By Juliet Aweko
Health systems across the world are being challenged by existing and emerging communicable diseases, such as Zika and Ebola, as well as the increase in chronic and non-communicable diseases (NCDs), like diabetes and cancer. Staggeringly, NCDs represent the single largest cause of mortality and morbidity in adults. So, is there anything we can learn to from the management of chronic and communicable diseases in tackling the growth of the NCDs.
NCDs burden to the health system
The burden of NCDs is expected to rise dramatically along with the shift towards ageing populations, and we will have to reshape our health systems to withstand and respond to this. Lower and middle income countries (LMICs) are likely to bear the brunt of this burden, particularly as their health systems are even more ill-equipped to respond to the double burden of disease.
Even in high-income countries (HICs), health care professionals are still oriented towards acute care. In fact, more focus has been on the clinical response, particularly hospital-based management of NCDs rather than prevention. There is inadequate focus on community involvement, integration and contextualization of NCDs prevention and management practices in routine care.
Why does resilience matter?
The recent Ebola outbreak exposed the struggling health systems of many low income countries and that these weak health systems posed to global health security and economic development. As a result, recent discussions and the focus of the Fourth Global Symposium for Health Systems Research are on building ‘resilient and responsive health systems for a changing world’.
Resilience is not a new concept. But it is one which should be an inherent objective of universal health coverage or a well-functioning health system, and applied to tackling both communicable diseases as well as NCDs. As defined by Kutzin and Sparkles: resilience of a health system is its ability to absorb disturbance, to adapt and respond with the provision of needed services.
Health systems need to be more innovative and prepared at all time to adjust to an emerging crisis while maintaining their core function. Moreover, they should be able to use applicable ideas and lessons learnt from previous experience in management of existing communicable diseases to tackle emerging diseases.
Lessons from chronic communicable disease care
Over the years, health systems in LMICs have traditionally focused on the management of poor maternal and child health, communicable diseases, and other related conditions. As a result, community empowerment strategies such as task-shifting and community care workers were initiated and integral to providing care services for certain conditions to people at community level. Strategies like these can and should be used for acute and communicable diseases can be adapted and scaled up across contexts worldwide to manage other chronic diseases particularly NCDs.
There are lessons which can be learnt and borrowed from the HIV-related experiences in Sub-Saharan Africa to address diabetes as a ‘chronic lifelong condition’ similar to HIV/AIDS. Integrated HIV and AIDS care approaches using task shifting at the primary health care level, use of expert patients and peer support groups have been utilized to tackle the heavy patient-load in understaffed health facilities. These ideas are highly relevant and very likely cost-effective to replicate where applicable.
SMART2D, an EU funded project, is an example of an initiative aimed at improving self-management for Type 2-diabetes. Alongside task-shifting, this project focuses on creating alternate teams of health care providers or community health workers and expanding care networks through peer support groups. These approaches are being integrated into routine care for type 2-diabetes across a varieties of countries with different needs and resources, such as Sweden, South Africa and Uganda.
It is high-time that we borrow these very practical ideas from chronic disease care strategies and adapt them accordingly. Taking these lessons will go far in supporting health systems to cope with the rising burden of NCDs in all communities.
This blog post is part of a series addressing: ‘resilient & responsive health systems for a changing world’. These blog posts were originally essays written by members of the Emerging Voices TWG.