Revival of health sector: A focus on non-communicable diseases
In recent years, non-communicable diseases (NCDs), such as cardiovascular diseases (CVD), diabetes, chronic obstructive pulmonary diseases (COPD) and cancers have become an emerging pandemic globally with disproportionately higher rates in developing countries.
There has been an increase in NCDs in Zimbabwe over the past decade. The cause of death by non-communicable diseases in Zimbabwe was reported at 39,26% in 2019, according to the World Bank with Covid-19 only overtaking cancer (a NCD) as the world’s leading cause of death.
Globally, the burden of NCDs continues to rise with 41 million people dying each year, equivalent to 71% of all deaths. Low- and middle-income countries account for 85% of these premature deaths while at least 15 million people between the ages of 30 and 69 years are dying from an NCD annually.
Despite this increase, the potential effects of NCDs on household welfare are unavailable despite strong evidence of economic and social consequences even in developed countries.
Due to the high expenditures that come with the management of NCDs, households are exposed to increased risks of financial catastrophe and poverty. Catastrophic expenditures occur when households are forced to dis-save or selloff assets to meet hospital bills or medical care.
Although households could be impoverished due to catastrophic expenditure, the expenditure enables them to consume essential medical care, thus slowing down the decline in income and labour productivity that is common among NCD patients.
NCDs indeed cause households to incur catastrophic expenditure due to the high costs of treatment and reduced productivity associated with them. Not only do these chronic NCDs cause premature deaths, they also have major adverse effects on the quality of life that the affected people live and they also create huge negative economic effects on households, the community, as well as the nation at large.
In Zimbabwe, it is estimated that the risk of premature death from an NCDs for people between the age of 30 and 70 years is 19% for females and 20% for males.
Most government budgets mainly concentrate on communicable diseases where funding and infrastructures are channelled towards catering for communicable diseases especially malaria and HIV/Aids and most recently Covid-19.
The Zimbabwean government is failing to cope due to the increase in the numbers of people that are in need of treatment and care due to the triple burden of infectious diseases, maternal and child health as well as NCDs.
Covid-19 also has not made it any easier for the government as part of, if not most of, the health funds are now being channelled towards Covid-19 management. The lack of understanding and empirical limitations on the impact of the NCDs on individuals, households and the economy, has contributed to the low attention and prioritisation of NCDs in Zimbabwe.
There is a general lack of knowledge and awareness among the population and the government on the impact, the risk factors and the ultimate control of the spreading of NCDs.
It therefore becomes important to note that the approach to health in the MDGs has and is still disease specific and vertical. This then incapacitates the health system to deal with the ever-increasing burden of NCDs. New infections of NCDs are on the increase due to the fact that there is not much attention that is being given to NCDs
In a way to revive the health sector, the authorities can embark on a health subsector approach Médecins Sans Frontières (MSF) recommends that the healthcare system in Zimbabwe needs to develop mechanisms to promote preventive care for NCDs through control of NCDs risk factors, since preventive health is more cost effective than curative health.
There is a need for the health authorities to revamp the health sector especially in the non-communicable diseases sector as this is still very underfunded in the country.
Effective public policies such as community-based routine screening for NCDs are required to address the rising prevalence of NCDs beside individual and household policies. Development of a health financing strategy (social protection and resource pooling) should be a high priority for the Ministry of Health and Child Care and its development partners.
Though the Health ministry can be commended for its first of its kind nurseled NCDs healthcare model across the country, there is still more that this sector needs to do in order to relieve the people affected by NCDs in the country. There is a need to strengthen the screening and treatment of patients with NCDs.
According to the WHO, the global epidemic of the NCDs can be transposed through modest investments in interventions so low in cost that even Zimbabwe can successfully implement the nine voluntary global targets and the 25 × 25 strategy.
However, there is a need, more importantly, to have high levels of commitment, proper planning, community mobilisation and an intensive focus on a small range of critical actions.
The measures stated above will ensure quick gains to reduce the significant behavioural risk factors, namely tobacco use, harmful use of alcohol, an unhealthy diet, and physical inactivity, as well as biological risk factors, such as blood glucose.
Quite a number of the common chronic NCDs such as cardiovascular disease, diabetes, hypertension and obesity can be avoided by addressing the major behavioural and metabolic risk factors associated with such conditions.
Their prevention and treatment require reliable, accurate and timeous information on their symptoms and associated risk factors. This then brings into play the importance of having correct, reliable and timeous information on NCDs.
The use of credible data is therefore essential in identifying current and potential NCDs morbidity, mortality, and related risk factors. The availability of NCDs data at local, regional, and national levels will be helpful for decision-makers to prioritise the prevention of NCDs and strengthen distribution and budget allocation in the healthcare system.
An effective health system is built on a well-functioning information system that collects accurate, reliable, timeous and relevant health data for optimal healthcare delivery and decision-making. The lack of data in the healthcare system is a hindrance to planning, allocating resources, and implementing appropriate NCDs intervention strategies.
NCDs surveillance data can be best collected by establishing and implementing data collection standardised protocols in the healthcare system.
The collection of NCD data alone is not enough to ensure effective prevention and intervention. What can also be done is to periodically evaluate the data quality to ensure that it is timeous and accurate on mortality, morbidity, as well as related NCD risk factors.
This will ensure effective and efficient decision-making that will go a long way in aiding the spread and control of the diseases.
Zimbabwe is still struggling to adequately establish robust information systems to help with their intervention, treatment, and related NCDs risk factors.
Lessons can be adopted from some of the developed countries such as in North America, Australia and Europe which have established standards and processes in their healthcare sector to obtain ongoing information on morbidity, mortality, NCDs risk factors, as well as determinants of their care services.
Middle-income countries, such as South Africa, and low-resourced countries, such as Ghana, Mozambique, Rwanda, Tanzania, and Zambia, conducted studies to investigate the capacity of their national health information systems, which resulted in them developing robust disease surveillance systems to understand the disease profiles of their population.
The availability of health information in the healthcare system enabled these countries to exchange health-related data between healthcare providers, organisations, and health service consuming communities. Zimbabwe can also copy such strides in a bid to improve its health care sector.
The availability and sharing of NCDs information within both the public and the private healthcare sector will promote timeous and appropriate health care decisions to be made, quick information retrieval, fast information sharing, improved data storage, improved information screening and reporting, all of which enhances the quality of health care.
Furthermore, having NCDs mortality, morbidity, and risk factor data about a population can help policymakers and healthcare providers to establish relevant preventive strategies in their national healthcare system.
By applying these not so cost intensive measures, it is prudent to hope that some noticeable changes can begin to be noticed in the healthcare sector which, if also then used in the other healthcare system sub-sectors, the revival of the whole healthcare sector, can begin to take shape.
Chivige is an economist. These weekly New Horizon articles are coordinated by Lovemore Kadenge, an independent consultant, past president of the Zimbabwe Economics Society and past president of the Institute of Chartered Secretaries and Administrators in Zimbabwe. Email: kadenge.zes@gmail.com/ cell: +263 772 382 852