ZEANA MASOUD SAID

Zeana has type 1 diabetes and hypertension. She lives with her family in Dar es Salaam, Tanzania.

Scaling up action on NCDs

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What are

NCDs?Non-communicable disease (NCDs), also known as chronic diseases, tend to be of long duration and result from a combination of behavioural, physiological, environmental, and genetic factors.1 Communicable or infectious diseases are caused by pathogens such as bacteria, viruses, parasites and fungi. These diseases can be spread directly or indirectly, from one person to another.2

Four major NCDs are responsible for almost 80% of NCD-related deaths:1

CANCER

CARDIOVASCULAR DISEASE

CHRONIC RESPIRATORY DISEASE

DIABETES

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3/4 OF NCD-RELATED DEATHS OCCUR IN LOW- AND MIDDLE-INCOME COUNTRIES1

The immense challenge of living with a non-communicable disease in a low-resource country

Rapid demographic, sociocultural and economic transitions are driving a surge in the number of people impacted by NCDs in low-resource countries.*1,5 The impacts, including significant health and economic consequences, are already evident.5

NCDs are the leading cause of death and disability globally, accounting for 71% of all deaths in 2016.1 An increasing number of these deaths occur in low-resource countries, affecting adults at a younger age.1

Each year, 15 million people between the ages of 30 and 69 die prematurely from an NCD. More than 85% of these premature deaths occur in low- and middle-income countries.1

Poverty is closely linked with NCDs.1 Vulnerable and socially disadvantaged people get sicker and die sooner than people in higher socioeconomic groups, essentially because they cannot access affordable diagnosis and healthcare.1,6

Globally, 2 billion people have no access to basic medicines, resulting in a cascade of preventable misery and suffering.7 The availability and affordability of essential medicines and technologies are impacted by several barriers at national level, including weak supply chains, insufficient funding, inadequate health systems, overburdened regulatory structures and conflicting national essential medicines lists.8

U LAY MYINT

U Lay Myint has type 2 diabetes, hypertension and diabetes-related eye complications. He is a rickshaw driver and lives in Myanmar.

© IMAGE : JESPER WESTLEY/WORLD DIABETES FOUNDATION

* Least developed countries (United Nations, 20183), low-income countries and lower-middle-income countries (World Bank, 20184).

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A Partnership for scaling up action

VISION Our vision is of a world where there is universal health coverage for all people

with NCDs.

MISSIONOur mission is to enable and assist all low-resource countries to scale up sustained action on NCDs.

PARTNERSHIPThe Defeat-NCD Partnership is a ‘public–private–people’ partnership anchored in the United Nations. We partner with governments, multilateral agencies, civil society, academia, philanthropic foundations and the private sector. The Partnership aims to gather and mobilise global and national knowledge, tools, capacities and finances to benefit low-resource countries.

ACTIONSThe Partnership will initially focus on diabetes and hypertension. Both conditions are closely related and contribute significantly to the burden of premature mortality and disability from NCDs.9,10 Subsequently, the Partnership will address other NCDs of major prevalence and impact such as certain cancers and lung conditions. The Partnership will drive action across four key areas :

NCD NATIONAL CAPACITY BUILDING: Help governments to strengthen key institutions and develop practical costed action plans

NCD COMMUNITY HEALTH SCALE-UP: Increase the provision of NCD services through community action and health system strengthening

NCD MARKETPLACE: Expand the consistent availability of affordable essential medicines, diagnostics and technologies for NCDs

NCD FINANCING: Support low-resource countries in securing financing to achieve universal health coverage for NCDs

DAW THEIN YI

Daw Thein Yi has type 2 diabetes and lung cancer. She lives in Yangon, Mayanmar.

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Urgent need for action

NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes the target (SDG 3.4) of reducing premature deaths from NCDs by one-third by 2030.5

Despite global advocacy, progress towards achieving SDG 3.4 has been slow.5

If cost-effective interventions are not scaled up, healthcare costs will escalate rapidly. The continued lack of investment in action on NCDs will have enormous health, economic and societal consequences in all countries.5

Innovative and bold public–private partnerships are needed to take decisive action that will defeat NCDs and achieve SDG target 3.4.

