.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO. Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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At UN, a Call to ‘Pandemic Proof’ the World Through Leadership 22/09/2022 Raisa Santos Leaders gathered on the occasion of the UNGA in New York this week to call for action on international pandemic preparedness. From left to right: Dr. Raj Panjabi, Dr. Ayoade Alakija, Ellen Johnson Sirleaf, David Miliband. NEW YORK – Global health leaders and experts urged nations to improve their preparedness and ability to respond to global pandemics in ways that go well beyond the health sector, even as political will to handle the COVID-19 pandemic and other health crises seems to be lagging. “Pandemic issues go far wider than health,” former New Zealand Prime Minister Helen Clark told a meeting that she moderated on the sidelines of the United Nations General Assembly’s annual high-level gathering in New York City. The event, hosted by members of the Independent Panel for Pandemic Preparedness and Response, the government of New Zealand, and the Pandemic Action Network, focused on stories of effective leadership seen during the COVID-19 pandemic and other complex health threats, as well as the leadership needed to prevent and mitigate future health crises. Clark had co-chaired the panel along with former Liberian President Ellen Johnson Sirleaf. Panel member and International Rescue Committee President David Miliband said the world needs “coherent global leadership” because it is not doing what’s needed to prepare. “We are not preparing for the next pandemic, we haven’t even finished the business of addressing the current pandemic either, at a global, national, or local level,” said Miliband. “Every part of society is impacted by a pandemic,” he said, “and we see a need for leadership at a global level, just as this leadership was needed at the national level and the regional level to step up and deal with pandemic preparedness and response effectively.” Using lessons learned from the pandemic to ‘strike while the iron is hot’ Clark, in her opening remarks, pointed out an opportunity to use the lessons learned from the pandemic and other health crises for the future. “We have to strike while the iron is hot,” she said. “We need to incorporate [these lessons] in an architecture which will be more fit for purpose next time.” Clark and Sirleaf have pushed for nations to use the lessons that have been learned from the almost 2-½ year old COVID-19 pandemic and to reform the world’s pandemic response, along the lines of the recommendations in their report last year, Make it the Last Pandemic. The panel included insights from current New Zealand Prime Minister Jacinda Ardern on how she led her country through COVID-19, and from Sirleaf on handling the 2014-2016 Ebola epidemic. ‘False sense of security’ in early days of pandemic in New Zealand New Zealand Prime Minister Jacinda Ardern speaks alongside Helen Clark, former New Zealand Prime Minister and Director of the UN Development Programme In recounting the earliest days of New Zealand’s response to the pandemic, Ardern said many people felt a “false sense of security” during the nationwide lockdown and pandemic restrictions. Following reports of confirmed COVID-19 cases in February and March 2020, New Zealand closed its borders to non-citizens and non-residents, and enacted a series of restrictions on movement, social gatherings, and economic activities. While initially the New Zealand government’s elimination strategy was effective in reducing the spread of COVID-19, community outbreaks occurred in the months that followed. This year, New Zealand has gradually begun to open its borders again and relax its pandemic measures. Ardern said politicians are very rarely confronted with a problem like this to solve, with so much incomplete information. “What sits in the politician’s mind — our job is to give confidence, to give comfort, to lead with confidence and to give a sense of assurance to your population when that’s what they’re seeking from you,” she said. Clark also New Zealand’s lack of experience with a recent pandemic also was a factor; it was left to Ardern, said Clark, to “invent as she went along, and learn as she went.” As she made and announced her decisions, Ardern also made clear to the public the limits of the information she had: what was known or still unknown about the pandemic. Coordination and communication through sectors during the Ebola epidemic in Liberia Ellen Johnson Sirleaf, former President of Liberia with Chair of Africa Union African Vaccine Delivery Alliance Dr. Ayoade Alakija Sirleaf’s experience with the Ebola epidemic in Liberia also hinged on effective communication and timely information to stop the spread of the disease. While the start of the 2014 – 2016 outbreak of Ebola in Liberia was relatively slow, case numbers soon multiplied and began to grow exponentially. As president, Sirleaf declared a three-month state of emergency and announced strict measures aimed at getting cases down. Reflecting on the outbreak, however, Sirleaf noted the need to address the public’s general lack of trust in government during those times as it tried to impose restrictions to control transmission. “We had to do more [than impose restrictions],” she recalled. “[We needed to make sure to address] communication to people, so that they knew exactly what was happening, tell them the truth, and [tell them] what sort of responses we were able to give.” Sirleaf said coordination among different parties was needed to deal with issues ranging from health to education to public information, so that “they were all speaking from the same page.” As a result of these efforts, Liberia was reported to have fought Ebola in “record time.” Inclusivity in leadership needed in pandemic preparedness The panel also addressed a need for more inclusive leadership that shifts the focus away from high-income nations and instead uplifts underrepresented and marginalized communities. “Yes, we need leadership, but we need the advisors to those leaders to come from the communities who are most impacted,” said Dr Ayoade Alakija, special envoy to the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Dr Raj Panjabi, a special assistant to US President Biden and senior director for global health security and biodefense at the White House, said the world must invest more in supporting communities. “Outbreaks start where? In communities. And where do they end? In communities,” said Panjabi. In that regard, global health leaders urged nations to follow the advice of scientists but do more consider citizens’ voices and address societal issues such as gender equity. “We are tired of meetings. We are tired of conversations,” Sirleaf summed up. “We need to be guided by scientists. We need to listen to people. We need action!” Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” WHO Unveils ‘Invisible Numbers’ of the NCD Crisis as Leaders Meet at United Nations 21/09/2022 Stefan Anderson The majority of Africans with high blood pressure are unaware of their condition. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis. The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday. The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway. “Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.” NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere. “This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.” Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.” Air pollution not fully represented as an NCD risk factor in database Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both. Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”. Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data. However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO. The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity. When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. A rich country problem? The data can be misleading However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past. “The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.” “There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.” A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions. While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average. But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically. In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations. Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it. As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. “If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. Underinvestment, lack of treatment facilities In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey. About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes. Diabetes, cardiovascular disease and their uneven risks Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region. In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%. Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000. “Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi. Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe. “Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.” “NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.” SDG goal out of reach? Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third. If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030. “There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.” According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years. “The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised. ‘It isn’t that simple’ “It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.” With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. “Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. “I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year. “In our time,” Afuko-Addo said, “this will be our legacy.” Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck: this is urgent.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO. Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Answering the Challenges Posed by Antimicrobial Resistance 22/09/2022 Pascale Ondoa & Yewande Alimi Staphylococcus aureus is the source of a skin infection that can turn deadly if drug resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), exceed 100,000 deaths globally in 2019. But up until recently, we did not have a solid grasp on how much of a problem MRSA—or any other antimicrobial resistant pathogen—was in Africa. It turns out, after testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues found that 40% of all Staph infections were MRSA. Africa, like every other continent, has an AMR problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem, or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem. We are failing to take AMR seriously, perhaps because it is not glamorous and relatable. The technology that we currently use to identify resistant pathogens is not fancy or futuristic looking. Combatting AMR does not involve miracle drugs, expensive treatments, or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work. Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. The global health and pharmaceutical industries do not seem to consider solving this problem to be very profitable. Compare that to the urgency of solving COVID-19, which has been embraced—and interventions such as diagnostics subsidized—by governments eager to end the pandemic. The COVID-19 response has been characterized by innovations popping up literally every other week. Why can’t we mobilize resources and passion for AMR? Are resistant pathogens too boring? Is it too difficult to solve through innovations? Does this make prospects for quick wins and fast return on investment too elusive for AMR, especially when compared to COVID-19 or other infectious disease outbreaks? The World Health Organization (WHO) has repeatedly stated that AMR is a global health priority—and is in fact one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3 million people died because of antimicrobial resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of AMR has also been identified in food-borne pathogens isolated from animals and animal products in Africa. Collectively, these numbers suggest that the burden of AMR might be on the level of—or greater than—that of HIV/AIDS or COVID-19. The growing threat of AMR is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations. And the paucity of accurate AMR information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of AMR infections and design effective interventions in response. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights on the under-detected and under-reported depth of the AMR crisis across Africa. Less than two percent of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago. While providing national stakeholders with critical information to advance their policies on AMR, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity, and serious, ongoing workforce shortages. Our work has painted the dire reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Center for Disease Control (CDC). The challenge is to find the funding to expand this initiative to cover the entire African continent. AMR containment requires a long-term focus—especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid. We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solving the crisis of AMR in particular. We also call upon bilateral funders and global stakeholders to focus their priorities on improving the health of African peoples. This might require more attention to locally relevant evidence to inform investments and less attention to profit-driven market interventions, as well as prioritizing the scale-up of technologies and strategies proven to work, whether or not they are innovations. Containing AMR means we have to fix African health systems. The work starts now. Dr Pascale Ondoa is the director of science and new initiatives of the African Society for Laboratory Medicine (ASLM) and Dr Yewande Alimi is the Africa Center for Disease Control (CDC) antimicrobial resistance programme coordinator. Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” WHO Unveils ‘Invisible Numbers’ of the NCD Crisis as Leaders Meet at United Nations 21/09/2022 Stefan Anderson The majority of Africans with high blood pressure are unaware of their condition. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis. The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday. The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway. “Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.” NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere. “This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.” Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.” Air pollution not fully represented as an NCD risk factor in database Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both. Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”. Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data. However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO. The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity. When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. A rich country problem? The data can be misleading However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past. “The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.” “There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.” A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions. While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average. But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically. In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations. Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it. As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. “If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. Underinvestment, lack of treatment facilities In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey. About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes. Diabetes, cardiovascular disease and their uneven risks Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region. In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%. Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000. “Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi. Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe. “Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.” “NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.” SDG goal out of reach? Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third. If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030. “There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.” According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years. “The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised. ‘It isn’t that simple’ “It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.” With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. “Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. “I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year. “In our time,” Afuko-Addo said, “this will be our legacy.” Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck: this is urgent.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO. Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Global Fund Still Short of $18 Billion Target for Fighting HIV, TB and Malaria – But UK and Italy Have Yet to Announce Pledges 22/09/2022 Kerry Cullinan Leaders at the Global Fund’s seventh replenishment conference in New York. The Global Fund raised $14.25 billion at its seventh replenishment conference in New York on Wednesday – still some way short of its $18 billion target for the next three years, although the United Kingdom and Italy had yet to make their commitments at the end of a day of public pledges. US President Joe Biden, who hosted the conference, said that the Global Fund offered a 31-fold return on investment in terms of health and economic gains in its fight against AIDS, tuberculosis and malaria. “Through our work together, it’s estimated the Global Fund has saved 50 million lives and dramatically, dramatically reduced the death rate of HIV, tuberculosis and malaria in the countries where it’s working,” said Biden, describing the replenishment drive as “one of the largest global health fundraisers in history”. “We’re putting equity at the core of our efforts,” added Biden. “We have to ensure that everyone – no matter who they are, who they love, where they come from – can access the care and treatment they need, are treated with dignity and are able to lead a healthy, productive, fulfilling life.” US President Joe Biden The US has pledged to cover one-third of the Global Fund’s budget target– $6 billion – on condition that every $1 billion it contributes is met by $2 billion from other countries. French President Emmanuel Macron drew applause when he announced his country pledged $1.6 billion – an increase of 300 million Euros over its previous contribution. “First and foremost, we should insist on the robustness of our health systems everywhere in the world,” said Macron, supporting the Global Fund’s proposal to invest $6 billion in health systems during the next three-year phase. Some 20% of France’s contribution will be dedicated to young women and gender equality said Macron, who also stressed the importance of investing in the local production of medicines, particularly in Africa. Germany’s Olaf Scholz pledged $1.3 billion, also stressing the importance of investing in health systems to safeguard against future pandemics. Canada’s Justin Trudeau pledged $1.21 billion. A range of wealthier countries – including Belgium, Canada, Germany, Ireland, Japan, Luxembourg, Portugal and Spain – increased their contributions by 30%. The European Union also upped its contribution by 30%, pledging 750 million Euros, and declaring support for stronger health systems. Notably, Africa’s Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Rwanda, South Africa, Tanzania, Togo and Uganda – all of which have been hit hard economically by COVID-19 – also increased their contributions by 30%. Truly humbled to see developing countries, many in Africa, and facing multiple crises, yet still making pledges to the @GlobalFund 7th Replenishment. Every bit counts in the fight against HIV, TB & malaria. Together we #FightForWhatCounts. 🙏🏾🙏🏾 https://t.co/4qJYjbkoI6 — Winnie Byanyima (@Winnie_Byanyima) September 21, 2022 However, the UK and Italy – while pledging support – did not specify how much they could offer. Traditionally, the UK has been one of the biggest funders of the Global Fund. But new UK Prime Minister Liz Truss only took office on 6 September, followed by Queen Elizabeth II’s death and funeral. And so her new government is yet to present a budget to Parliament. Meanwhile, Italy is holding national elections on Saturday, September 25. COVID setbacks USAID administrator Samantha Power This year’s pledging drive was framed as a moment in which countries could band together to resume the drive to reduce death rates from the world’s three most deadly infectious diseases following the setbacks that the COVID pandemic triggered. “Setbacks are not destiny,” said USAID Administrator Samantha Power as she opened the conference by enumerating the ways in which COVID-19 had rolled back years of gains in the fight against tuberculosis and malaria in particular. TB and malaria diagnosis and treatment rebounded to near pre-pandemic levels in 2021 a recent Global Fund report shows. But the world remains far off course in terms of meeting the ambitious targets of the 2030 Sustainable Development Goals to end all three epidemics. “The latest data from UNAIDS shows that HIV infections actually rose last year by 1.5 million just when we need to see rapid declines to reach our shared goal of ending HIV/AIDS as a public health threat by the end of this decade,” said Power. “Last year, an estimated 800,000 children living with HIV were still not receiving life-saving treatment,” she added. “TB deaths rose in 2020 for the first time in more than a decade, with 1.5 million deaths in 2020 alone, and with global malaria, where we saw remarkable progress as death rates dropped by 47% between 2002 and 2020, cases and deaths are both tragically on the rise.” Global Fund executive director Peter Sands concluded the conference by thanking the contributing countries. “We know these are challenging times with competing demands and fiscal pressures,” said Sands. “We know you have gone the extra mile. Thank you to all of you from civil society and communities. Your passion, and your determination is an inspiration to us all. “Together, we can end AIDS, TB and malaria and make a better world free of the fear and pain of infectious diseases, a world where no one is left behind. And today, with your help, we have taken a giant step towards making this happen.” Image Credits: Global Fund. The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” WHO Unveils ‘Invisible Numbers’ of the NCD Crisis as Leaders Meet at United Nations 21/09/2022 Stefan Anderson The majority of Africans with high blood pressure are unaware of their condition. