NCDS AT GLANCE, IS ZAMBIA IN SYNC?
AMONG many challenges the world is facing today are Non-Communicable Diseases (NCDs) accounting for 74 percent of all diseases globally, killing 41 million people each year.
The latest data on the World Health Organisation (WHO) shows that the proportion of premature NCD-related deaths in Africa stands at 63.6 percent, much higher than the global average of 41.7 percent, and has been consistently higher than that of the global average every year since 2000.
This is the reason why WHO working with Tanzania’s Ministry of Health, Helmsley Charitable and Trust NCDI Poverty Network recently, organised the First International Conference on the PEN-Plus Regional Strategy to Address Severe Non-Communicable Diseases (NCDs) in Africa (ICPPA) in Dar-Es-Salaam, Tanzania.
The ICPPA held from April 23 to 25 this year under the theme: “Priotising Person-Centred Approach to Chronic and Severe Non-Communicable Diseases type one diabetes, sickle cell and childhood heart diseases,” attracted representation from over 24 countries including Zambia highlighted how NCDs have become a threat to humans. Zambia Non-Communicable Diseases Alliance (ZANOCODA) chairperson, Professor Fastone Goma said in an interview on the sidelines of the ICPPA that NCDs in Zambia require urgent attention.
He said there was a need to build capacity at community level so that everyone is aware about NCDs and what to do to prevent and address them. “Zambia is not utilising the community health workers to a large extent. This is the reason why the country is lagging behind as compared to other countries like Ethiopia,” Prof. Goma observed.
According to the ICPPA abstracts document, Ethiopia has implemented a health extension workers-led home-based multi-component intervention resulting in significant blood pressure control.
Prof. Goma said Zambia’s NCD policy was supposed to be part of the 2013 strategic plan, but has not been operationalised despite being launched in 2016. “We see that the current Government is looking forward to having it but this is still in a draft form. That plan is supposed to give us targets on NCDs,’’ Prof. Goma said.
He said Zambia is on record of having 29 percent of deaths as a result of NCDs with hypertension topping the list.
He said of all NCD-related deaths across the globe, more than three quarters are in low-middle-income countries, the category under which Zambia falls.
Prof. Goma said WHO online database shows that the African region is already battling a high burden of NCDs which are responsible for 37 percent of all deaths, up from 24 percent in 2000.
In as much as Zambia is one of the countries battling high NCD cases, WHO country representative for Zambia Nathan Bakyaita observed otherwise.
He said in an interview on the sidelines of the ICPPA that while Zambia might be among other African countries that are battling NCDs, it is important to note that the country has made some strides by investing in NCDs.
He said one of the achievements Zambia has made is in the health financing landscape. “As WHO and other partners, we supported the government to develop the National Health Insurance Management Authority (NHIMA). Investing in NCD programmes makes common sense because if over 35 percent of deaths in Zambia are due to NCDs, then it means that we need to invest in that,” he said.
Dr Bakyaita said Zambia has also recorded success in having health facilities that are offering cancer screening services while those found with cancer are put on treatment.
“Zambia has a heart diseases hospital, there is a cancer diseases hospital at University Teaching Hospital and a new one is under construction on the Copperbelt and another one is in Livingstone,’’ Dr Bakyaita said.
He said people with NCDs and are on NHIMA have benefitted a lot because their burden is cushioned as compared to the way things were in the past. Dr Bakyaita said the only problem that Zambia has is that NCD services are only offered at general hospitals and not at primary health care level.
“If we confine such services to General hospitals, can you imagine how somebody based in Chavuma would be able to go to Solwezi to get these services. What is most important is to increase the reach up to the primary health care level,” he said. Dr Bakyaita said since Zambia already has the health policy strategy defining what other sectors can do to promote the well-being of the people, there is a need to work with other sectors to win in preventing, controlling and managing the NCDs.
“We need to reach out to all sectors so that they can play their part in prevention.
He said Zambia needs to relook at what it already has and see how best it can tweak the models of health care systems so that there is an increase in coverage of health services. He said investing in NCDs is the way to go because the burden in the health systems is already there and is a huge drain on the national resources.
Dr Bakyaita said some of the major causes of NCDs in Zambia are bad eating habits, alcohol abuse and lack of physical exercise.
He expressed concern that many people stigmatise those with NCDs due to lack of knowledge, adding that not all CDS are due to unhealthy lifestyles.
