MANILA — If 70 percent of deaths globally are due to noncommunicable diseases according to the World Health Organization, the question is where and in what contexts?
The most common response is that most of these deaths are occurring in low- and middle-income countries, accounting for 31 million of the 40 million deaths from NCDs worldwide annually. This is a result of several factors at play, including aggressive advertising of unhealthy food and beverages to a population with little education or increasingly gaining some disposable income.
But does that capture those refugees and displaced communities in the midst of conflict and suffering from disrupted and weakened — if not broken — health systems?
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Increasingly, aid actors are recognizing the growing burden of NCDs in humanitarian emergencies. But developing programs specific to NCDs and managing these chronic conditions well, particularly in an unwelcoming environment, can be challenging. Chronic diseases, for one, require follow-up and long term commitment.
But several actors are hoping to make headway in terms of better addressing and managing them.
Late last week, the International Committee of the Red Cross, Danish pharmaceutical company Novo Nordisk, and the Danish Red Cross announced they are engaging in a new partnership aimed at better tackling the growing issue of chronic diseases such as diabetes and cardiovascular diseases in conflict and fragile settings. The partnership is in response to the increasingly changing epidemiological profile of people on the ground where these actors are involved.
Apart from close collaboration and harnessing each actor’s expertise, part of the plan is to launch — in the next three years — two to three projects aimed at providing care to people suffering from hypertension and diabetes in conflict and fragile settings.
“What we want to do is document what practices are applicable and more beneficial for the patients in conflict settings. Also, how can we, based on evidence, influence policy so in the long run there is a more sustainable system that caters to patients in conflict settings or in high fragility areas in general,” said Esperanza Martinez, ICRC’s head of health.
Martinez said they have so far pre-identified some countries in the Middle East and Africa where projects could be developed. In the Middle East for example, they examined Lebanon, currently serving as temporary home to a large volume of refugees from neighboring countries like Syria, and facing significant burden of chronic diseases.
“We are also looking at countries like Syria and Iraq, as the war basically has impacted health systems and rendered them unable to cope with the demands for treatment and follow up of patients with chronic diseases,” she said.
In Africa, they’re looking at countries like Nigeria and South Sudan, where protracted crises have furthered an already “very low functioning health system.”
But none of it is final, and they are still discussing the feasibility and relevance of working in these different contexts. After all, their goal is much more than just to make interventions.
“Currently, we are evaluating if these initially identified contexts would be feasible for NCDs program development as access of patients to healthcare services and of health care workers to communities is essential. If we don’t have access, then it will be difficult to move from just a traditional philanthropic donation towards actual follow-up of patients, data collection and ultimately, the identification of what model works,” the ICRC official said.
“If what we want to achieve in this partnership is to inform best practice and quality delivery of (NCD) care, it can only be done if we’re able to deploy these projects in contexts where we’re allowed to have regular access to the communities affected,” she added.
The London School of Hygiene and Tropical Medicine will help conduct needs assessment, guide the design of the interventions, and, perhaps most importantly, evaluate them to help inform the future direction of NCD prevention and care in humanitarian settings.
But there is another area where the partnership could come “very handy,” Martinez said: improved data management.
“Data collection in humanitarian settings is very complex, and for patients with multiple conditions, the disaggregation of data is challenging,” she said.
“For example we may treat a patient who is amputated. He is amputated due to complications following a gunshot. However, the gunshot might not have led to amputation if the person had his diabetes under control. So probably the person is reported in our data systems as a gunshot wound, or as weapon wounded, when in reality he should have been reported as well as a diabetic patient,” she added. Improving these data collection hurdles would allow for better monitoring of the burden of NCDs in these contexts.
For more coverage of NCDs, visit the Taking the Pulse series here.