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis. The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday. The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway. “Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.” NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere. “This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.” Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.” Air pollution not fully represented as an NCD risk factor in database Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both. Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”. Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data. However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO. The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity. When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. A rich country problem? The data can be misleading However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past. “The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.” “There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.” A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions. While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average. But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically. In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations. Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it. As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. “If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. Underinvestment, lack of treatment facilities In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey. About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes. Diabetes, cardiovascular disease and their uneven risks Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region. In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%. Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000. “Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi. Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe. “Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.” “NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.” SDG goal out of reach? Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third. If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030. “There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.” According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years. “The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised. ‘It isn’t that simple’ “It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.” With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. “Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. “I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year. “In our time,” Afuko-Addo said, “this will be our legacy.” Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck: this is urgent.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO. Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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The Hefty Price Tag of Obesity 21/09/2022 Kerry Cullinan Obesity Goitsimang Euginia Ramailane – Bothlokong After three years of number-crunching, economists have come up with a price tag for what overweight and obesity cost countries in 2019, and it’s a staggering 2.19% of their gross domestic product (GDP). On average, African countries paid $20 per capita to address the consequences of overweight and obesity, while in countries in the Americas, the cost per capita was $872, according to a study of 161 countries published in BMJ Global Health on Wednesday. But the cost is predicted to balloon to 3.3% of GDP by 2060 if nothing is done to curb overweight and obesity, according to the study. “The report provides the first ever country-specific global estimate of the economic impacts of obesity-related non-communicable diseases,” the lead author, Dr Rachel Nugent from RTI International, told a media briefing this week. “It was born out of the need to improve the economic evidence,” she said. “We wanted to develop estimates that are credible, comparable and transparent.” Cost-of-illness approach The study used a cost-of-illness approach for 28 diseases linked to overweight and obesity, including 13 cancers, six cardiovascular disease conditions, respiratory, neurological, kidney, muscular skeletal, sense organ and endocrine diseases, Nugent said. Globally, nearly two-in-five adults are now living with overweight and obesity. The study projects this will increase to three-in-four adults by 2060. Already, there are an estimated 5 million deaths each year from NCDs that are attributable to being overweight or obese. “Some 77% – more than three-quarters of those – are in low- and middle-income countries, and over half occur under the age of 70,” said Nugent. “Now to economists like myself, that’s really important because it means that a lot of people of working age who are productive in the economy, who drive economic development and growth, are affected by these diseases and conditions.” Dr Rachel Nugent Particularly concerning was the increase in prevalence in low- and middle-income countries between 2000 and 2016. It was double that of high-income countries – a 2% increase in prevalence, compared to 1% in high-income countries. If current trends continue, by 2060 the economic impacts from being overweight or obese are projected to rise to 3.29% of GDP globally, with China, US and India most affected. Curbing junk food Dr Simón Barquera, president-elect of the World Obesity Federation, described the study as one of the most important related to obesity in recent years. He said the higher economic cost of obesity in low-income countries will only perpetuate regional disparities and poor economic growth. But, he added, there’s good news as well. According to this study, a 5% decrease in obsesity in those countries could same them $430 billion a year. “Even small reductions in the projected prevalence of NCDs could have huge savings,” said Barquera, who directs the Nutritional Health Research Centre at the National Institute of Public Health in Mexico. Simón Barquera, President-elect of the World Obesity Federation, Barquera said it’s important to “stop blaming these conditions” on individuals. Instead, he said, people need to recognise that obesity is “a complex disease with complex interactions and solutions.” Among the solutions, he stressed, are ways to help people spurn unhealthy food that contributes to obesity through strategies such as soda and junk food taxes, marketing restrictions on unhealthy products, particularly those directed to children, the promotion of breastfeeding, and more awareness of junk food in schools and public spaces. Nugent said it’s not just an issue for individuals. “This is an issue for systems and broad policy thinking,” she said. “We need to shift the narrative from personal responsibility to systemic investments and integrated approaches.” WHO Unveils ‘Invisible Numbers’ of the NCD Crisis as Leaders Meet at United Nations 21/09/2022 Stefan Anderson The majority of Africans with high blood pressure are unaware of their condition. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis. The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday. The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway. “Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.” NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere. “This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.” Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.” Air pollution not fully represented as an NCD risk factor in database Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both. Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”. Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data. However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO. The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity. When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. A rich country problem? The data can be misleading However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past. “The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.” “There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.” A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions. While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average. But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically. In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations. Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it. As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. “If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. Underinvestment, lack of treatment facilities In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey. About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes. Diabetes, cardiovascular disease and their uneven risks Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region. In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%. Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000. “Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi. Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe. “Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.” “NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.” SDG goal out of reach? Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third. If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030. “There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.” According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years. “The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised. ‘It isn’t that simple’ “It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.” With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. “Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. “I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year. “In our time,” Afuko-Addo said, “this will be our legacy.” Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck: this is urgent.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO. Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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WHO Unveils ‘Invisible Numbers’ of the NCD Crisis as Leaders Meet at United Nations 21/09/2022 Stefan Anderson The majority of Africans with high blood pressure are unaware of their condition. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. In Europe, less than a third of people living with NCDs die that early. This is just one of the stark statistics contained in the most extensive data-visualization tool yet produced by the World Health Organization (WHO) to assist countries in identifying the scale and costs of the global NCD crisis. The launch of the tool, accompanied by a landmark report, coincides with the first high-level meeting of the Global Group of Heads of State and Governments on NCDs at the United Nations General Assembly (UNGA) on Wednesday. The closed-door UNGA meeting is a follow-up to the launch in April of the Presidential Council on NCDs, announced at an international meeting hosted by the presidents of Ghana and Norway. “Almost three-quarters of global deaths are due to NCDs, and yet these numbers remain invisible and under-addressed,” said Dr Leanne Riley, report author and unit head of surveillance, monitoring and reporting at WHO’s NCD division. “We hope to shine a light on these by bringing out the portal and report.” NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. While NCDs like diabetes and cardiovascular disease have long been portrayed as the problems of rich countries, the data shows this view to be outdated with more Africans succumbing to such disease than elsewhere. “This report is a reminder of the true scale of the threat of NCDs and their risk factors: every year, NCDs claim the lives of 17 million people under the age of 70 – one every two seconds,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “NCDs affect all countries and regions, but by far the largest burden falls on low- and middle-income countries, which account for 86% of premature deaths.” Bente Mikkelson, Director of WHO’s NCD division, said: “The data paints a clear picture. The problem is that the world isn’t looking at it.” Air pollution not fully represented as an NCD risk factor in database Air pollution is noted (above) as a risk for CRD, but not for premature deaths from cardiovascular disease and lung cancer – despite being a major cause of both. Even so, there are still some gaps. Air-pollution, responsible for an estimated 16% of all premature deaths annually around the world, mostly from NCDs, is only included in the portal as a risk factor for “chronic respiratory diseases”. Proportion of premature deaths from leading NCDs attributable to air pollution according to WHO data. However, it isn’t included as a separate risk factor for NCDs more generally in the same way as obesity, diet, tobacco, alcohol and lack of physical activity. This, despite the fact that air pollution also is estimated to cause between one-quarter and one-third of premature deaths from lung cancer, stroke and heart disease, according to WHO. The agency maintains an extensive data base on air pollution exposures by country, as well as a corresponding data on burden of disease from air pollution in WHO member states by the four main NCD disease categories. But this data is much less user-friendly, and it is not linked up with the NCD portal – despite the fact that air pollution was recognised officially by WHO as the “fifth” leading NCD risk factor in 2018 – alongside tobacco and excessive alcohol use, unhealthy diets and physical inactivity. When asked, WHO officials could provide no timeline as to when the air pollution data might be fully connected to the new NCD portal. A rich country problem? The data can be misleading However, the data portal succeeds well in fleshing out the huge and growing problems faced by low- and middle-income countries in battling NCDs – something often overlooked in the past. “The relative risk of dying from an NCD prematurely is two to three times higher in a low- or middle-income country than in a rich one,” said senior WHO adviser Doug Bettcher at a closed-door press conference last week. “The risks are far greater in the least developed countries.” “There has been this perception for a long time that NCDs are a problem for rich countries, but this is absolutely not the case,” Riley said of the report’s findings. “So many of these premature deaths are occurring in low- and middle-income countries where