“We will never achieve our development goals if we don’t take seriously the noncommunicable ailments of our patient populations — ailments which most of our citizens must simply endure since they cannot pay for treatment.”
Hon. Min. Agnes Binagwaho, Rwanda Ministry of Health
Foreward, The PIH Guide to Chronic Care Integration for Endemic NCDs
Efforts to extend care for noncommunicable diseases and injuries to the poorest billion are underfunded worldwide. NCD funding currently accounts for only 1.2 percent of all development assistance for health, according to an IHME study. Funding for work on NCDs and injuries in low-income countries can be unreliable, rigidly divided by individual disease, and highly dependent on donor priorities year-to-year.
In international NCD advocacy, where debates around policy and clinical priorities can affect the global direction of NCD funding, the voices and needs of the very poorest communities are too often lost. This imbalance of input forces ministries of health in low-income countries to design their services according to the prioritization of certain risk factors by high-income countries whose disease burden is very different than their own.
Courtesy of the Kenya Ministry of Health
Dr. Joseph Kibachio, Kenya Ministry of Health, with the head of the NCD division Dr. Ibrahim Amira during World Cancer Day awareness week at the Kenya Ministry of Health headquarters in Nairobi
How we are moving forward
In order to achieve success in addressing NCDs and injuries in the very poor, inequity in funding streams and advocacy must be confronted at the national, regional, and global level. As the global health community works to achieve universal health coverage, there is a moral imperative that NCDs and injuries among the poorest and most vulnerable are highlighted and prioritized in global dialogues. The 80 x 40 x 20 commentary in The Lancet, an outcome of the 2013 NCD Synergies conference in Rwanda is a call to action that outlines an equity-based agenda for reducing premature mortality from all NCDs and injuries by 80 percent in individuals younger than 40 years by the year 2020.
Working together, we can sustain and expand funding for treatment of NCDs and injuries, support equitable policies that are representative of the national disease burden, and better include people living with NCDs and injuries in decision making.
NCD Synergies’ policy and advocacy efforts have centered around the following focus areas in recent years:
- Better inclusion of populations living in extreme poverty and a focus on integrated NCD care – Prioritizing the burden of NCDs and injuries specific to settings of extreme poverty will be essential to move forward universal health coverage (UHC) in low-income countries. Instead of siloed approaches focusing on disease by disease solutions, an integrated health systems approach to NCDs and injuries holds the most promise for real change among the world’s poorest populations.
- Voices of NCDI Poverty – We must commit to more meaningfully including the voices of people, families, and caregivers living with NCDs and injuries in settings of extreme poverty, which have often been unheard or ignored among national, regional, and global policymakers. The Voices of NCDI Poverty project is a platform that enables those impacted by NCDs and injuries in low-income countries across the world to share their story and experience.
- Nationally-led solutions – NCD Synergies has been working with the Lancet NCDI Poverty Commission to support 11 countries to establish National NCDI Poverty Commissions aiming to assess the local disease burden on NCDs and injuries and recommend national priorities for interventions that address challenges specific to settings of poverty. This work provides Ministries of Health and Finance the tools needed to determine cost-effective and equitable policies, with an emphasis on severity and priority to the poorest.
- Engage in global policy dialogues – Since its inception, NCD Synergies has engaged with the World Health Organization and other development agencies to emphasize the need to address the NCD and injury burden among the poorest. With regular engagement at high-level meetings and global dialogues, and by collaborating with strong advocacy partners, we strive to impact policies and funding that will reach those living in extreme poverty
Kim Nguyen / NCDFREE
NCD Synergies Program Manager, Maia Olsen (second from right) accompanies four patient advocates from Ethiopia and Haiti to Geneva for meetings with the World Heart Federation and patient advocacy dialogues hosted by NCD Alliance
Learn more about how to get involved with this important work.