This report is based on extensive data analysis and desk research, complemented by five in-depth interviews with experts on NCDs. The main findings of the research are as follows.
The burden of disease attributable to NCDs in developing countries is increasing relentlessly. NCDs account for over half of the overall burden of disease in lower-middle-income countries, and close to one-third in low-income countries. The evidence shows that, in absolute terms, this burden increased by nearly 30% between 2000 and 2015 and impacts people at a younger age than in wealthier countries, exacerbating social and economic costs. Cardiovascular disease is the main contributor to the increase.
Existing healthcare systems are ill-equipped to manage these conditions. In general, healthcare systems in developing countries have evolved to cope with the burden of infectious diseases and to improve child and maternal health. There is now a pressing need to include the prevention and management of chronic diseases in these systems, requiring new thinking on how such medical services are financed. These services include the provision and use of appropriate treatments as well as screening and diagnostic services.
Much could be achieved through preventive policy intervention, but there is no “one-size-fits-all solution”. Driven by urbanisation, a shift to more sedentary occupations and less healthy diets, much of the increase could be mitigated through preventive healthcare policies. Such policies include targeting key risk factors, such as obesity, smoking tobacco products and alcohol abuse. Health awareness programmes, urban planning that facilitates physical activity and taxation strategies that seek to reduce demand for tobacco are all good starting points, but there is no “one-size-fits-all” solution; countries need to develop policy frameworks that reflect the national burden of disease, funding constraints and the nature of the healthcare system while also taking cultural factors into account.
Delivering appropriate NCD care to patients requires addressing multiple challenges. They encompass insufficient access to medical care and to healthcare facilities and professionals (physicians, nurses etc), but also policy weaknesses. Policies may not exist or, if they do, may not be comprehensive because they lack clear and achievable targets, adequate resources for implementation and monitoring, and evaluation processes.
Developing countries face an acute financing constraint for healthcare in general, and for NCDs in particular. On a per-capita basis, total spending on healthcare in low-income countries amounts to less than 1% of the expenditure of high-income countries, and in lower-middle-income countries it amounts to less than 2%. Out-of-pocket expenditure still represents the largest proportion of spending in developing countries, exposing most households to catastrophic healthcare expenditure. At the same time, only a tiny percentage of development assistance on health is allocated to NCDs.
Technological and organisational innovations as well as sustained, co-ordinated efforts across multiple stakeholders are required. The healthcare infrastructure developed to address Millennium Development Goals can be leveraged to face the NCD challenge. For example, there is an opportunity to leverage primary-care clinics established to deliver reproductive, maternal and child health to extend the provision of screening and treatment for cervical cancer and hypertension, as well as patient education programmes. Innovative business models offer the opportunity to create incentives for patients and healthcare providers to pursue prevention programmes. In both cases initiatives are in their infancy and warrant scaling up, an effort that will require financing.
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