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The Partnership will drive action across four key areas

NATIONAL CAPACITY BUILDING

Help governments to strengthen key institutions and develop practical costed action plans

The Defeat-NCD Partnership will support governments and national ministries of health in assessing gaps in their institutional capabilities and health systems to help establish or update national NCD action plans.

Assistance includes epidemiological, economic and service delivery studies, training and technical advice, procurement and distribution capacity planning, developing domestic public–private partnerships, and support with organising domestic and international financing. National expertise, institutions and civil society will be prioritised in the development of plans to ensure an inclusive and participatory process.

The overall objective is to ensure that partner countries have credible action plans, and unified and nationally coordinated financing frameworks, to tackle NCDs in a sustainable manner.

COMMUNITY HEALTH SCALE-UP

Increase the provision of NCD services through community action and health system strengthening

Tackling the rising NCD epidemic requires close interlinkage between community-based and primary healthcare systems, and strong partnerships with private caregivers.

The Partnership will work with national and local partners to bring NCD services directly to more people. By scaling up community education and screening for risk factors, early disease management, and increasing the use of digital tools, we aim to expand affordable access to treatment. Primary healthcare facilities will be equipped and supplied, and healthcare workers will be trained to identify those at risk and treat those with an NCD.

The Partnership will also have a humanitarian crisis support function for people with NCDs who find themselves in crisis situations due to disaster or conflict.

The overall objective is to ensure that more people receive earlier diagnosis of and quality treatment for NCDs, avoiding costly complications and enabling them to lead healthy and productive lives.

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MARKETPLACE

Expand the consistent availability of affordable essential medicines, diagnostics and technologies for NCDs

The NCD Marketplace will be a mechanism to make the provision of essential medicines, diagnostics and equipment simpler and more cost-effective for low-resource countries. With market sizing and price tracking studies conducted in resource-poor countries, the Marketplace is structured to create a competitive environment serving the interests of both buyers and suppliers while bringing transparency to the process.

Leveraging market dynamics, such as pooled purchasing power, the Marketplace – including its online procurement facility – seeks to achieve lower prices, improved quality control, standardisation and more effective supply chains.

Financial returns from the Marketplace will be ploughed back into countries to assist them with building stronger national procurement and supply chain management capacities.

The overall objective is to help countries improve procurement and distribution of essential medicines and technologies, to ensure consistent availability and optimise affordability.

FINANCING

Support low-resource countries in securing financing to achieve universal health coverage for NCDs

Health resources must be prioritised to address the growing NCD burden. Therefore, the Partnership will work to advise countries in finding the fiscal space that will permit them to invest more in the prevention and management of NCDs from their own national and social welfare budgets.

However, low-resource countries will still face significant financing gaps that need filling, which is why the Partnership will establish an NCD Financing Facility to provide help through a mix of approaches. These will include financing schemes such as microfinancing and insurance, innovative commercial investing via public–private partnerships, social and philanthropic funding, and additional development assistance from multilateral and bilateral partners.

The overall objective is to establish a long-term sustainable business model for improving access to treatment and care for NCDs in low-resource countries, recognising that these are lifelong conditions requiring ongoing attention.

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TUNISIA 86%

CENTRAL AFRICAN REP 26%

GUINEA-BISSAU 30%

SAO TOME AND PRINCIPE 55%

NIGERIA 29%

CAMEROON 35%

CONGO, REP 35%

CONGO, DEM REP 28%

GUINEA 35%

SIERRA LEONE 33%

LIBERIA 31%

BURKINA FASO 33%

IVORY COAST 37%

GHANA 43%

TOGO 38%

BENIN 36%

MOROCCO 80%

MALI 30%

GAMBIA 34%

HAITI 57%

NIGER 27%

BOLIVIA 64%

EL SALVADOR 74%

HONDURAS 66%

SENEGAL 42%

CAPE VERDE 70%

CHAD 27%

KOSOVO NO DATA

NICARAGUA 76%

3 OUT OF 5 DEATHS IN LOW-RESOURCE COUNTRIES WERE DUE TO AN NCD-RELATED CAUSE IN 201611

ROSE BY15%FROM 2010 TO 2016 IN LOW-RESOURCE COUNTRIES, RISING FASTER THAN THE RATE OF DECLINE OF COMMUNICABLE DISEASES11

NCD DEATHS

MAURITANIA 37%

Impact of NCDs in low-resource countries Percentage (%) of total deaths due to NCDs, 201611

