Many people believe that noncommunicable diseases, such as heart disease, diabetes, asthma and cancer, are predominantly seen in high-income countries. In fact, World Health Organization data show that almost three-quarters of NCD deaths — 28 million — occur in low- and middle-income countries. This is partly a reflection of steady economic progress: as countries become wealthier and more urbanized, people adopt unhealthy lifestyles with the associated risks of obesity, and smoking- and alcohol-related disease.
In addition, the success of most African countries in reducing deaths from infectious diseases, pregnancies and malnutrition has led to significant gains in life span. In Ethiopia, for instance, the average life expectancy has increased by 10 years over the past decade. As a result, in many lower-income countries we are now witnessing a transition from infectious disease toward NCDs as a key cause of death and disability.
Many African governments recognize the threat and are trying to educate the public about the risks of unhealthy lifestyles. In Kenya, the government has created a five-year strategy to achieve higher public awareness around chronic diseases, and Rwanda has a similar public education program. But experience from infectious diseases shows that the availability of affordable medicines for NCDs will be essential, as it is only when people know that they can access treatment that they attend a health clinic for a diagnosis.
Empowering LICs to address chronic diseases
“Experience shows that investing in health is wise — workforces become more productive, fewer households fall into absolute poverty, and improved health in itself represents a real economic and developmental outcome.”— Harald Nusser, global head, Novartis Access
We need novel approaches to tackle the challenge of NCDs in poorer countries. With this in mind, Novartis has launched Novartis Access, a new program to provide governments, nongovernmental organizations and other public-sector customers access to a portfolio of medicines at a price of $1 per treatment per month to treat cardiovascular diseases, diabetes, breast cancer and respiratory illnesses.
Novartis Access is currently being rolled out in Kenya and we are hoping 30 lower-income countries will join over time. Given the expected scale of the program and the fact that chronic conditions often require lifelong treatment, the long-term sustainability of the program is key. While the program is loss-making at this stage, in the medium term we hope to break even. The fixed cost means health systems can plan expenditure more predictably.
Partnership is at the core of the program. In Kenya, we work closely with the government and leading Christian groups providing health care services, including the Kenyan Conference of Catholic Bishops, the Christian Health Association of Kenya, and the Mission for Essential Drugs and Supplies.
The medicines we provide meet the government’s priorities in fighting NCDs, and we are working closely with the ministry of health and the counties to plan the rollout of the program across the public health system in the country. But, this is not just about supplying medicines — we have to ensure health care workers are trained on the proper diagnosis and treatment of NCDs. This is not an easy task in a health system where most doctors and nurses — understandably — have been trained mainly to diagnose and treat infectious diseases.
Learning from infectious diseases, coping with chronic diseases
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Dr. Jonathan Kiliko, the head of customer service at Mission for Essential Drugs and Supplies, predicted in a recent panel discussion that new approaches such as Novartis Access will help change the way many Kenyans look at chronic diseases. In his view, when patients know that early diagnosis and adherence to treatment can help them live well for many years, a virtuous circle of peer education starts.
In other words, patients on treatment start to teach the rest of the community about the benefits of being treated. This has already been seen in HIV/AIDS, and is likely to be replicated with NCDs.
Continuity of drug supply is essential in chronic disease, where patients are mainly taking their treatment on a daily basis. Novartis Access is working with Management Sciences for Health to strengthen supply chains in Kenya. Dr. Jonathan D. Quick, the president and CEO of MSH, said learning from existing systems of inventory control used in infectious diseases can help ensure patients actually receive the treatments they need at an affordable price. He also points out that medicine supply needs to be supported by access to cost-effective diagnostic tools, such as blood pressure cuffs and blood glucose meters.
All of this costs money. Low-income countries can access funding for treatment for the big infectious disease killers such as tuberculosis, malaria and HIV/AIDS through the Global Fund, but no such financing facility exists for NCDs. New financing routes are needed to help countries establish basic primary care, which is the bedrock for effective management of NCDs. This is likely to come from a combination of increased domestic fiscal space for health, concessionary loans for health care infrastructure from development finance institutions, and by development assistance for the poorest countries.
Experience shows that investing in health is wise — workforces become more productive, fewer households fall into absolute poverty, and improved health in itself represents a real economic and developmental outcome.
What gets measured gets managed
Developing a culture of continuous learning, transparency and accountability is very important. Novartis Access will be independently assessed by a team led by professor Richard Laing of Boston University, and their findings will be published in due course. This research will reveal what works well and what doesn’t, helping us improve our systems and processes — hopefully also benefitting others working to improve health care systems in such countries.
We are still at the early stages of our journey. We have much to learn, but we do know that success will be determined by working with governments and other partners to empower them to manage the impact of NCDs. Chronic diseases such as hypertension and diabetes tend to smolder quietly over time. MSH’s Quick likens NCDs to an underground forest fire: initially it smokes a little, but all of a sudden flames are leaping up everywhere. We are hoping that Novartis Access can make a real contribution to stopping that fire taking hold.
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