Opinion: To stem the tide of NCDs, redesign the health care systems

People at a hospital in Ghana. Photo by: C.C. Chapman / CC BY-NC-ND

Today’s health care systems were not designed to protect us against the rapidly rising health threats of the 21st century. The legacy systems in most countries were designed to treat patients suffering from acute illnesses, primarily caused by infectious diseases. While germs aren’t going away, the rapid rise in noncommunicable diseases — including heart disease, cancer, and diabetes — has left health care systems poorly equipped to serve the needs of patients with chronic illnesses.

NCDs have risen so dramatically in recent years that they now account for over 70 percent of deaths worldwide. While NCDs are ubiquitous, they hit low- and middle-income countries hardest. As global living standards improve, emerging economies can produce harmful effects that promote NCDs: unhealthy diets, sedentary lifestyles, alcohol abuse, polluted air. Today, 4 in 5 premature deaths from an NCD occur in low- and middle-income countries.

New data from health experts in Ghana and the United Kingdom show that even severely resource-constrained communities can achieve major gains against NCDs when the health care system is redesigned to be more community-based. This means bringing health care service delivery closer to where people live, work, and shop, rather than continuing to centralize services within health care facilities.

Innovating in health care service delivery

Cardiovascular disease risks growing out of control, in Ghana just 4 percent of people with hypertension have their condition controlled — the leading risk factor for cardiovascular disease.

To prevent this situation from fueling a future wave of cardiovascular disease, a partnership between the Ghana Health Service, London School of Hygiene and Tropical Medicine, University of Ghana School of Public Health, nonprofit organization FHI 360, and Novartis Foundation created an array of new hypertension screening points — not in health facilities, but rather inside popular local shops and businesses.

This initiative titled the Community-based Hypertension Improvement Program placed this critical service within communities, and used simple digital technology to connect participants with health care providers when needed. Hypertension control rates among people who participated in the program for more than a year doubled — from 36 percent to 72 percent. This practical approach has been so effective that Ghana’s government is now adopting it within national policy.

The effectiveness of community-based care

The community program provided strong proof of concept, and we see real potential to replicate this approach in other countries and for other NCDs. Here are three lessons we’ve learned.

1. Local partnerships make all the difference. By teaming up with local businesses and community leaders — including shopkeepers who had never played a role in health care before — many people were able to access cardiovascular screenings for the first time.

2. Digital health is essential. Technology was the glue that connected the screening points with health care workers who could make diagnoses and provide care while supporting health care workers’ decision-making. SMS alerts helped patients manage their condition. Leveraging simple existing solutions such as mobile phones meant we could limit new investments in digital technology — good news for bringing to scale.

3. A people-centered approach empowers individuals to care for their own health. The SMS text alerts helped patients adhere to treatment, diet, and exercise routines, which is crucial to managing their conditions and avoiding complications from poorly controlled hypertension.

To stem the rising tide of NCDs, existing health care systems must evolve by forging new partnerships with unconventional actors and patients and empowering everyone through digital technology. The health care systems that will prove most effective at keeping people well through the next century are those that are not only facility-based but also involve nontraditional health players in the community.

Devex, with financial support from our partner MSD for Mothers, is exploring how the private sector is driving innovations in global health. Visit the Focus on: Future of Health Partnerships page for more.

About the authors

  • Portrait%2520ann%2520aerts

    Ann Aerts

    Dr. Ann Aerts has been head of the Novartis Foundation since January 2013. The foundation is an organization committed to having a transformational impact on the health of low-income populations. Ann holds a degree in medicine and a master's in public health from the University of Leuven, Belgium, and a degree in tropical medicine from the Institute of Tropical Medicine in Antwerp, Belgium. In 2014, Ann was nominated by PharmaVOICE as one of the 100 Most Inspiring People in the life science industry.
  • Peter lamptey

    Peter Lamptey

    Peter Lamptey is a professor of noncommunicable diseases at the London School of Hygiene and Tropical Medicine and serves on the Global Advisory Group for the LSHTM Centre for Global Chronic Conditions. He is president emeritus/distinguished scientist at FHI360. He is an internationally recognized public health physician and expert in communicable and noncommunicable diseases in low- and middle-income countries. With a career at FHI360 spanning more than 35 years, Peter has been instrumental in establishing FHI360 as one of the world’s leading INGOs in implementing HIV/AIDS programs.