For instance, Dr Bakyaita explained that diabetes type one (1) is genetic and that the risk factors include family history and, mutations in genes among others.
He said there is a need to provide the people centred health services through the community health workers.
“Can we look holistically at the community health systems in Zambia, we need the integrated community health system that is empowered to support NCD programmes.
Dr Bakyaita was part of the Zambian delegation that was attending the ICPPA.
Across countries in the region, deaths attributed to NCDs ranged from 27 percent to 88 percent of all deaths.
The PEN-Plus, a proven, integrated, decentralized, community-focused, and person-centered health care delivery model-bridges the service gap for people living with NCDs by bringing life-saving care close to home.
In many parts of Sub-Saharan Africa, treatment for people with severe NCDs, such as type 1 diabetes, sickle cell diseases, and rheumatic or congenital heart disease is available only at referral hospitals in major cities, leaving rural communities without vital access to care. According to WHO, the latest data shows that the proportion of premature NCD-related deaths in African region stands at 63.6 %, much higher than the global average of 41.7 percent, and has been consistently higher than that of the global average every year since 2000.
During the conference, it clearly came out that NCDs not only affect the health and well-being of the affected individuals but exert significant socio-economic impacts as they exuberate the financial difficulties of individuals and households, leading to low productivity in the workforce.
Between 2011 and 2030, the cost of the lost productivity resulting from four major NCDs is estimated to be a staggering US$30 trillion globally, or US$47 trillion if mental health is included.
WHO regional director, Matsoshido Moeti said during the official opening of the ICPPA that unhealthy diets and lifestyles have highly contributed to the skyrocketing cases of NCDs on the continent.
Dr Moeti described the NCDs as a silent epidemic that in the past two decades has been driven by increasing incidences of recycles and unhealthy diets leading to increased body calories. “Data in low and middle income countries show that 26 percent of total health spending was due to NCDs , second only to infectious and parasitic diseases meaning, it’s urgent to give these often overlooked diseases, the kind of attention they deserve,” she said.
She said implementation of the ICPPA strategy would only be possible with full engagement of the partners, NonGovernmental Organisations donors, and people that have lived experiences of NCDs. Dr Moeti said country local initiatives must be accelerated based on the NCD implementation roadmap 2023 to 2030 by applying the best buy adding that WHO already has these technical packages.
“This includes re-orienting our healthcare, and reinforcing health systems. Through domestic or natural and unnatural channels, you must develop strategies for preventing and controlling the cities in low and middle income countries,” she said.
She called on the need for resilient health care systems and driving policies and actions to eradicate NCDs.
UNICEF Country representative for Tanzania, Elke Wisch said there is a need by Governments civil society, the private sector, academia, and international partners to work together in implementing evidence-based interventions, strengthen health systems, promote healthy lifestyles, and advocate for policies that support prevention and control.
She said innovation and technology plays a crucial role in advancing the joint efforts from tele- medicine and digital health solutions to data analytics and research collaboration. We must harness the power of innovation in health care provision. Tanzania’s President Samia Suhulu Hassani said un health habits including alcohol abuse are some of the contributors to NCDs.
Dr Hassan said her country has recorded a reduction in alcohol consumption from 26 percent in 2012 to 16 percent in 2023.
In a speech read by Tanzania’s Minister of Health Tanzania Ummy Ally Mwalimu, Dr Hassan said the gathering is a testament to the committeemen her country has in addressing the NCDs which are affecting the economic progress.
“Yet in the face of this challenge, we are not discouraged. This saves as a platform to collaborate and exchange ideas……. Propose initiatives to combat NCDs,’’ she said.
WHO Director for Communicable and NonCommunicable cluster Benido Impoima said during a press briefing that some of the major problems that Africa is facing towards NCDs is lack of treatment and prevention.
He said there is a need for the African countries to adopt the PEN-Plus NCD strategy on addressing NCDs in the region. Dr Impoima said WHO is also working towards mobilising resources at local and global levels to ensure that there are zero cases of NCDs.
The ICPPA was held by WHO in collaboration with Tanzania’s Ministry of Health, HELMSLEY Charitable and Trust NCDI Poverty Network.
The conference aimed to come up with initiatives to prevent and reduce NCDs by improving the health systems and providing quality health care.
Zambia adopted the WHO PENPlus model at primary care level and this was done through task shifting of service provision to clinical officers and nurses.