DEVELOPMENT ASSISTANCE FOR NCDS IS PROPORTIONALLY LOW COMPARED WITH OTHER DISEASE AREAS12

INVESTING IN NCD PREVENTION AND MANAGEMENT NOT ONLY IMPROVES HEALTH AND SAVES LIVES, BUT CAN ALSO IMPROVE A COUNTRY’S ECONOMIC PRODUCTIVITY13

Low-resource countries in scope for The Defeat-NCD Partnership

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ANGOLA 27%

BANGLADESH 67%

AFGHANISTAN 44%

ZAMBIA 29%

LESOTHO32%

SWAZILAND 37%

ZIMBABWE 33%

MOZAMBIQUE 27%

MADAGASCAR 43%

MALAWI 32%

TANZANIA 33%

KENYA 27%

SOUTH SUDAN 27%

SOMALIA 24%

UGANDA 33%

RWANDA 44%

COMOROS 42%

BURUNDI 32%

ETHIOPIA 39%

NEPAL 66%

INDIA 56%

INDONESIA 73%

SRI LANKA 83%

BHUTAN 69%

TAJIKISTAN 69%

PAKISTAN 58%

KYRGYZSTAN 83%

EAST TIMOR 45%

MYANMAR 68%

KIRIBATI 64%

TUVALU NO DATA

LAOS 60%

CAMBODIA 64%

VIETNAM 77%

PHILIPPINES 67%

PAPUA NEW GUINEA 56%

KOREA DPR 84%

MONGOLIA 80%

SOLOMON ISLANDS 69%

VANUATU 74%

ERITREA 45% YEMEN 57%

DJIBOUTI 44%

SUDAN 52%

EGYPT 84%

SYRIA 45%

MOLDOVA 90% GEORGIA 94%

UZBEKISTAN 84%UKRAINE 91%

MICRONESIA FED. STATES 75%

Countries classified as least developed countries (United Nations, 20183), low-income countries and lower-middle-income countries (World Bank, 20184).

Countries in scope may change as the official lists are updated annually.

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100 MILLION PEOPLEARE PUSHED BELOW THE POVERTY LINE ANNUALLY DUE TO THE HIGH COST OF HEALTH SERVICES17

POVERTY AT HOUSEHOLD LEVEL

POPULATIONS IN LOW-RESOURCE COUNTRIES

Increased exposure to NCD risk factors Chronic respiratory

disease

Chronic kidney disease

Diabetes

Cardiovascular disease

Loss of income due to unhealthy behaviours

Loss of income due to poor health and premature death

Loss of income due to high cost of healthcare

Development of NCDs

Limited access to equitable healthcare services and medicines

Malaria

Tuberculosis

HIV

NCDs, poverty and development

NCDs and other diseases

Cycle of NCDs and poverty Interactions between communicable diseases and NCDs20

Poverty contributes to NCDs, and NCDs contribute to poverty.

Poverty exposes individuals to the adverse political, economic and cultural conditions that cause NCDs and increases the risk of disability and premature death.14–16 Furthermore, developing an NCD in a low-resource country increases the risk of falling into poverty.17

NCDs are interconnected and also interact with communicable diseases.

Driven by common risk factors, together with demographic changes, NCDs are closely interconnected. Often, two or more NCDs manifest in the same individual.18

Health systems also increasingly have to manage patients living with communicable diseases alongside NCDs. For example, people with HIV are living longer and thus developing NCDs as they age, and some antiretroviral drugs increase the risk of developing NCDs such as diabetes.19

