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

Neil Gupta,Julie Makani,Fred Amegashie,Isaac Ssinabulya,Biraj Karmacharya,Santigie Sesay,Emily Wroe,Mary Mayige,Mary Amuyunzu-Nyamongo,Gerald Mutungi,Gene F Kwan,Gene Bukhman,Ann R Akiteng,Justice Mudavanhu,Vincent Rakotoarison,Jeanine Condo,Bhagawan Koirala,Yogesh Jain,Jones Masiye,Sharon Kapambwe,Jean Pierre Nyemazi,Sarah Maogenzi,David Watkins,Gladwell Gathecha,Said Habib Arwal ,Nancy Charles Larco ,Ana Olga Mocumbi ,Ole Frithjof Norheim ,Abraham Haileamlak ,Solomon Tessema Memirie

doi:10.9745/ghsp-d-21-00035

Abstract

Health sector priorities and interventions to prevent and manage noncommunicable diseases and injuries (NCDIs) in low- and lower-middle-income countries (LLMICs) have primarily adopted elements of the World Health Organization Global Action Plan for NCDs 2013-2020. However, there have been limited efforts in LLMICs to prioritize among conditions and health-sector interventions for NCDIs based on local epidemiology and contextually relevant risk factors or that incorporate the equitable distribution of health outcomes. The Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion supported national NCDI Poverty Commissions to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions. Fifteen national commissions and 1 state-level commission were established from 2016-2019. Six commissions completed the prioritization exercise and selected an average of 25 NCDI conditions; 15 conditions were selected by all commissions, including asthma, breast cancer, cervical cancer, diabetes mellitus type 1 and 2, epilepsy, hypertensive heart disease, intracerebral hemorrhage, ischemic heart disease, ischemic stroke, major depressive disorder, motor vehicle road injuries, rheumatic heart disease, sickle cell disorders, and subarachnoid hemorrhage. The commissions prioritized an average of 35 health-sector interventions based on cost-effectiveness, financial risk protection, and equity-enhancing rankings. The prioritized interventions were estimated to cost an additional US$4.70-US$13.70 per capita or approximately 9.7%-35.6% of current total health expenditure (0.6%-4.0% of current gross domestic product). Semistructured surveys and qualitative interviews of commission representatives demonstrated positive outcomes in several thematic areas, including understanding NCDIs of poverty, informing national planning and implementation of NCDI health-sector interventions, and improving governance and coordination for NCDIs. Overall, national NCDI Poverty Commissions provided a platform for evidence-based, locally driven determination of priorities within NCDIs.

Highlights

Noncommunicable diseases and injuries (NCDIs) are a major contributor to morbidity and mortality in low- and lower-middle-income countries (LLMICs).[1]
There have been limited efforts in LLMICs to prioritize among conditions and health-sector interventions for NCDIs based on local epidemiology and contextually relevant risk factors or that incorporate the equitable distribution of health outcomes
To quantify the Current expenditure on NCDIs reported by the comprehensive commissions varied widely by country, though these findings may be subject to high variability burden of NCDIs and low reliability of national health accounts.[34] and provide

Summary

Introduction

Noncommunicable diseases and injuries (NCDIs) are a major contributor to morbidity and mortality in low- and lower-middle-income countries (LLMICs).[1]. Q Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Cc Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. Global Health: Science and Practice 2021 | Volume 9 | Number 3 prising the disease burden in LLMICs.[4,5] The conditions comprising this burden in resourceconstrained settings are diverse, and infectious diseases and conditions related to poverty comprise a large component of associated risk factors.[6,7] These conditions result in a large burden of disease in LLMICs, but due to younger population demographics, delays to diagnosis, and limited service availability, they tend to occur earlier and more severely in these populations.[8] Prolonged chronicity of these conditions along with dependency on out-of-pocket payments for NCDI services result in dramatic impoverishment and productivity losses as compared to other disease areas.[9,10]

Methods

Results

Conclusion