Lancet NCDI Poverty Commissioners reconvene at 2nd in-person meeting in Rwanda

Author: Chris Noble, NCD Synergies
October 11, 2016

The second in-person meeting for the Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion (NCDI Poverty) was recently held in Kigali, Rwanda from 28-30 September 2016.

The meeting was attended by 14 global Commissioners either in-person or by teleconference, highlighted work by advisors and research staff, and featured representation from 11 countries, including:

  • East and Southern Africa: Rwanda, Ethiopia, Mozambique, Malawi, Kenya, Tanzania
  • South Asia: India, Nepal, Afghanistan
  • Caribbean and West Africa: Haiti, Liberia
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Aaron Levenson / Partners In Health
The final day of NCDI Poverty Lancet Commission meetings in Kigali opened with a roundtable discussion among commissioners focused on articulating key messages and outlining a potential final report structure, moderated by Ole Norheim and Rachel Nugent. 

Over three days, commissioners reviewed progress of the four working groups, revisited key messages and the outline of the final report, heard updates from representatives of established or forming National Commissions/Groups, and had the opportunity to visit examples of Rwanda innovations in NCDIs within the Rwandan health care system.

Day 1

Day 1 began with an opening address by Honorable Minister Patrick Ndimubanzi and a brief overview by Commission Co-Chair Gene Bukhman regarding progress since the opening meeting in London and the upcoming timeline leading up to report launch. This was followed by thorough updates from each of the four working groups: 

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Aaron Levenson / Partners In Health
Commissioner Dr. Agnes Binagwaho addresses the room as Andrew Marx, Program Manager of the HMS Program in Global NCDs and Social Change, takes notes.

  • WG1 Poverty and Disease: Presented an updated analysis of the Commission’s definition of the poorest billion and discussed proposed data sources for analysis of disease burden and risk factors, including IHME GBD estimates, population surveys with SES microdata, and disease specific registries.
  • WG2 Integrated Delivery Strategies and Priority-Setting: Presented on a proposed process for prioritizing NCDI interventions and packages according to principles of “priority to the worst off” (in terms of impact to both health and poverty), cost-effectiveness, and financial risk protection. This was supplemented by presentations on disease-specific research in progress, including injuries, mental health, and cancer. 
  • WG3 Financing and Commodities: Presented two primary analyses in process, including an updated review of the global NCDI financing landscape and research on household expenditure and domestic financing in India. The WG then discussed potential future work to analyze commodities, human resources, and potential efficiencies in informing global and national investment cases.
  • WG4 History, Advocacy, and Governance: Presented on work focused on understanding the history and public perception of the NCD category, and an initiative to highlight the voices of NCDI patients and providers among the poorest billion. The session concluded with a discussion regarding opportunities to amplify NCDI Poverty messaging leading into the UN High Level Review of NCDs in 2018 (led by Katie Dain from the UK by Skype), and the overarching communications and dissemination strategy for the Commission moving forward.

Day 2

Day 2 provided commissioners and national representatives an opportunity to visit three different aspects of Rwanda’s innovative NCDI service delivery model.

  • Group 1: Butaro Hospital and Cancer Center of Excellence – The first group visited the Butaro District Hospital and Cancer Center of Excellence, with presentations and discussion centered on Rwanda’s NCDI care at the referral level, the national cancer and mental health programs, and Butaro Hospital’s integrated NCD clinic. The group also had a chance to hear from staff from the newly launched University of Global Health Equity (UGHE), an exciting higher education initiative focused on the delivery of equitable health care.
  • Group 2: Eastern Province – Group 2 visited three sites in the Eastern Province to learn about the region’s hospitals, health centers, and community initiatives. The first stop was PIH’s Rwinkwavu District Hospital to hear about mid-level provider models in NCDIs, followed by a tour of Kabarondo Health center where the group observed an NCD community support group and discussion of patient centered chronic care models. The day ended with a tour of Kibungo Hospital and a discussion with community health workers who have been newly trained in administering palliative care.
  • Group 3: CHUK / Rwanda Biomedical Center – Group 3 began with presentations on the landscape of NCDI policy in Rwanda from the Rwanda Biomedical Center (RBC). Afterwards, the group visited the University Teaching Hospital of Kigali (CHUK), where the group discussed human resources and competence building in NCDI care, and the team met with specialized physicians and students studying to become NCD home-based care workers.
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Aaron Levenson / Partners In Health
Gedeon Ngoga, Associate Director of NCDs at PIH Rwanda, presents to NCDI Poverty commissioners and research staff on integrated NCD care at Butaro District Hospital.

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Andrew Marx / Harvard Medical School
William Namanya, Director of Kibungo District Hospital, leads discussion with NCD community health workers focused on providing palliative care in their communities. 

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Adnan Hyder / Johns Hopkins
Dr. Adnan Hyder, Director of Johns Hopkins International Injury Unit, takes a selfie with commissioners and community health workers at University Teaching Hospital of Kigali.

 

 

 

 

 

 

 

After an extensive and enriching day, meeting participants returned to Kigali. Day 2 concluded with a side meeting for commissioners to discuss internal matters in greater detail, including the outline of the commission report and organization of the secretariat and working groups. During that session, national representatives, advisors, and staff had a separate working dinner discussion moderated by PIH Rwanda’s NCD Director Dr. Paul Park, reflecting on their visits, issues around equity, and how innovative NCDI delivery models could be expanded to their own country contexts.

Day 3

Day 3 opened with a roundtable discussion, where each commissioner had the opportunity to voice key messages and reiterate priorities for the tone and content of the main Commission report. This open-ended forum resulted in a structured brainstorming session among commissioners regarding the potential structure of the report outline.

The session after lunch, facilitated by the NCDI Poverty team and NCD Synergies’ Dr. Neil Gupta, centered on the intersections between the global Commission and national case studies and priority-setting, operationalized by the establishment of National NCDI Poverty Commissions in a number of countries. In this session, staff and advisors presented the analytic plans for the national commissions to model their work. National representatives from India, Haiti, Ethiopia, Malawi, Liberia, Rwanda, Mozambique, Afghanistan, Nepal, Tanzania, and Kenya were then asked to address the group, sharing the status of their group to date and participating in a roundtable discussion regarding the national commission process, deliverables, and potential concerns. The session concluded with a presentation by Miriam Schniedman from the World Bank, who showcased the Cancer Care and Control South-South Knowledge Exchange program, as a possible avenue for National Commissions to coordinate and share their findings through the process.

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Aaron Levenson / Partners In Health
Attendees from the 2nd Lancet NCDI Poverty Commission meeting gather for a group photo outside Umubano Hotel in Kigali. 

After an incredibly full three days, the Commission was honored to close the 2nd in-person Lancet NCDI Poverty meeting with remarks from Dr. Jean Pierre Nyemazi, the Permanent Secretary of Health of the Republic of Rwanda. Concluding on a high note, Commissioners have returned to their home institutions refocused on the important work to come. 

The next Lancet Commission meeting is planned for March 2017. To learn more, visit the website or follow @NCDIPoverty on Twitter. Stay tuned for an upcoming NCDI Poverty newsletter to be circulated periodically, a link to submit an email address to this listserv can be found here.