Funding challenges should be overcome as new data emerges that clearly shows the impact and potential of low-cost, effective prevention strategies.
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However in this period of economic downturn, political turmoil, and multiple natural disasters, there continues to be a reactive response to funding allocation. The return on investment on NCD prevention is many years down the road and the metrics used to calculate successful outcomes are not always easily understood. Our messaging needs to be clear, succinct, and bold. These interventions need to be sustainable. There needs to be collaboration between public healthcare agencies and industry.
We need to engage industry in a productive and positive manner. Educating the population in a way that creates demand for healthier products, lifestyles, and work environments are imperative. In low-resource settings it is critical not to duplicate prevention efforts. There are many examples of cost-effective projects, programs, and policies - yet these are not often shared. Creating visibility, sharing information of these successful, low-cost, sustainable interventions are important. Creating policies that address both population strategies and personal strategies are essential.
Utilizing and developing preventive technologies and tools, rather than reaching for the most recent high tech treatment often most expensive strategies, will be important. We need to educate governments and policy-makers that following models of sick care systems like that in the US are not effective and we should instead create systems that are health focused. One of the most valued resources of low- and middle-income countries is their intellectual assets. Brain drain has contributed to the impediment of improving healthcare.
Funding is necessary to ensure that the public sector healthcare providers are sufficiently reimbursed to prevent movement to private sectors and emigration. Funding is necessary for public health training, policy development and then implementation, information technology, and health communication. It remains illogical that healthy behavior and healthier foods are more expensive and more difficult to obtain than the unhealthy alternatives.
In difficult economic times, donors are strapped, governments have fewer funds, and the personal out-of-pocket expense for the individual makes discussions and forums such as these essential and timely.
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My fellow panelists have done a terrific job initiating the conversation around questions , so perhaps I will focus my initial comments on question 4. When we talk about integrated service delivery, I find it immensely helpful to be quite precise about definitions. As Rifat Atun and his colleagues have illustrated quite elegantly, disease-focused programs are often integrated within health systems at some levels and in some ways and not at others.
Should we be attempting to integrate NCD services with primary care services? Or with each other? It probably goes without saying that not all NCD services can or should be integrated with primary care services. Providing integrated wellness counseling at the primary care level makes a lot of sense.
Having non-specialists prescribe radiation treatment for cancer, or perform valve replacement surgery for mitral stenosis is obviously a less sensible approach. Similarly, providing integrated services for chronic conditions such as diabetes and hypertension is considerably more feasible than providing integrated services for, say, chronic lung disease and road traffic accidents.
Similarly, local context is key. From a programmatic perspective, the challenge of providing continuity care over a lifetime is quite similar, no matter which chronic disease you are treating. And in many countries, HIV scale-up has created the first large-scale chronic care program in history - something that can be adapted and built upon to provide services for other chronic diseases.
And we have taken this one step further in Ethiopia, adapting HIV systems, tools, and approaches for use in diabetes care and treatment. I can describe some of this work in more detail in later posts, if people are interested. Building on what Brian Bilchik noted above, a major impediment has been the limited focus on identifying the major risk factors for NCDs among the poor in developing countries.
I also am a faculty at the Foundation. Should global health donors alter their priorities and strategies to include NCDs, or are there ways to address the NCD needs in developing countries within existing priorities and strategies? I can talk with India as an example of a developing country.
The situation is particularly grave in rural areas, where more than 70 percent of the country's 1. Yet expenditure on health care is paltry- a mere 1. The Lancet NCD Action Group and the NCD Alliance proposed five overarching priority actions for responding to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies.
Currently there is no department or Ministry for ensuring all these interventions categorically. We must also build up a much more powerful partnership between the generators of the research and the generators of policy. At present, there is no regular consultative mechanism. Dr Srinath Reddy had suggested in one of his interviews that the health ministry could have an informal committee of experts broadly for the area of public health which can meet once a month and take a view on critical challenges.
And this committee come up with suggestions that could be considered by policy makers.
This group represented by officials from ministry, private sector, academicians, medical professionals, etc, have discussed several issues on Universal health care as a part of coming up with the recommendations for the next 5 year plan for the Indian Government. This complimentary service would aid the policy making decisions, plays a role in the advisory capacity and can also shoulder responsibilities assigned by stakeholders for public health action.
One more example is from the field of higher education and research. We need to utilise our existing resources much more efficiently. For example, medical colleges in India are grossly underutilised. We can initiate short term skill building courses or training programs— on NCD epidemiology, public health, community nutrition, etc for interested students or professionals.
Forums of young professionals where dynamic youth bring fore the energy, passion and multiple disciplines together should be encouraged. How much does it cost to address NCDs in resource-limited settings, and what is the right contribution for donors to contemplate? I am not sure of the numeric costs and I am sure it will vary a lot depending on which country are we talking about..
However, I think one comment which I can make is that both direct and indirect costs should be considered while computing these. Costs which donors should contemplate while contributing need to encompass: 1. Costs for providing treatment for the ones already inflicted with NCDs 2.
Costs for putting prevention mechanisms in place including knowledge generation activities 3. Costs for preventing and treating Risk factors for NCDs Are there good examples of integrated service delivery or innovative partnerships to address NCDs? We have no method of telling how many Indians suffer a heart attack each year. I see Surveillance at national and global levels to play a critical role in addressing or at least mapping out trends, vulnerable areas, incidence of disease, risk factors etc.
