a Request for Applications (RFA) for countries interested in establishing National NCDI Poverty Commissions; and
a Request for Interest (RFI) for countries that would like support in implementing integrated PEN-Plus services for severe, chronic NCDs.
As Commission co-chairs Gene Bukhman and Ana Mocumbi explained in an email to leaders of existing national commissions, “We believe that the COVID epidemic makes our work even more important. The global economic recession that will surely affect most all countries this decade will blunt progress on poverty eradication and make it even more unlikely that countries will be able to finance their most urgent health system needs from domestic resources. The epidemic will also reveal the special vulnerability of those already affected by endemic non-communicable conditions to economic and biological shocks.”
Request for Applications – National NCDI Poverty Commissions Countries with high concentrations of people living in extreme poverty are invited to submit applications for technical and financial support in establishing National NCDI Poverty Commissions. These expert committees are comprised of diverse and interested stakeholders, including national policy makers, clinicians and academic researchers, health planning and financing experts, implementing partners and donors, civil society, and patient advocates. These groups assemble and synthesize existing data to propose evidence-based recommendations and catalyze local and national efforts to address NCDIs affecting the poorest. The full RFA and related documents, including a list of eligible countries and the Application Form are availablehere.
Request for Interest – PEN-Plus Implementation Countries that already have established national commissions are invited to submit letters of interest for support in initiating implementation of PEN-Plus services for severe, chronic NCDs at first referral-level hospitals. PEN-Plus is an integrated strategy that builds on the World Health Organization’s Package of Essential Noncommunicable Disease Interventions (WHO PEN) in order to increase the quality of services for severe chronic NCDs at primary referral facilities (e.g. district hospitals). PEN-Plus also seeks to accelerate decentralization of services for common NCDs at primary care facilities (e.g. health centers). Conditions addressed by PEN-Plus providers typically include relatively complex diseases such as type 1 diabetes, advanced rheumatic heart disease, and sickle cell disease. PEN-Plus providers also train and mentor WHO PEN workers addressing conditions such as type 2 diabetes, uncomplicated hypertension, and asthma at health centers. More information, including the full RFI document and a template for submitting a Letter of Interest, is availablehere.
This statement, on behalf of the Program in Global NCDs and Social Change at Harvard Medical School, the Division of Global Health Equity at Brigham & Women’s Hospital, and the NCD Synergies project at Partners In Health, reflects the priorities of our work in the midst of the COVID-19 pandemic.
Our family of NCDI Poverty organizations is committed to saving and improving the lives of those doubly afflicted by extreme poverty and severe non-communicable diseases and injuries (NCDIs). Mostly, these people are children and young adults living in rural sub-Saharan Africa and South Asia. We have sought to help these individuals by working with a global partnershipto support countries through a multi-stage process leading ultimately to national implementation and financing of integrated delivery models such as PEN-Plus. The epidemic of COVID-19 that is sweeping the world in 2020 is an economic and biological threat to these vulnerable populations.
In response to the epidemic, we are pursuing the following general strategies:
Protecting patients and providers currently engaged in outpatient care at first-level hospitals for Type 1 Diabetes, Rheumatic Heart Disease, Sickle Cell, and other severe chronic NCDs (PEN-Plus). We are doing this by directing cash transfers and other forms of social protection (i.e. food packages, transportation support, etc.) to cohorts of patients in our network. We believe that this strategy will allow patients to stay home more safely, protecting themselves and health workers from potential COVID-19 exposure, and from the certain consequences of dire poverty. We are also providing guidance on how to adapt chronic carein the context of quarantine measures being taken by countries.
Supporting countries to stop the COVID-19 epidemic. One of the greatest things that could be done for the poorest patients with NCDIs is to stop COVID-19 from spreading in their communities. At this stage, it may still be possible to contain the epidemic by aggressively testing, isolating and treating those infected, and tracing their contacts as was done in some Asian countries. Partners In Health (PIH) has been rolling out a strategy of procuring rapid tests, protective equipment, and oxygen concentrators for use in countries where PIH is an implementing partner. We hope to amplify this strategy by working with governments in our broader network.
Planning to resume our normal activities when the pandemic is better controlled. We remain focused on advancing implementation and financing of integrated NCDI services for the poorest. We are publishing two Requests for Interest (RFIs) for activities to begin in late 2020. The first is aRequest for Applicationsfor support in initiating new National NCDI Poverty Commissions. The second RFI is soliciting Letters of Interest for support in initiating PEN-Plus implementation among countries that have already established National NCDI Poverty Commissions.
