"The NCDs that afflict people living on less than a dollar a day in countries like Rwanda or Haiti have received far less attention and have very different causes. For this 'bottom billion,' NCDs like rheumatic heart disease, type 1 diabetes, mental illnesses, epilepsy, and cervical cancer are often the result of lack of access to food, shelter, education, and health care interventions readily available in developed countries.”
Dr. Gene Bukhman, director of NCD Synergies
Dr. Gene Bukhman
GHDOnline Blog, March 2011
Through his leadership at Harvard Medical School (HMS) Program in NCDs and Social Change and Partners In Health, Dr. Gene Bukhman’s work has focused on equity issues for the poor with complex and chronic diseases. He began working with multi-drug resistant tuberculosis in the late 1990s, refocused to cardiac disease in 2000s and has prioritized NCDs and injuries more broadly since 2008. In addressing this problem over the past 15 years, Dr. Bukhman has divided his work evenly between direct clinical care for patients as a cardiologist and internal medicine doctor and supporting policy and planning at the district and national level.
The bottom line
We need a community explicitly making sure that the poorest living with NCDs and injuries are not excluded from progress in global health.
- It’s important to be responsive to the nature of the disease burden. When no individual NCD, injury, or risk factor causes a dramatic number of premature deaths, integrated responses are needed.
- The district hospital plays an essential role as a first step for getting services closer to where patients live. Strong district hospital teams can train, mentor, and supervise lower levels of the health system.
- Work at scale will never look like the model of an individual facility. It’s important to be flexible and keep the big picture goals in mind.
Local barriers to care
The NCDs and injuries endemic to very low-income settings fall between the cracks of different global health agendas. On the one hand, they are not individually the major killers like HIV, malaria, and tuberculosis addressed by the Millennium Development Goals. On the other hand, the global NCD movement has been framed as a coming epidemic of lifestyle diseases.
- Dr. Bukhman is proud to have supported development of integrated services for NCDs in three districts in Rwanda. Lessons learned through this work were reported in the 2011 book, The PIH Guide to Chronic Care Integration for Endemic Non-Communicable Diseases.
- Dr. Bukhman also had the opportunity to open the conversation on the endemic NCDs of the poorest at the March 2011 conference at Harvard Medical School.
- Since that time, Dr. Bukhman has continued to work with Rwanda and support exchange among countries through the NCD Synergies project.
Affiliation with NCD Synergies
As Founder and Director of the NCD Synergies project, Dr. Bukhman is closely involved with strategic direction of the initiative moving forward. He continues to contribute to knowledge-sharing activities in many ways, including research and publications, input on website and content development, and consulting on planning for NCD Synergies-supported countries.
Gene Bukhman, MD, PhD is the Director of the NCD Synergies project, an initiative focused on developing a community of support for governments addressing health system design for noncommunicable diseases (NCDs) and injuries of the poorest billion. Dr. Bukhman has worked for eight years supporting NCD service integration in Rwanda, serving as the Senior Technical Advisor on NCDs to the Rwanda Ministry of Health since 2010. Dr. Bukhman is the Senior Health and Policy Advisor on NCDs for Partners In Health, and is the lead author and editor of the PIH Guide to Chronic Care Integration for Endemic NCDs. He is also an Assistant Professor of Medicine at Harvard Medical School where he directs the Program in Global NCDs and Social Change. By training, Dr. Bukhman is a cardiologist with special competence in echocardiography as well as a medical anthropologist. His work focuses on the design, planning, and evaluation of integrated strategies to address noncommunicable diseases and injuries of poverty.