On Wednesday September 25 2019, the NCD Synergies team at Partners In Health (PIH), the Program in Global NCDs and Social Change at Harvard Medical School (HMS), and the Helmsley Charitable Trust (HCT) convened a small group of stakeholders from across the global health community for an expert roundtable on “Prioritizing severe, chronic NCDs within strategies to achieve UHC”.
The event was held during the same week as the 74th UN General Assembly in New York and included participants from 16 institutions, including Global Health Council, Medtronic Philanthropy, World Diabetes Foundation, Santé Diabète, T1 International, Children’s HeartLink, Resolve to Save Lives, SickleInAfrica, MSF, CHAI, and the Stop TB Partnership.
Dr. Gina Agiostratidou, Director of the Type 1 Diabetes Program at HCT, welcomed participants, encouraging those in attendance to provide thoughtful feedback in how to build global momentum to secure better access to care for severe, chronic NCDs like type 1 diabetes to achieve UHC.
Dr. Gene Bukhman, Director of NCD Synergies and the Program in Global NCDs and Social Change at HMS, acknowledged that while strides towards achieving UHC demonstrate a positive paradigm shift, we, as a global community, have fallen short in establishing global financing commitments and in providing a roadmap for countries to equitably strengthen health care systems. To address this gap, PIH and HMS is collaborating with the Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion, Ministries of Health, and national partners to conduct country-level analysis to identify and prioritize health services that will reach the poorest and most vulnerable. WHO and its partners in the African Region have also begun exploring a “PEN-Plus” strategy to decentralize and integrate longitudinal care for people with severe, chronic NCDs over the next decade.
Next, the expert roundtable focused on two sets of key questions:
- What can we learn from successful multi-country initiatives across NCDs and other disease areas on evaluating and prioritizing scale and impact? Of the programs represented in the room, how did your institution decide program scale, population focus, and indicators for success?
- Given the current NCD and UHC landscape, what are the challenges and opportunities for achieving greater support for scale-up of outpatient care for severe, chronic NCDs like type 1 diabetes, rheumatic and congenital heart disease, and sickle cell disease? What can we learn from the HIV and TB communities around building an advocacy and financing movement?
Participants had a lively and wide-ranging conversation throughout the afternoon. Attendees discussed how their institutions have weighed program decision-making to date – reflecting in particular on the balance between prioritizing equity and reaching those in most need with evaluating organizational risk in selecting settings with a minimum threshold of resource availability, infrastructure, and political will. Many also stressed the importance of adapting goals to a specific country or cultural context, as each program within a multi-country initiative will look differently.
Questions then arose on maintaining quality long-term programming for patients in chronic care and how to successfully convince the donor community that interventions at 1st level hospitals fit within a primary care framework. Participants acknowledged the challenges around these issues but as Bent Lautrup-Nielsen from WDF stated, “Never has the global community had a better opportunity to do something meaningful in NCDs,” noting the strong platform WHO’s African Regional office and member states are providing for severe, chronic NCDs through review of a draft “PEN-Plus” strategy.
As the discussion transitioned to opportunities and challenges in building advocacy and financing momentum for packages of care like “PEN-Plus,” various participants reviewed lessons learned from other health movements. Phumlani Kango, a South African HIV and PrEP advocate, and Karlynn Holland, an advocate from T1 International, shared the successes they’ve found in mobilizing youth advocates living with HIV and type 1 diabetes – as both a way to show people they aren’t alone as well as to bring collective energy and advocacy to particular issues like #Insulin4All. Other participants, such as Prof. A.R. Kamuhabwa from Muhimbili University in Tanzania, stressed the importance of working with research institutions to generate compelling data to support policy brought before Ministries of Health and other national stakeholders.
The group ended with a discussion on how to better align UHC financing with packages like “PEN-Plus” that are cross-cutting and rooted in care delivery and management beyond a limited primary care approach. Participants like Dr. Bukhman, Dr. Kee Park from the Program in Global Surgery and Social Change at HMS, and Danielle Heiberg from Global Health Council left the group with a few final questions to consider:
- To what degree can financing be led by patient voices and leverage the emotional tie-ins to lived experience as opposed to the donor community’s current understanding of UHC?
- Given how vertically governments like the US approach bilateral funding within global health, is it possible to change the conversation and effectively talk about building strong health systems?
Our teams at PIH and HMS look forward to continuing to explore these critical questions as we move forward in this new global era of UHC.