Noncommunicable Disease (NCD) strategic plans in low- and lower-middle income Sub-Saharan Africa: framing and policy response

Abstract

Background: Global efforts to address NCDs focus primarily on 4-by-4 interventions-interventions to prevent and treat four groups of conditions affecting mainly older adults (some cardiovascular disease and cancers, type 2 diabetes, chronic respiratory disease) and four associated risk factors (alcohol, tobacco, poor diets, and physical inactivity). However, the NCD burden in Sub-Saharan Africa (SSA) is composed of a more diverse set of conditions, driven by a more complex group of risks, and impacting all segments of the population. Objective: To document the NCD priorities identified by NCD strategic plans, to characterize the proposed policy response, and to assess the alignment between the two. Methods: Using a two-part conceptual framework, we undertook a descriptive study to characterize the framing and overall policy response of strategic plans from 24 low-and lower-middle-income countries across SSA. Results: The national situation assessments that ground strategic plans emphasize a diversity of conditions that range in terms of severity and frequency. These assessments also highlight a wide diversity of factors that shape this burden. Most include discussions of a broad range of behavioral, structural, genetic, and infectious risk factors. Plans endorse a more narrow response to this diverse burden, with a focus on primary and secondary prevention that is generally convergent with the objectives established in global policy documents. Conclusions: Broadly, we observe that plans developed by countries in SSA recognize the heterogeneity of the NCD burden in this region. However, they emphasize interventions that are consistent with global strategies focused on preventing a narrower set of cardiometabolic risk factors and their associated diseases. In comparison, relatively few countries detail plans to prevent, treat, and palliate the full scope of the needs they identify. There is a need for increased support for bottom-up planning efforts to address local priorities.

Population-level interventions targeting risk factors of diabetes and hypertension in South Africa: a document review

“…Supportive environment interventions targeting risk factors for diabetes and hypertension implemented at country level seems not to be well documented. This could be due to the fact that most of supportive environment activities are implemented at community and individual level with little or non-existence of systematic documentation of such programs [ 45 ]. In addition, documentation on the process of implementation and evaluation (M&E) is missing in the literature.…”

Stakeholders’ perceptions and experiences on planning for population-level interventions targeting risk factors for hypertension and diabetes in South Africa: a qualitative study.

“…In line with the World Health Assembly's call for a 25% reduction in NCD deaths by 2025 amongst the age group 30-70 years (9), the South African government committed to reduce the relative premature mortality due to NCDs, for people under 60 years of age, by at least 25% by 2020 (10). To prevent NCDs, their modi able risk factors, such as poor diet, insu cient physical activity, smoking and excessive alcohol consumption (11,12,13,14), must be reduced. These risk factor distributions at the populationlevel can potentially be changed by promoting lifestyle changes, the environments where people live or work through policy and programs.…”

Prioritizing Health-Sector Interventions for Noncommunicable Diseases and Injuries in Low- and Lower-Middle Income Countries: National NCDI Poverty Commissions

“…To date, NCDI strategic plans and frameworks in LLMICs have been largely influenced by elements of the existing global action plan and monitoring framework. 11 Efforts to adapt or contextualize the WHO Global Action Plan for Prevention and Control of NCDs to the national burden of NCDI conditions or health system capacities in LLMICs have been inadequately prioritized or resourced. 11 – 13 Interventions proposed to avert the burden of NCDIs have focused on primary and secondary prevention of conditions due to behaviorally mediated risk factors and have not frequently considered a broader range of NCDIs and their associated risk factors.…”

“… 11 Efforts to adapt or contextualize the WHO Global Action Plan for Prevention and Control of NCDs to the national burden of NCDI conditions or health system capacities in LLMICs have been inadequately prioritized or resourced. 11 – 13 Interventions proposed to avert the burden of NCDIs have focused on primary and secondary prevention of conditions due to behaviorally mediated risk factors and have not frequently considered a broader range of NCDIs and their associated risk factors. 11 Furthermore, these interventions have been largely evaluated and selected based on measures of cost-effectiveness and feasibility within resource-constrained environments and have not traditionally included measurements of equitable distribution of health outcomes at country-level.…”