Continuing to advocate on behalf of those afflicted by NCDIs of extreme poverty. The COVID-19 epidemic makes it even more likely that extreme poverty will persist at high levels throughout the coming decade. Governments in low- and lower-middle income countries will have fewer domestic resources for health available at their disposal. Wealthy countries and global institutions will be more focused on existing priorities, and especially on health security and containing infectious disease outbreaks. In this environment, it will be essential to have organizations focused on the NCDIs of extreme poverty, mobilizing the technical, social, and financial resources needed to assure a decent life for the most vulnerable. We will continue to work with our partners and National NCDI Poverty Commissions to maintain a focus on how the epidemic is affecting their patients and to identify and address unrecognized needs. Beginning on April 21st, we plan to launch the first in a series of video conferences to begin a dialogue on COVID-19 and NCDI Poverty.
We thank all of our friends and colleagues for many years of support and collaboration. We will need each more than ever to confront this new threat to our common humanity.
The Program in Global NCDs and
Social Change at Harvard Medical School in collaboration with Brigham and
Women’s Hospital and the NCD Synergies program directed a two-day Continuing
Medical Education (CME) course from February 29 – March 1, 2020 on Cardiovascular
Disease and Global Health Equity at Harvard Medical School, co-directed by
Dr. Gene Bukhman and Dr. Gene Kwan. This was the second time our team hosted
this course.
Thistwo-day course in CVD and Global
Health Equity aimed to equip participants with the knowledge, clinical
skills, and assessment strategies needed to deepen their involvement in
cardiovascular policy and service delivery in low- and middle-income countries.
The course had an emphasis on rural communities with a high burden of conditions
such as rheumatic and congenital heart disease.
Over 12 participants completed
the course. Participants had a diverse range of backgrounds, including
physicians-in-training, cardiology fellows, and early and mid-career cardiologists.
Participants also had a range of global health experience: some who were very
interested and wanted to learn more, while others had long-term relationships
in low-income country settings and were looking to gain more skills and
knowledge.
The course brought together 14
faculty members including experts in cardiology, interventional cardiology,
electrophysiology, cardiothoracic surgery, emergency medicine, nursing,
neurology, epidemiology, clinical mentoring, and community-based care. The
discussions spanned topics around costing of cardiology care, prioritizing
equity in providing treatment in lower-resource settings, and the use of
integrated care teams in delivering high-quality care.
Gene Bukhman / Harvard Medical School Participants in front of Harvard Medical School’s Gordon Hall upon completion of the Continuing Medical Education Course on “Cardiovascular Disease and Global Health Equity”.
This course bridged the gap
between interest in global policy and knowledge of treating these prevalent
conditions in lower-resource settings. Upon conclusion of the course,
participants will continue to build on their obtained knowledge by contributing
to cardiovascular research and supporting clinical capacity building in lower-
and middle-income countries.
Our teams at Partners In Health and Harvard Medical School look forward to continuing to further expand training and mentorship for the treatment of cardiovascular disease in global health, and working to bring care and treatment of cardiovascular disease closer to patients and their families.
From October 31st to November 3rd 2019, the Pan-African Society of Cardiology (PASCAR), South Africa Heart Association (SA Heart), and AfricaPCR held their annual Congress in Johannesburg. Dr. Gene Bukhman and Dr. Sheila Klassen represented the NCD Synergies team at Partners In Health and Harvard Medical School, joining cardiology colleagues leading discussions around the effective control of cardiovascular disease across Africa.
Honoring the late Bongani Mayosi, a South African cardiologist and former commissioner of the Lancet NCDI Poverty Commission, the Bongani Mayosi Memorial Lecture on November 2nd highlighted Rheumatic Heart Disease (RHD) in Africa. Until his untimely death in 2018, Dr. Mayosi was a leading voice for addressing cardiovascular diseases of poverty in Africa. This session was dedicated to rheumatic heart disease, a disease of poverty stemming from Strep throat and rheumatic fever.
The plenary session highlighted some of Africa’s foremost RHD advocates and thought leaders:
Dr. Prebo Barango, the NCD Focal Point for the WHO Intercountry Support Team for East & Southern Africa, presented on Africa’s response to the WHA resolution calling for greater action on RHD. In this discussion he highlighted the role of both WHO’s Package of Essential Noncommunicable Disease interventions (PEN) for primary care, as well as a potential strategy to address severe, chronic NCDs in the African region (PEN-Plus) to strengthen WHO AFRO’s emerging work on RHD control in Africa, specifically emphasizing decentralization of echocardiography, heart failure management, and anti-coagulation to rural district hospitals in the region.