This quality information is required urgently to tackle this huge burden of NCDs. We can definitely triangulate information from other national surveys like NFHS but a sustainable and quality surveillance mechanism in place can really act as a great health index for any country. Another area I feel needs innovative partnerships and inter-sectoral participation is improving the health education curricula and delivery. A recent commission of global experts from various fields also recommended designing new instructional and institutional strategies to combat multiple looming health challenges Lancet publication Frenk et al, The recommendations include aligning national efforts through joint planning, especially in the education and health sectors, engaging all stakeholders in the reform process and developing global collaborative networks for mutual strengthening.
They also advocate developing competency-based curriculum of globally recognized high academic standards. Courses and thereby professionals on public health, NCD epidemiology, public health nutrition, physical activity and lifestyle management are virtually nonexistent in a country like India where they are needed the most. Should external funding from the private sector be utilized to address NCDs in poor countries? We at PHFI are also a public-private partnership working towards nurturing and producing a pool of professionals who could contribute in bettering the public health current scenario in India.
But if by private sector you mean industry- my personal view would be to refrain any technical involvement of industry especially the food industry. We all recognize that unhealthy diet is one of most important risk factors for NCDs. Thus I feel that allowing industry to openly blur our objectivity is a waste of resources.
[PDF] Tackling Noncommunicable Diseases in Bangladesh: Now Is the Time (Directions in Development)
There are several arguments put forward by Jeff Koplan, Kelly Brownell and others against food industry being allowed to influence decisions for public health. An option however could be accepting blind donations without any obligation to announce where the money came from. So if the industries genuinely feel like endorsing improved public health, they should give the money in a blinded fashion. Other ways to help tackle NCDs could be announcing public health scholarships for bright students from resource-constrained countries to pursue their passion in this field.
Tackling noncommunicable diseases in Bangladesh : now is the time (English) | The World Bank
Nutritional disorders: Deficiencies of elements such as iron required for normal growth and development are widespread. An evolving and complex background of persisting undernutrition and emerging obesity also increase disease risks.
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Risk behaviours: "Western" lifestyles eg, unhealthy diets, physical inactivity are increasing, and may amplify adverse effects of traditional risk behaviours, augmenting disease risk. These social, environmental, and behavioural risk factors tend to cluster in households, share antecedents and causes, amplify each other's effects, and depend on one another in complex and non-obvious ways. Importantly, they can also exert importantly different effects in differing contexts such as across rural, urban, and slum settings.
Hence, approaches that could tackle such chronic disease risk factors in combination rather than in isolation are likely to be more powerful, as well as approaches that can take account of the context in which they occur. Yet, Bangladesh's research infrastructure is not configured to evaluate the country's multiple risks and multiple settings, perhaps preventing the emergence of evidence that could suggest "joined up" solutions. Our proposal aims to address this grand challenge. We will mobilise a multidisciplinary team of about 25 leading investigators from seven organisations in Bangladesh and the UK that have a substantial track-record of working together.
We will adopt a wide-angle approach, focusing on intertwined risk factors for chronic disease that have not previously been considered in an integrated framework. The plan offers a fundamentally new approach to address this problem because it combines four innovative and inter-linked components: 1 Creation of a ,participant study "cohort" in urban, rural, and slum areas to enable study of the social, environmental, and behavioural risk factors for chronic diseases. We acknowledge that such an impact is unrealistic within a 4 year grant period, especially since the funding call requests "feasibility, scoping, exploratory, proof of concept studies" rather than fullscale implementation trials.
The models will improve the ability to predict likely effects of interventions before deciding how to invest resources in real interventions, a major benefit for Bangladesh's resource-constrained authorities We recognise that impact is a 2-way process, with our research priorities shaped by policy and public health needs, encouraging us to pursue a partnership approach, co-producing tools and publications and working closely with policymakers and public health practitioners.
Publications The following are buttons which change the sort order, pressing the active button will toggle the sort order Author Name descending press to sort ascending. Corbin LJ Formalising recall by genotype as an efficient approach to detailed phenotyping and causal inference. Emdin CA Analysis of predicted loss-of-function variants in UK Biobank identifies variants protective for disease. Farahi N Neutrophil-mediated IL-6 receptor trans-signaling and the risk of chronic obstructive pulmonary disease and asthma. Malik R Multiancestry genome-wide association study of , subjects identifies 32 loci associated with stroke and stroke subtypes.
Saleheen D Human knockouts and phenotypic analysis in a cohort with a high rate of consanguinity. Through this policy, Bangladesh witnessed early success in PPPs. To build on this success in other areas of infrastructure, the Government of Bangladesh introduced the Private Sector Infrastructure Guidelines in This marked the start of the program-based PPP initiatives in Bangladesh.
However, the results during this period were more modest, with only a handful of projects coming to fruition. The Plan focuses on the enhancement of infrastructure investment from approximately two to six percent of GDP, using PPP as a key tool in meeting this infrastructure gap.
With strong political support and enhanced institutional capability, underpinned by real financial commitment and a PPP Act in the final stages of enactment in the parliament, the key fundamentals are in place for an enabling PPP environment in Bangladesh. The first signs of success are there, and a clear path has been laid out for this success to continue and grow in the years ahead.
As PPP projects are delivered one after another, as lights get switched on in homes, as industries get powered, as new roads mitigate transport bottlenecks and as new health services save lives, it is worth sparing a thought for the one who introduced PPPs. Through PPPs, developing countries now have an additional delivery mechanism to meet their public service commitment and drive increased prosperity.
PPPs have provided an enhanced opportunity to make a real difference in the delivery of public services. Perhaps we will never be able to identify who introduced PPPs. Publication does not imply endorsement of views by the World Economic Forum.
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