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1. World Health Organization. Noncommunicable Diseases. Fact sheet. 2018; available at: www.who.int/mediacentre/factsheets/fs355/en/. Accessed July 2018. 2. World Health Organization. Health topics: Infectious diseases. 2018; available at: http://www.who.int/topics/infectious_diseases/en/. Accessed August 2018. 3. United Nations. List of Least Developed Countries. 2018; available at: www.un.org/en/development/desa/policy/cdp/ldc/ldc_list.pdf. Accessed August 2018. 4. World Bank. World Bank list of economies. Washington, DC: The World Bank Group; 2018; available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed August 2018. 5. World Health Organization. Time to deliver: report of the WHO Independent high-level commission on noncommunicable diseases. 2018. 9241514167. 6. World Health Organization. Equitable access to essential medicines: a framework for collective action. 2004. 7. World Health Organization. Ten years in public health 2007–2017. Geneva, Switzerland: WHO. 2017. 8. PATH. Diabetes Supplies: Are they there when needed? Seattle, US: PATH;2015. 9. Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension. 1992;19(5):403–418. 10. Parving H-H, Hommel E, Mathiesen E, et al. Prevalence of microalbuminuria, arterial hypertension, retinopathy, and neuropathy in patients with insulin dependent diabetes. British Medical Journal (Clinical research ed). 1988;296(6616):156. 11. World Health Organization. Global Health Estimates 2016: Disease burden by Cause, Age, Sex, by Country and by Region, 2000–2016. Geneva, Switzerland: WHO;2018. 12. Institute for Health Metrics and Evaluation (IHME). Financing Global Health 2016: Development Assistance, Public and private Health Spending for the Pursuit of Universal Health Coverage. Seattle, US: Institute for Health Metrics and Evaluation (IHME);2017. 13. World Health Organization. Saving lives, spending less: a strategic response to noncommunicable diseases. WHO;2018. 14. World Health Organization. Global status report on noncommunicable diseases 2014. Geneva, Switzerland: WHO;2014. 15. Hosseinpoor AR, Bergen N, Mendis S, et al. Socioeconomic inequality in the prevalence of non-communicable diseases in low-and middle-income countries: results from the World Health Survey. BMC Public Health. 2012;12(1):474. 16. Hosseinpoor AR, Bergen N, Kunst A, et al. Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey. BMC Public Health. 2012;12(1):912. 17. Niessen LW, Mohan D, Akuoku JK, et al. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda. The Lancet. 2018. 18. Lee JT, Hamid F, Pati S, Atun R, Millett C. Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis. PloS one. 2015;10(7):e0127199. 19. van Zyl Smit R, Pai M, Yew W-W, et al. Global lung health: the colliding epidemics of tuberculosis, tobacco smoking, HIV and COPD. European Respiratory Journal. 2010;35(1):27–33. 20. Oni T, Unwin N. Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition. International health. 2015;7(6):390–399. 21. International Diabetes Federation. IDF Diabetes Atlas, 8 ed. Brussels, Belgium: International Diabetes Federation;2017. 22. Lehtimäki T, Uusitalo H, Collaboration NRF. Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants. 2018. 23. Zhou B, Bentham J, Di Cesare M, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. The Lancet. 2017;389(10064):37–55.

145 MILLION ADULTS

IN LOW-RESOURCE COUNTRIES HAVE

DIABETES, 60% OF WHOM ARE

UNDIAGNOSED21

27% OF ADULTS IN LOW-RESOURCE COUNTRIES HAVE HYPERTENSION, AND ITS PREVALENCE CONTINUES TO RISE22,23

Health is a key driver within the SDGs, and reducing health inequalities and NCDs are critical to achieving the overall SDG agenda.

Diabetes and hypertensionDiabetes and hypertension are closely associated.

Many people with diabetes also have hypertension. Having both these conditions can exacerbate complications, if not treated.9,10

Debilitating complicationsof diabetes and hypertension21

References

Stroke

Kidney disease

Blindness

Cardiovascular disease

Amputation

The Defeat-NCD PartnershipUnited Nations Office for Project Services (UNOPS)Avenue de la Paix 8–14CH-1211 Geneva 10Switzerland

secretariat@defeat-ncd.org

The Defeat-NCD Partnership was established in January 2018 to help tackle the most significant global health challenge of the century: premature death, sickness and disability from and the associated social and economic impacts of certain non-communicable diseases (NCDs). The public–private–people partnership is hosted by the United Nations Office for Project Services (UNOPS) and includes governments, multilateral agencies, civil society, academia, philanthropic foundations and the private sector.

LEARN MORE: defeat-ncd.org

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