the services may not be as well developed to address them.” A cursory dive into the data available on the newly released portal reveals where this misunderstanding can be construed from. First, a look at the percentage of total deaths due to NCDs shows an apparent heavy burden carried by the world’s wealthiest regions. While the global average sits at 74%, in the European region NCDs are responsible for a staggering 90% of deaths. In Africa, on the other hand, NCDs are responsible for just 37% of deaths on average. But when the perspective is flipped to the percentage of NCD deaths occurring prematurely – at or under 70 years of age – suddenly the picture changes dramatically. In Europe, the average of premature NCD deaths is 30%, with some countries like Sweden achieving rates as low as 16%. In stark contrast, the African region averages 64% in premature NCD mortality, with countries like Kenya, Chad, Niger and Cameroon sitting at 70% and over. Furthermore, between 50% and 88% of deaths in seven countries in Africa, mostly small island nations, are due to NCDs, according to the 2022 WHO NCD Progress Monitor. In most parts of Africa, NCDs are only treated at health facilities in big cities, putting treatment for chronic diseases out of the reach of most rural, semi-rural and low-income populations. Lack of accessible services often means chronic conditions go undiagnosed, leading to less chances for treatment and successful intervention to stymie their oft-fatal impacts. For example, while two-thirds of the people with hypertension live in LMICs, almost half of the people with hypertension are not even aware they have it. As health services in low and middle-income countries in Africa and beyond have yet to adapt to the growing burden of NCDs, their threat is growing exponentially. “If you look at the top 10 causes of death versus rates of increase today, it is only continuing to go up for NCDs while going down for infectious diseases in almost every income setting,” a spokesperson for WHO told Health Policy Watch. WHO’s Africa Regional Director, Dr Matshidiso Moeti, emphasized the need for decisive action by continental leaders on the eve of a high-level summit on NCDs in Ghana this April. “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa,” she said. Underinvestment, lack of treatment facilities In August, African health ministers adopted a new regional strategy, known as PEN-PLUS, to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is largely unavailable today. Just 36% of African countries said they had essential medicines for NCDs in public hospitals, according to a 2019 WHO survey. About 97 million Africans – more than 8% of the population – incur catastrophic healthcare costs every year, according to a 2021 report on healthcare in Africa from the Africa Health Agenda International Conference. This pushes about 15 million people into poverty annually. A comparison of the risk factor rates relative to their NCD outcomes between the two regions through the data portal shows a stark picture of how underinvestment hurts health outcomes. Diabetes, cardiovascular disease and their uneven risks Taking the examples of diabetes and cardiovascular disease versus their key risk factors, or precursors, which are obesity and physical inactivity, the data disparities between Europe and Africa are telling. In Europe, the data shows that 59% of the population is overweight, with the obesity rate sitting at 23%. The average physical inactivity rate is 29% across the region. In Africa on the other hand, the data shows just 31% of people are overweight, and only 23% are obese. The difference in average physical inactivity rate is less striking, but still seven points lower than the European region at 22%. Despite these apparent advantages in the prevalence of key risk factors, the age-standardized death rate in Africa for diabetes is 48 per 100 000 people, nearly five times higher than Europe’s rate of 10 per 100 000. “Only 50% of people have access to insulin some 100 years after its discovery”, Mikkelson noted, citing a WHO report from 2021. 90% of the the insulin market is tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi. Data on cardiovascular disease deaths tells the same story: 262 deaths per 100 000 people in Africa, in comparison to 190 deaths per 100 000 in Europe. “Chronic diseases are now beginning to outstrip infectious diseases as the main driver of preventable ill health and death in lower and middle income countries,” said Katie Dain, CEO of the NCD Alliance. “Families [in these regions] are becoming just as concerned about the health and economic costs of diseases like diabetes and hypertension as they are about HIV, tuberculosis or malaria.” “NCDs will both fuel and be fuelled by the growing inequalities in our countries and globally,” Dain said. “Inaction and paralysis is not a viable option.” SDG goal out of reach? Only a handful of countries are set to reach the 2030 deadline of the global Sustainable Development Goal (SDG) to reduce NCD-related premature deaths by one third. If past trends continue, LMICs – along with most of the rest of the world – will fall far short of the SDG targets. Yet with extra spending equivalent to 0.6% of LMICs’ gross national income per capita, 90% of LMICs could meet the target. In addition, if every country were to adopt the NCD intervention strategies that are known to work, at least 39 million deaths could be averted by 2030. “There are cost-effective and globally applicable interventions that can protect people from NCDs or minimize their impact,” the report states. “Every country, no matter its income level, can and should be using and benefitting from these policies – saving lives and saving money.” According to a recent study published in the Lancet, spending an additional US$18 billion per year across all low- and middle-income countries (LMICs) could generate net economic benefits of US$17 trillion over the next seven years. “The benefits of action go far beyond health, and [the data] proves once again that health should be seen as an investment, not a cost”, the report advised. ‘It isn’t that simple’ “It is often suggested that we as individuals are responsible for making decisions that lead to developing an NCD,” the report concludes. “But it isn’t that simple.” With 2019 data showing assistance for NCDs amounted to just 5% of external aid sent to low- and middle-income countries, it is clear the NCD issue is not only a question of health, but also one of equity and sustainable development. While the UNGA meeting, led by Ghana and Norway, hopes to herald a new era in the global fight against NCDs, progress is far from certain. The interventions outlined by WHO in the report are not new, and to date, there has been a global failure by countries to adopt them. “Tackling the phenomenon of NCDs requires leadership to provide visibility to NCD issues,” said Ghanaian President Nana Afuko-Addo, co-chair of the UNGA meeting alongside Norwegian Prime Minister Jonas Gahr Støre. “I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group, and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals,” he appealed at a meeting in Accra earlier this year. “In our time,” Afuko-Addo said, “this will be our legacy.” Mikkelson echoed the need for cooperation and urgency: “WHO is calling on all governments to adopt the interventions that are known to work to help avert 39 million deaths by 2030,” she said. “We need to come together, all hands on deck: this is urgent.” Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO/NCD Portal, WHO/NCD portal , BreatheLife/WHO. Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Global Fund Blitz Aims to Offset Shortfall 20/09/2022 Kerry Cullinan The Global Fund has electronic displays in Times Square in New York City this week. The Global Fund goes into its pledging conference on Wednesday substantially short of its $18 billion minimum target to fight HIV/AIDS, tuberculosis and malaria over the next five years. Hosted by US President Joe Biden on the sidelines of the United Nations General Assembly (UNGA), the seventh replenishment conference is the culmination of a months-long fundraising campaign that has galvanised thousands across the world. “We have an unprecedented number of heads of state turning up and actually we’re really excited about the momentum as we go into these closing few hours,” Global Fund executive director Peter Sands told a private sector conference on Monday. The Global Fund has already saved 50 million lives since it was launched in 2002, according to its recent Results Report – primarily by enabling people living with HIV to get antiretroviral medicine. It says it can save a further 20 million lives between 2023 and 2028 if it raises its target budget. “In 2000, life expectancy in Malawi was 46,” said Sands. “In 2019, 19 years later, life expectancy in Malawi was 65. So in 19 years, 19 years of life expectancy were added. Two-thirds of that difference was due to the reduction in mortality from HIV, TB and malaria.” Sands said this has had a “transformative impact” on Malawi and other countries. “We are hoping to save 20 million lives and reduce the mortality rate across the three diseases by almost two thirds by 2026, which is not very far away. That will have a similarly transformational impact,” added Sands. “The @GlobalFund and @PEPFAR represent the best equalizers in humanity… we must leverage their infrastructure and health systems to fight pandemics.” @USAmbPEPFAR #FightForWhatCounts pic.twitter.com/AIwB2Ot70m — Friends of the Global Fight (@theglobalfight) September 18, 2022 US pledges one-third of budget At last count, only four countries had made their pledges known and their combined commitments reached US$8.66 billion. The lion’s share comes from the US, which has pledged $6 billion – one-third of the budget ask. Germany has pledged US$1.3 billion and Japan $1.08 billion – both 30% increases on previous years. Sweden is pledging $280 million, a cut of $10 million as the war in Ukraine eats into its resources. However, the UK, France, Canada and the European Commission – the other major supporters of the Global Fund – have yet to declare their pledges. The Global Fund is seeking a $4 billion increase its previous three-year funding cycle in part to offset the impact of COVID-19. Over the past few days, there has been a frenzy of activity in New York in support of the replenishment including electronic billboards in Times Square, an opening reception and a private sector conference. Mark Suzman, CEO of the Bill and Melinda Gates Foundation (BMGF), told the private sector conference that the Global Fund was “quite literally one of the very best investments that the Gates Foundation has ever made in anything and especially in global health”. Bill and Melinda Gates Foundation CEO Mark Suzman. ‘Kindest thing’ “My boss, Bill Gates, has called it one of the best and kindest things people have ever done for one another,” said Suzman on Monday. The BMGF is the Global Fund’s biggest private sector donor, and Suzman announced that US$100 million of the money it intends to pledge has been allocated to unlocking matching funds from the private sector. “Fifty million lives saved over the last two decades is an amazing tribute to the collaboration and the partnership and the commitment and dedication of so many people around the world, and the private sector has been fundamentally essential to that success,” he said. “Less well known is how the Global Fund, driven by private sector initiatives, quickly mobilised during COVID-19 to help maintain essential HIV, TB and malaria services, while also combating the pandemic using the expertise it has in procurement and distribution in critical areas like oxygen, saving many many more lives.” Global Fund executive director Peter Sands addressing the private sector conference on Monday. Sands told the private sector conference that his organisation had launched the investment case for the seventh replenishment on the day that Russia invaded Ukraine, and knew it was a tough ask in the current climate. “But we need to succeed because we have been knocked backwards by COVID-19. And we’re in a world where conflict, food and hunger crisis, climate change-related events are just making everything harder, and particularly for the poorest and most marginalised in the world,” Sands said. Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Uganda Detects Rare Ebola Strain With No Approved Vaccine, Marburg outbreak ends in Ghana 20/09/2022 Paul Adepoju A health worker dresses in protective clothing before entering the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019. Ugandan health officials have announced an Ebola outbreak following the confirmation of the relatively rare Sudan strain in the country’s Mubende district, while the government of Ghana has declared the end of the country’s first ever Marburg outbreak. According to the health authorities in Uganda, the Uganda Virus Research Institute confirmed Ebola in a 24-year-old male who has since died. The country’s National Rapid Response investigated six suspicious deaths in the district this month, while eight suspected patients are receiving care in a health facility. “This is the first time in more than a decade that Uganda is recording the Ebola Sudan strain. We are working closely with the national health authorities to investigate the source of this outbreak while supporting the efforts to quickly roll out effective control measures,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Uganda is no stranger to effective Ebola control. Thanks to its expertise, action has been taken to quickly to detect the virus and we can bank on this knowledge to halt the spread of infections.” Vaccine may not against Sudan strain Recent Ebola outbreaks in a number of African countries, including in the Democratic Republic of the Congo (DRC), have benefited from ring vaccination of high-risk people in contact with Ebola patients with the Ervebo (rVSV-ZEBOV) vaccine. However, the vaccine has only been approved to protect against the Zaire strain of Ebola and not the Sudan strain driving the outbreak in Uganda. WHO noted that another vaccine produced by Johnson and Johnson may be effective but has yet to be specifically tested against the Sudan strain. This is not the first Ebola outbreak caused by the Sudan strain. Seven previous outbreaks of the strain have been reported, four of which occurred in Uganda and three in Sudan. Uganda’s last outbreak of Ebola Sudan occurred in 2012. Seven years later, the country experienced an outbreak of Ebola Zaire (in 2019) when the virus was imported from neighbouring DRC which was battling a large epidemic in its northeastern region. Even though the case fatality rates of the Sudan strain have varied from 41% to 100% in past outbreaks, health authorities believe that an early initiation of supportive treatment which has been shown to significantly reduce deaths from Ebola will better position the country to combat the disease. Ghana overcomes Marburg