Dr. Emmy Okello of the Uganda Heart Institute furthered this discussion on PEN-Plus and reiterated the need to integrate and incorporate RHD into continent-wide policy on severe, chronic NCDs.
Dr. Ana Mocumbi, Vice President of the PASCAR Southern region and co-chair of the Lancet NCDI Poverty Commission, discussed the need to frame RHD as a disease of poverty and inequality. Dr. Mocumbi highlighted the objectives of the NCDI Poverty Commission and the need to focus on the diverse set of severe conditions affecting those living in extreme poverty.
Gene Bukhman / Harvard Medical School Dr. Ana Mocumbi, Vice President of the PASCAR Southern region and co-chair of the NCDI Poverty Commission, presents on the need to frame RHD as a disease of poverty and inequity.
To further the goals of the Lancet NCDI Poverty Commission, the second Southern African Regional NCDI Poverty meeting was held while the group was congregated in Johannesburg. The group, met to broadly discuss next steps for the Southern African region to better assess the NCDI burden specific to settings of poverty and interventions needed to address these challenges.
Harvard Medical School Members of the second Southern African Regional NCDI Poverty meeting congregated in Johannesburg during the week of the PASCAR Congress.
In late August of 2019, Partners In Health in Malawi, known locally as Abwenzi Pa Za Umoyo (APZU) had the unique opportunity to co-host a camp for children and young adults living with type 1 diabetes (T1D) throughout the country. Camp Tikhoza, meaning “Yes we can” in Chichewa, was co-hosted by theSonia Nabeta Foundation, a partner organization based in Uganda that works to improve care for children with T1D throughout Africa and the Non Communicable Disease (NCD) Unit of the Malawi Ministry of Health.
Over 60 children, varying in age from 9 to 22 years old,
attended the weeklong camp in the capital city of Lilongwe. The camp welcomed children
and young adults receiving treatment at the country’s four central hospitals
(Lilongwe, Blantyre, Mzuzu, and Zomba).
Divided into six different teams, each led by a counselor
from Uganda also living with T1D, the children participated in a variety of interactive
activities throughout the week. Teams also heard from several Malawian NCD
leaders – including Dr. Jones Masiye, Director of Clinical Services for the
Malawi Ministry of Health and a representative from the Diabetes Association of
Malawi – while Dr. Cissy Nalunkuma, a pediatric endocrinologist from Uganda, taught
sessions in managing and controlling their condition.
Todd Ruderman / Partners In Health Campers get ready to begin Camp Tikhoza.
The camp was joined by nurses and doctors from Malawi and Uganda, with workshops on insulin injecting techniques, the importance of checking blood sugars, appropriate diet for someone living with diabetes, and psycho-social support. The Malawian nurses who attended the camp also received training on diabetes care, adjusting and managing insulin, and diet counseling for people living with diabetes. The children also participated in lively social activities including a Sports Day and a talent show, providing an opportunity to get to know each other and build community among peers living with the same condition.
Todd Ruderman / Partners In Health Nurses and clinical officers help distribute glucometers, test strips and lancets to the campers.
Unlike higher income countries, most children in Malawi only have their insulin checked once per month – the day they visit the clinic. Fifty-five percent of the children who attended the camp did not have home glucometer machines, making insulin adjustments very difficult. In order to improve this reality, every child attending the camp who did not have a home glucometer was given one, along with a five-month supply of lancets and test strips. They were taught how to use the glucometers to monitor their blood sugars appropriately, while also each receiving a hemoglobin A1C (HbA1C) test that will be passed on to their clinicians to improve long term blood sugar control. Although supplying the children with a few months of supplies is a short term solution, APZU is working with the Ministry of Health and the Sonia Nabeta Foundation to develop national strategies to provide ongoing supply of diabetic equipment.
Todd Ruderman / Partners In Health Campers sharing an optimistic message while painting at Camp Tikhoza.
Although Camp Tikhoza offered the opportunity to bring children from across Malawi together, the reality is that many children with T1D cannot make it to a clinic to obtain an acceptable standard of care, as transportation is largely inaccessible for many Malawians and only four hospitals have dedicated type 1 diabetes clinics. Through continued activities such as Camp Tikhoza, PIH/APZU and the Ministry of Health will continue to collaborate with national stakeholders to improve the availability of care for severe NCDs such as type 1 diabetes around the country, bringing care closer to patients and their families.
