Care for the poorest: PIH builds comprehensive, integrated systems

Copyright: Partners In Health

"I couldn't work in the garden. I couldn't clean. I couldn't care for my child. I couldn't really do anything for myself. I couldn't even manage to build a fire to cook food. But now, I can go into my garden and harvest my crops. I can do everything. I can even build a fire and cook. So you can see, I've been restored to health."
Anet Mukakibibi, asthma patient
Inshuti Mu Buzima, Rwanda

Among those living on less than $1 a day, NCDs are often caused by malnutrition, infection, congenital abnormalities, and toxic environments—factors made worse by poverty. Addressing the inequalities in NCD and injury treatment among the poorest billion is a priority for Partners In Health. Across the sites where PIH works, NCD programs draw on lessons learned from community-based initiatives to address HIV/AIDS and tuberculosis, allowing PIH to treat the diseases and address the economic factors that allow NCDs to wreak havoc in resource-poor nations.

The bottom line

The effort to combat NCDs among the bottom billion will require services to prevent, treat, and manage illness, as well as strong advocacy to address the overwhelming burden of these diseases on the destitute sick.
Cancer & Chronic Diseases, www.pih.org

Efforts to address NCDs

Each PIH site has its own unique challenges in delivering NCD and injury treatment to the very poor.

• In Haiti, there is a need to expand NCD training and community outreach efforts in the central region, built into district level operational planning and data collection efforts.
• In Rwanda, while there are strong partnerships in some districts to expand access to treatment, many of Rwanda’s poorest people living with NCDs and injuries remain unable to access care.
• In Malawi and Lesotho, an increasing NCD and injury burden must be integrated into existing services at local and national levels to coordinate care for patient populations still facing high levels of TB and HIV/AIDS.
• In Chiapas, Mexico, doctors and nurses serving poor and disenfranchised communities are often in transition between training opportunities, so these clinics need strong data and systems in place to ensure consistent care for people living with NCDs and injuries.

Common to all of the countries in which PIH works is a heavy burden of chronic disease, limited funding, and too few trained NCD specialists.

Rebecca E. Rollins / Partners In Health
Drs. Regan Marsh, Luther Ward and Jooby Bien-Aime load a patient with a broken neck into an ambulance at Mirebalais Hospital in Haiti. He was taken to Port-au-Prince to be placed in a halo collar, a brace that helps the neck heal.

Leadership in NCD accompaniment

PIH has taken on a leadership role in rallying the global community to meet this challenge. For instance, PIH helped convene “The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion,” a March 2011 conference held at Harvard University in preparation for the September 2011 high-level U.N. general assembly meeting on NCDs.

But it is the work PIH does with its partners around the world that speaks most clearly to their commitment to NCD treatment for the very poor. The list of NCD victories in the countries where PIH works is long and growing. High profile successes like the publication of The PIH Guide to Chronic Care Integration for Endemic NCDs, edited by Gene Bukhman and Alice Kidder, and the national scale of efforts to provide comprehensive care in Lesotho demonstrate PIH’s track record of success in accompanying ministries as they expand treatment for NCDs.

NCD Synergies is a PIH affliated project.