Tackling NCDs and injuries in Southern Africa: new momentum in the drive for equity

Author: Amy McLaughlin, NCD Synergies
June 27, 2018

The Mozambique Institute of Health Education and Research (MIHER) in collaboration with the NCD Synergies team at Partners In Health and the Program in Global NCDs and Social Change at Harvard Medical School co-hosted a two-day meeting: Noncommunicable Diseases and Injuries in Southern Africa: A Dialogue on Science, Implementation and Policy.

The goal of the meeting was to broaden the NCD and injuries dialogue beyond its conventional cardiometabolic focus, and to emphasize the need to prioritize interventions to address severe conditions affecting children and young adults.

This dialogue built on the findings of the Mozambique and Malawi National NCDI Poverty CommissionsThese Commissions are part of a growing movement of countries coordinating National Commissions and Groups supported by the global Lancet Commission on Reframing NCDIs for the Poorest Billion.  The two-day meeting featured an in-depth discussion on strengthening health systems to provide treatment to the most vulnerable populations throughout the region. In addition to representatives of the World Bank, WHO AFRO Regional Office, WHO Mozambique, participants included Ministry of Health leads, researchers, Partners In Health Colleagues from Lesotho, Malawi and Rwanda, and clinical implementers representing nine countries: Lesotho, Madagascar, Malawi, Mozambique, Rwanda, South Africa, eSwatini (formerly Swaziland), Zambia and Zimbabwe.

Amy McLaughlin / Partners In Health
Over 40 participants from more than 10 countries gathered in Maputo for a two-day dialogue on severe, chronic NCDs and Injuries in the Southern Africa Region.

Day 1

Amy McLaughlin / Partners In Health
Global NCDI Poverty Commissions, Dr. Gene Bukhman and Dr. Ana Mocumbi at the two-day discussion in Maputo.

Day 1 opened with introductory presentations from global NCDI Poverty Commission co-chairs Dr. Gene Bukhman and Dr. Ana Mocumbi, providing participants with important context for the burden of NCDs and poverty in Southern Africa and the global initiatives gaining momentum to address these critical issues. Next, the group heard in-depth presentations sharing key National NCDI Poverty Commission findings from Dr. Humberto Muquingue (Mozambique) and Dr. Jones Masiye (Malawi).

The Malawi and Mozambique NCDI Poverty Commissions shared some commonalities that question common assumptions and rhetoric around NCDs. For example, both groups found that a significant proportion of NCD disease is not attributable to known behavioral/metabolic or environmental risk factors (50% of the burden of disease in Malawi and 60% in Mozambique).

In order to gather additional data among the poor, the Malawi team also shared a productive partnership with WHO to conduct a national STEPs survey, which built in socioeconomic factors to collect critical representative data

Amy McLaughlin and Neil Gupta / Partners In Health
Dr. Jones Masiye (Malawi) and Dr. Humberto Muquingue (Mozambique) present the key findings of the National NCDI Poverty Commissions.

At the end of Day 1, the group heard presentations from Ministry of Health NCD leads from Lesotho, Madagascar, Swaziland, Zambia, and Zimbabwe. Key similarities successes, and challenges across the region were discussed in a session moderated by Dr. Humberto Cossa and Dr. Gene Bukhman. Lack of data presents a fundamental challenge, as the real burden of NCDs and injuries, particularly in rural areas is not known. Specialized services are typically restricted to capital cities and can come at an extremely high cost. Finally, each Ministry representative emphasized the need for integration of NCD services, particularly within existing HIV platforms and other vertical programs.

Day 2

Day 2 discussions centered on the “how” of service provision. The morning session opened with a video of Sheila Chipenge, a 14-year old girl living with type 1 diabetes in rural Malawi and receiving care from Partners In Health. Throughout the day, many presenters referenced the experience of Sheila and others with severe chronic illness, emphasizing the need to reach those living in rural communities.