Meanwhile, Ghana’s Ministry of Health has declared the country’s first-ever Marburg outbreak over after no new cases were reported in the past 42 days or two incubation periods – the time between infection and the onset of symptoms. During the outbreak that was declared on 7 July, three confirmed cases, including two deaths, were recorded. The outbreak declaration followed laboratory confirmation of the virus that affected the country’s Ashanti, Savannah and Western regions. Some 198 contacts were identified, monitored and completed their recommended initial 21-day observation period which was then extended for another 21 days. Genomic sequence analyses of the Marburg virus at Senegal’s Institut Pasteur and Ghana’s Noguchi Memorial Institute for Medical Research connected the outbreak to a case reported in Guinea in 2021. However, there are suggestions that the origin of the outbreak may be a shared animal reservoir or population movements between the two countries. Elsewhere on the continent, previous outbreaks and sporadic cases have been reported in Angola, DRC, Kenya, South Africa and Uganda. Even though the outbreak is over, WHO has warned that a resurgence of Marburg can still occur, and it is working with Ghana’s health authorities to maintain surveillance and improve detection and response to a potential flare-up of the virus. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Patients often develop severe haemorrhagic signs within seven days. Image Credits: Photo: Anna Dubuis / DFID. Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Ghana Faces New Challenge to Integrate Chronic Diseases into Universal Health Coverage 19/09/2022 Jessica Ahedor A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts aimed at improving survival rates of mothers and children DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel almost 500 kilometres for hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common non-communicable diseases (NCDs). A nurse at her primary health facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she had travelled from, could tell something was wrong but lacked the tools needed for proper diagnosis and treatment. “The nurse told me my blood pressure is high while she observed me, and placed her hand on my forehead and neck,” Amewornu said in an interview with Health Policy Watch. But there was “no blood pressure machine or medicine at the facility,” she recalled, so the nurse referred her to Donkorkrom Presbyterian Hospital, almost 500 kilometres away. Donkorkrom, the only hospital in Afram Plains North District, provides services for an area greater than 5,000 square kilometres. “Due to the distance between the two facilities, I arrived late at the hospital and I had to go through a Caesarean session because I couldn’t push my baby,” Amewornu recalled while sitting on a wooden bench in front of her home after returning from the hospital. “I was tired and had complications.” NCDs such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa. But health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a report last year by the NCD Alliance. In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization’s (WHO) Africa Regional Office. But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge since most of them depend on donor-driven funds, rather than local budgetary allocations. A 2022 report tracking the rollout of universal healthcare in the region shows government spending on health as a proportion of total health expenditure is lowest in African countries. Only seven of the 47 WHO Africa member states – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their own services. “The overall funding for health as a proportion of GDP and proportion of health funded by the government must increase to enable countries to reduce out-of-pocket spending and be able to steer their UHC agenda,” the report says. Ghana’s universal health coverage, NCDs yet to be integrated Ghana’s UHC Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and the government’s aid for citizens to access health care has declined sharply. Ghana’s President Nana Akufo-Addo hosted a summit in April for African leaders to focus on fighting NCDs, and he is following it up with another session this week on the sidelines of the United Nations General Assembly’s high-level gathering in New York City. Despite the attention to the issue, few Ghanaians have access yet to routine screenings for NCDs like high blood pressure and glucose at the primary care level, according to officials with Ghana Health Service, part of the nation’s Ministry of Health. Data from the health service’s NCDs program show that one-in-five people were diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas. Ghana’s primary care challenges affect not only patients but also caregivers. One nurse, Belinda Kumatu, who works in the Afram Plains North and South districts, said local care facilities have only enough resources to offer care for antenatal, malaria and family planning needs, and are forced to refer cases to Donkorkrom or one other hospital. She said there also are no readily available ambulance services for emergency situations. “We cannot do even normal delivery, because there is no equipment, a midwife or electricity,” said Kumatu, adding she hopes the government will step in and improve the overall level of care. “The ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.” Ghana’s concept of primary care to expand to NCDs Initially, the government’s concept of primary care focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Ghana Health Service’s program manager for NCDs. But even primary care hasn’t gotten enough resources, she said, and some places lack blood pressure machines, glucometers and other resources for handling diabetes. And some nurses also are well-equipped to educate people about NCDs, she said. A preliminary survey by the health service found only a few primary care facilities do NCDs screenings. But that is changing, according to Commeh. “The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, because we saw most people with underlying health conditions dying during the outbreak,” she said. “NCDs have received low coverage because little attention is paid to them over the years.” Ghana is not the only African country challenged by not having enough resources to fight NCDs. Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCDs prevention and care services focused on maternal and child care. Such financing mechanisms could ensure a more integrated approach for millions of people worldwide living with NCDs and other chronic health conditions, but health systems must adapt to provide a more long-term perspective rather than reacting to short-term conditions. Restructuring Ghana’s health insurance provisions to include NCDs A WHO consultant and researcher, Dr Koku Awoonor-Williams, suggested restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national care for NCDs. He called it “unfortunate” that more information on NCDs is not widely available to the public. “We need to restructure the NHIS to cover education, awareness creation, and prevention of NCDs besides the curative measures,” said Awoonor-Williams. “People should know the lifestyles that bring about NCDs and they should be able to go to the hospital for checkups under the NHIS coverage, not only when they are sick,” he said. “People should be able to go for screenings and check-ups under the NHIS cover.” Image Credits: Kate Holt/USAID. Posts navigation Older postsNewer posts