The process of prioritization of non-communicable diseases in the global health policy arena

Abstract

Although non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, the global policy response has not been commensurate with their health, economic and social burden. This study examined factors facilitating and hampering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith’s (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 370: 1370–9.) political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization’s (WHO) NCD Global Action Plan 2013–20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled. Much work has been done to frame the challenges and solutions, but implementation processes and their applicability remain challenging globally. NCD responses need to be adapted to local contexts, focus sufficiently on both prevention and management of disease, and have a stronger global governance structure.

Adapting and implementing training, guidelines and treatment cards to improve primary care-based hypertension and diabetes management in a fragile context: results of a feasibility study in Sierra Leone

“…Similarly, greater communication should be stimulated between the health system and communities through, for example, social mobilisation or other community engagement activities around NCDs which are connected to the wider public health system. Such activities have been recently advocated [28,29] and found to be valuable in tackling NCDs in other fragile health settings [30,31].…”

Using routine health information data for research in low- and middle-income countries: a systematic review

“…As LMICs are undergoing an epidemiologic transition and the importance of NCDs is increasing [127], LMIC health systems face the increasing challenges of addressing the dual burden of communicable and non-communicable diseases [128,129]. In spite of the limited implementation of non-communicable diseaseinterventions [129], the few studies that used RHIS data for non-communicable disease research mainly analyzed the gap in service provision and estimated disease burden, highlighting the large unmet need for health care in affected populations. A couple of the studies described how their research was limited by data availability and quality, such as the lack of diagnostic categories of the investigated health conditions in the RHIS.…”

Using Routine Health Information Data for Research in Low- and Middle-Income Countries: A Systematic Review

“…As LMICs are undergoing an epidemiologic transition and the importance of NCDs is increasing 109 , LMIC health systems face the increasing challenges of addressing the dual burden of communicable and non-communicable diseases 110,111 . In spite of the limited implementation of non-communicable diseases interventions 111 , the few studies that used RHIS data for non-communicable disease research mainly analyzed the gap in service provision and estimated disease burden, highlighting the large unmet need for health care in affected populations. A couple of the studies described how their research was limited by data availability and quality, such as the lack of diagnostic categories of the investigated health conditions in the RHIS.…”