On December 5th, the Program in Global NCDs and Social Change at Harvard Medical School with support from the NCD Synergies program at Partners In Health hosted a four-day NCDI Poverty National Commission Initiator’s Workshop at the Harvard Medical School Center for Global Health Delivery in Dubai, UAE. The Workshop brought together Ministry of Health and implementer colleagues from across 16 low and lower-middle income countries.
National NCDI Poverty Commissions are an initiative of The Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion. They are a group of low- and lower-middle income countries with large concentrations of people among the poorest billion to assess the burden of disease from NCDIs, and to identify policies and integrated delivery platforms that would effectively address and reduce that burden.
The Workshop welcomed 45 participants and facilitators to delve into the work of the National NCDI Poverty Commissions that has been accomplished by the 10 established groups, and provided an exploratory platform for six new countries to begin the Commission process.
Participant-facilitators included representatives from Afghanistan, Haiti, Ethiopia, Kenya, Liberia, Malawi, Mozambique, Nepal, Rwanda and Tanzania from the existing National NCDI Poverty Commissions. In addition, we were joined by Ministry of Health colleagues and national NCDI implementers from Chhattisgarh State in India, Madagascar, Sierra Leone, Uganda, Zambia and Zimbabwe.
Day 1 – NCDI burden among the poorest billion
Drs. Gene Bukhman and Ana Mocumbi, co-chairs of the Global NCDI Poverty Commission, opened the first day by welcoming participants and introducing the key concepts addressed by this network of Commissions to date. Dr. Bukhman then introduced the focal point for the course – the global burden of disease that has shaped NCD policy is not a reflection of those living in extreme poverty. Dr. Mary Mayige, co-chair of the Tanzania NCDI Poverty Commission, moderated all discussions and presentations.
Dr. Neil Gupta introduced the course, its objectives and approach, and Matt Coates gave two in-depth presentations on the measurement of poverty and global burden of disease (GBD). Finally, the group heard from Dr. Gladwell Gathecha and Noel Kasomekera who presented key findings on national data disaggregated by socioeconomic status from the Kenya and Malawi NCDI Poverty Commissions.
In the afternoon, the group of participants were divided into three groups, and led through a series of exercises to apply the methods presented earlier, to measure poverty and burden of disease using national-level data sources.
Day 2 – Priority setting for key interventions to address NCDIs of poverty
The second day built on the analytical framework that was established on Day 1. Dr. Gladwell Gathecha was a moderator throughout the day and introduced Dr. Solomon Memire of Addis Ababa University and Dr. David Watkins from the University of Washington to introduce the principles of priority setting and how the Disease Control Priorities Group (DCP3) has defined health interventions.
The participants then heard from from Drs. Solomon and Emily Wroe, who presented on the priority setting experience of the Ethiopia and Malawi National NCDI Poverty Commissions. In this session, they discussed how each country approached priority setting, not just using cost-effectiveness as a factor, but including equity, severity and financial risk protection as fundamental reasoning.
Participants were then led through a series of two exercises in groups – the first looked at the prioritization of NCDs and injuries based on national disease burden, and then subsequent prioritization of interventions based on these chosen conditions. Finally, the group heard from SP Kaulanee from Possible Health and the Nepal NCDI Poverty Commission – he presented on how the Nepal Commission measured the impoverishing impact of NCDs in their recently published report.
In the evening, the group celebrated the rare occasion of all being together and spent the evening cruising sand dunes and watching performances in the desert!
Day 3 – Planning and organizing health services for expanded NCDIs
Day 3, moderated by Noel Kasomekera of the Malawi NCDI Poverty Commission, took the analysis conducted on Days 1 and 2 and introduced service availability and readiness and the organization and clustering of services for NCDIs within the health system.
Matt Coates opened the day with a presentation on approaches to service availability and readiness and intervention coverage. Dr. Fred Amegashie of the Liberia NCDI Poverty Commission shared their team’s experience in measuring service availability. The groups then worked through a skill set using facility surveys to assess the availability of services using national data sources.
The large group was then divided into groups to watch four Voices of NCDI Poverty videos, and then work together to develop a care delivery value chain for severe NCDIs such as type 1 diabetes, rheumatic heart disease, pediatric cancer and severe mental health disorders. Dr. Emily Wroe then led the group through a large brainstorm to identify opportunities for NCDI service integration and decentralization.
Next, Dr. Gene Bukhman walked the group through health services prioritized on Day 2 can be integrated and decentralized across the national health system. Dr. Darius Fenelon, from PIH’s sister organization Zanmi Lasante and the Haiti National NCDI Poverty Commission, then demonstrated how this organization of health services had been conducted by their team.
Finally, Dr. Paul Park presented on clinical models of NCDI service delivery at first-level hospitals as seen across PIH sites in Rwanda and Malawi. Dr. Christian Rusangwa subsequently followed to present on the national scale-up of the “PEN-Plus” model in Rwanda.
Day 4 – Determining and mobilizing resources and stakeholders for action
SP Kaulanee moderated and guided the final day of the workshop. Dr. Neil Gupta opened the day with a presentation on the costing of prioritized NCDI interventions and Dr. Solomon Memire built on this presentation by highlighting the work that had been on fiscal space analysis by the Ethiopia NCDI Poverty Commission. The groups were then led through two concrete exercises to understand how to cost prioritized health interventions and analyze fiscal space in their own national context.
The conversation continued as Dr. Gene Bukhman presented on global donor funding and fiscal global space for NCDIs. Amy McLaughlin followed-up the presentation with an overview of global NCDI policy and opportunities for advocacy in 2019 for NCDs.
The day concluded with a panel discussion with all existing National NCDI Poverty Commissioners to offer insight into their Commission experience and share how their respective Commissions had acted as a catalyst for national change and impact, leading to a rich discussion between country teams.
After an incredibly full four days, Drs. Gene Bukhman and Neil Gupta closed the workshop with key highlights and lessons from each day. The incredible discussions that began in Dubai will continue as the work of the National NCDI Poverty Commissions strengthen, with many opportunities for collaboration in the coming year.