Responding to non-communicable diseases in Zambia: a policy analysis

Abstract

BackgroundNon-communicable diseases (NCDs) are an emerging global health concern. Reports have shown that, in Zambia, NCDs are also an emerging problem and the government has begun initiating a policy response. The present study explores the policy response to NCDs by the Ministry of Health in Zambia using the policy triangle framework of Walt and Gilson.MethodsA qualitative approach was used for the study. Data collected through key informant interviews with stakeholders who were involved in the NCD health policy development process as well as review of key planning and policy documents were analysed using thematic analysis.ResultsThe government’s policy response was as a result of international strategies from WHO, evidence of increasing disease burden from NCDs and pressure from interest groups. The government developed the NCD strategic plan based on the WHO Global Action Plan for NCDs 2013–2030. Development of the NCD strategic plan was driven by the government through the Ministry of Health, who set the agenda and adopted the final document. Stakeholders participated in the fine tuning of the draft document from the Ministry of Health. The policy development process was lengthy and this affected consistency in composition of the stakeholders and policy development momentum. Lack of representative research evidence for some prioritised NCDs and use of generic targets and indicators resulted in the NCD strategic plan being inadequate for the Zambian context. The interventions in the strategic plan also underutilised the potential of preventing NCDs through health education. Recent government pronouncements were also seen to be conflicting the risk factor reduction strategies outlined in the NCD strategic plan.ConclusionThe content of the NCD strategic plan inadequately covered all the major NCDs in Zambia. Although contextual factors like international strategies and commitments are crucial catalysts to policy development, there is need for domestication of international guidelines and frameworks to match the disease burden, resources and capacities in the local context if policy measures are to be comprehensive, relevant and measurable. Such domestication should be guided by representative local research evidence.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…There have been a number of initiatives across Africa to improve identification, prevention, and management of T2DM to reduce subsequent morbidity, mortality, and costs. to demonstrate the need for strategies to improve guideline adherence and to assess their impact in practice (Igbojiaku et al, 2013;Mukanu et al, 2017;Pastakia et al, 2017;SEMDSA, 2017). There have also been strategies to improve access and availability of medicines (Sandoz -A Novartis Division, 2015;Meyer et al, 2017;Nuche-Berenguer and Kupfer, 2018;Shannon et al, 2019;Rockers et al, 2019), as well as strategies to improve the monitoring and follow-up of patients including advice on the doses of medicines prescribed (Pastakia et al, 2015;Morris-Paxton et al, 2018;Chang et al, 2019).…”

The Sub-National Politics of Setting Health Development Agenda: An Insight Into Yobe Health Development Plan

“…This constitutional provision is not surprising as health is now considered and promoted at the centre stage of national and international development as a fundamental human right (Pieterse, 2016: UN, 2001 With these declarations similarly adopted at national and sub-national levels including in Yobe state, the informants argued it shows that international policy makers and stakeholders exert an important influence on how health care programme is designed, adopted and implemented just as advanced by Mukanu et al (2017). These scholars further buttressed that this was the reason for the emergence of MDGs (Mukanu et al, 2017) which tasked the UN signatory nations to adopt and implement similar policies and programmes in their respective countries Mukanu et al, 2017).…”

“…However, while at the national level, the federal governments have developed broad visions, missions, programmes, strategies and interventions towards reducing public health challenges (Oyibocha et al, 2014;Mukanu et al, 2017) the literature largely ignored the sub-national levels such as Yobe state. This means that the previous methodology applied in most cases neglected how, where and why certain health policies are developed (Mukanu et al, 2017) in specific communities.…”

“…However, while at the national level, the federal governments have developed broad visions, missions, programmes, strategies and interventions towards reducing public health challenges (Oyibocha et al, 2014;Mukanu et al, 2017) the literature largely ignored the sub-national levels such as Yobe state. This means that the previous methodology applied in most cases neglected how, where and why certain health policies are developed (Mukanu et al, 2017) in specific communities. Based on the decentralisation argument, the provision of health care by the state government is generally seen as an element that underscores sub-national government effort towards achieving universal health coverage (Awosusiet al, 2015) through social justice and fairness which advocates affirmative action especially for the most vulnerable groups in the society.…”

Challenges in policy reforms for non-communicable diseases: the case of diabetes in Kenya

“…This was also evident in the challenges of monitoring local policy interventions against set international targets. This problem of data generation is not unique to Kenya and has been mirrored in other African countries [49][50][51][52] and to a greater extent LMICs. Investment in implementation research to generate relevant local data and improve progress monitoring is warranted for evidence-informed decision-making.…”