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Aug 09, 2011.
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Added on 09 Aug 2011
Last updated on 30 Aug 2013
Authors: By Robert Szypko; Reviewed By Rachel Nugent, PhD
Securing funding for expanded non-communicable disease (NCD) prevention and treatment in low- and middle-income countries is a major concern, particularly as the global burden of chronic conditions increases. Low- and middle-income countries confront nearly 80% of the global NCD disease burden, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease (Alwan 2011). Many also rely on external funds to meet a share of their health needs, with donors providing nearly $1 in $6 spent on health care in the developing world. Especially in low-income countries, these largely preventable diseases will become increasingly expensive to manage the longer that the donor community waits to address them (Alwan 2011).
As the global health community prepared for a United Nations Summit on NCDs in September 2011, GHDonline hosted a discussion around the costs, funding sources, and priority shifting related to financing NCD prevention and treatment programs in resource-poor settings. Researchers, doctors, business consultants, and other professionals discussed the challenges to expand funding for NCDs and examined ways that the public and private sectors can forge integrated solutions to address the pressing NCD challenges.
- Low-income developing countries rely on external funding to achieve health objectives, and although most global health donors recognize the magnitude of the NCD-related disease burden, funding for NCDs is lacking.
- A global epidemiological transition is occurring, with mortality and morbidity due to NCDs rising as infectious disease-related death and illness decline.
Challenges in addressing NCDs
- Addressing NCDs requires significantly more funding. For example, fully implementing cardiovascular disease prevention would require a 76 percent increase in global health expenditures.
- NCD prevention efforts require long-term planning and don’t produce immediate benefits. As a result, acute crises in low-resource settings often take precedence.
- Infectious disease projects often leave limited remaining funds for NCD efforts.
- While donors may proclaim the need for NCD prevention efforts, they do not always follow through with funding.
Key Roles for NCD Donors and Advocates
- Donors should work with leaders in the developing world to improve NCD-related service delivery systems, knowledge, and existing technology. Donor planning and project implementation must involve government ministries and other local actors to ensure project sustainability.
- The indirect factors contributing to NCDs should be considered when designing program financing and implementation. For example, donors should support efforts to support education programs that advocate for healthier products, lifestyles, and work environments.
- Donors should consider how to support local human resource development and expand local research capacity. Investing in higher education, such as public health schools, could support development of a cadre of local practitioners and researchers.
- Changes to funding structures will require time, but advocates can work immediately on prioritizing policy change around tobacco, alcohol, and food.
Possibilities for Service Integration
- NCD programs need not reinvent the wheel. Lessons from decades of scaling up infectious disease service can inform future efforts toward combating NCDs. A primary lesson is that early efforts must be designed so they are scalable and affordable.
- Donors, advocates, and governments should prioritize operations research on low- and no-cost ways to integrate NCD programs into existing infrastructure and programs for infectious diseases, such as HIV, tuberculosis, and malaria, and also programs for promoting maternal and child health.
- NCD efforts can be incorporated into some, but not all, primary care service systems.
- National-level efforts should be aligned and coordinated across numerous ministries and sectors, such as the ministries of education, social welfare, transportation, and agriculture.
Role of the Private Sector
- The private sector’s role in addressing NCDs cannot be ignored. Public health practitioners should be strategic in how they curtail harmful private-sector practices and conversely leverage the private sector’s expertise and funding to advance an agenda for a healthier future.
- Advocates can encourage employers to keep their employees healthy through prevention and wellness programs, by emphasizing the economic advantages of lower employee absenteeism, lower health insurance premiums, and higher productivity.
- Alwan, A, ed. Global Status Report on Non-communicable Diseases 2010. Geneva, Switzerland: World Health Organization; 2011.
- Beaglehole R, Bonita R, Horton R, et al. Priority Actions for the Non-communicable Disease Crisis. The Lancet. 2011;377(9775):1438-1447.
- Boseley S. Heart Disease and Cancer – The Global Threat Omitted from the MDGs. The Guardian. April 6, 2011.
- Morrison JS, Sridhar D, Piot P. Getting the Politics Right for the September 2011 UN High-Level Meeting on Noncommunicable Diseases. Center for Strategic & International Studies, Global Health Policy Center. February 2011.
- Murray CJL, Anderson B, Burstein R, et al. Development Assistance for Health: Trends and Prospects. The Lancet. 2011;378(9785):8-10.
- Nugent R, Feigl AB. Where Have All the Donors Gone? Scarce Donor Funding for Non-Communicable Diseases. Center for Global Development Working Paper 228. November 2010.
- Rabkin M, El-Sadr WM. Why Re-invent the Wheel? Leveraging the Lessons of HIV Scale-up to Confront Non-communicable Diseases. Global Public Health. 2011;(6)3:247-256.
- Reddy KS. Shouldn’t Every Minister be a Health Minister? The Hindu. June 3, 2009.
- Samb B, Desai N, Nishtar S, et al. Prevention and Management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries. The Lancet. 2010;376(9754):1785-1797.
- Sixty-fourth World Health Assembly. Preparations for the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases, Following on the Moscow Conference. A64/A/Conf. Paper. May 21, 2011;10.
Enrich the GHDonline Knowledge Base
Please consider replying to this discussion with the following information
- If you currently work with NCDs or are involved in donor organizations, please post your experiences regarding funding NCD prevention and treatment programs.
- If you are interested in NCD funding or are looking for advice in acquiring funding for an NCD project, consider posting your observations, questions and feedback.
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