The group first heard from Dr. Paul Park, who presented on a model of outpatient clinics for severe, chronic NCDs, which has been successful in Rwanda. Following Dr. Park, a number of other innovative service delivery models were presented:

  • Swaziland, ICAP
  • Swaziland, National cancer registry program,
  • Malawi, Integrated Chronic Care Clinic (IC3) Partners In Health / Abwenzi Pa Za Umoyo (PIH/APZU),
  • Malawi, Dignitas International,
  • Zimbabwe, Medecins Sans Frontieres

Given the prevalence of HIV in this region, the following discussion moderated by Dr. Karen Sliwa and Dr. Park centered heavily on the integration of NCD services into HIV programs, including the potential challenges posed by overloading HIV funding. In this discussion, participants acknowledged that achieving UHC means providing curative services and treatment, not just prevention of NCDs. In addition, robust maternal and child health programs can also provide a platform for the integration of NCD services.

Following the discussion, the group heard from colleagues working on innovative service delivery models for complex NCDs. This featured:

  • Zambia, CIDRZ
  • Zambia, Rheumatic heart disease programs
  • South Africa, Chronic Disease Initiative
  • Lesotho, Partners In Health’s model of care for NCDs
  • Rwanda, Partners In Health / Inshuti Mu Buzima integrated NCD program that was nationally scaled in 2016

In this discussion moderated by Sir Magdi Yacoub and Dr. Simon Stewart, the group recognized the financial and geographical barriers that make accessing care for severe, chronic NCDs even more difficult, particularly for vulnerable and marginalized groups.

Amy McLaughlin / Partners In Health
Dr. Ana Mocumbi with Dr. Emily Wroe and Dr. Neil Gupta of the NCD Synergies team during the two-day regional dialogue.

The following sessions on Human Resources moderated by Dr. Albertino Damasceno, Dr. Custodia Mandlhate and Dr. Sharon Kapambwe; and Monitoring & Evaluation, moderated by Dr. Fassil Shiferaw and Professor Fastone Goma enabled the group to discuss the relevant recommendations from the Mozambique and Malawi Commissions in more detail. For example, Dr. Emily Wroe and Dr. Jones Masiye of the Malawi NCDI Poverty Commission highlighted the need to have a standardized set of priority indicators across the health system – ones that are feasible to collect in paper-based systems – to better understand and track the national burden of disease and patient outcomes. This can be facilitated by the use of systems such as simple standard patient charts and other data collection tools to improve patient tracking and follow-up.

Finally, Dr. Ana Mocumbi and Dr. Simon Stewart presented on key findings from an in-depth analysis studying outcomes from Emergency Departments at Maputo Hospitals. Their findings highlight a breadth of NCDs and injuries being presented, that emphasize the need for health system readiness to provide sufficient care for this broad range of conditions.

Call to Action

Amy McLaughlin / Partners In Health
Participants broke into group to discuss themes from the two-day dialogue, and identify key lessons and messages. 

Day 2 closed with breakout sessions to discuss the following key themes in addressing NCDs and injuries across the region:

  • Priority setting
  • Human resources
  • Health Information Systems
  • Financing
  • Governance and Advocacy

Given such lively discussion throughout the two days, meeting participants are now working on a Call to Action for the southern African region. This outcome document will highlight the urgency and absolute need for actionable, practical steps to address severe and endemic chronic NCDs.

Mozambique NCDI Poverty Commission Launch

On Monday June 11th the Mozambique NCDI Poverty Commission launched their final report in Maputo. With over 100 people in attendance, Dr. Ana Mocumbi, Lancet NCDI Poverty Commission co-chair and lead of the Mozambique Commission presented key findings and highlights of the report. In addition to fellow commissioners and researchers, the audience included several stakeholders namely, health professionals, academics, researchers, civil society and patient groups.

The full report is available here in Portuguese. The report in English will be published here as soon as it is available.

Amy McLaughlin / Partners In Health
Dr. Ana Mocumbi presents key findings of the Mozambique National Commission to a packed room in Maputo at the launch of the final report.