NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Learning How to Deliver Noncommunicable Disease Care in East Africa

On Sept. 25, 2015, the Sustainable Development Goals (SDGs) were unanimously adopted by all 193 member states of the United Nations (UN). Though this is the second ambitious 15-year development commitment the UN has adopted in the 21^st century, it is the first to include noncommunicable diseases (NCDs).

This is a hallmark moment in global health, as the UN’s development commitments influence donor funding, government priorities and research agendas. For the first time, the global health community is being called to act against the rise of NCDs, the root cause of 38 million of the 56 million deaths in 2012.

What may come as a shock, given that NCDs are generally thought of as diseases of affluence, is that Africa as a whole is poised to bear the bulk of the NCD burden in the coming years:

• By 2020, projections indicate that the largest increases in NCD deaths will occur in Africa; and
• By 2030, deaths from NCDs in Africa are projected to exceed the combined deaths of communicable and nutritional diseases and maternal and perinatal deaths.

NEEDED: INNOVATIVE PARTNERSHIPS

To help stem this tide of emerging diseases, dynamic and innovative partnerships between governments, the private sector and NGOs are needed. And if we as the pharmaceutical industry are to truly innovate in this space, partnership will require stepping outside the traditional role of a philanthropic financier in global health.

Through our Healthy Heart Africa program, AstraZeneca is testing new ways of working with local governments, bringing scientific and logistic offerings to bear, and marrying them with the expertise of multiple local and international NGOs. The result is a “360 degree” approach to address hypertension in Kenya – one of the leading causes of cardiovascular disease – by raising the general public’s awareness about high blood pressure, training health care workers to provide comprehensive and appropriate non-emergency levels of care, and providing access to affordable, high-quality treatments for hypertension.

Since Healthy Heart Africa’s launch in Kenya in October 2014, 1.2 million blood pressure screenings have taken place through the program and identified 150,000 people with hypertension.

INITIAL LEARNINGS

Through monitoring and evaluation, Healthy Heart Africa has generated learnings around how to effectively deliver preventative NCD care in resource-limited settings.

We are now using these lessons to expand the approach both in Kenya and to Ethiopia, where an estimated 34 percent of all deaths were due to NCDs in 2011and roughly 20 percent of the overall population is estimated to be hypertensive.

Related Post: Integrating NCDs Into Post-2015 Agenda

As we continue to expand the program, our experience has suggested that the following learnings will be key to expanding access to chronic NCD care:

• Identifying the right patients: Reaching individuals at risk for NCDs, particularly hypertension, is a challenging task given the asymptomatic nature of these conditions; many don’t recognize the need to seek care until complications occur. To overcome this barrier, we’ve identified an array of strategies for how to reach particular populations at risk for hypertension, including men of working age who historically have had more limited interactions with the health system.

• Linking patients into care: It is not uncommon for a patient’s point of entry into the health care system to be different than where he or she ends up receiving treatment for chronic care; many patients receive care for chronic diseases at hospitals as opposed to primary care facilities, as low-level health facilities are ill-prepared to address diagnosis and treatment of patients with NCDs. Multiple blood pressure readings are required to make a diagnosis, requiring repeated interaction with the health system. To ensure patients remain in the health system from screening through to treatment, we’re creating linkages between facilities through patient navigation networks across different levels of care – known as a cluster approach.

• Ensuring adherence to treatment: In health systems geared largely toward providing acute care rather than long-term chronic care, rates of compliance for chronic diseases are often low. To reduce patient drop-off, we’re testing strategies to strengthen follow-up services to ensure individuals are retained in care once enrolled on treatment.

Underlying all of these learnings is the consistent takeaway that care must be brought as close to the target population as possible, and tailored to the specific characteristics of this population where possible.

A CALL TO ACTION

As the global health community begins to rally behind the SDGs and fully realize the importance of combating the rise of NCDs, bringing these commitments to life will require a reimagining of the private sector’s role in this fight. Reflecting on the Healthy Heart Africa experience, there are a number of ways to do so:

• Bring more than money to the table and leverage core business skills to overcome notable challenges in the NCD space;
• Take a flexible approach and be willing to course correct often and thoughtfully; and
• Rigorously evaluate these models and rapidly share results with key stakeholders in the NCD space.

Mark Mallon