The human cost of non-communicable diseases (NCDs) is high with the World Health Organization (WHO) attributing over 71% of the annual global deaths to NCDs. The burden of NCDs is also unevenly increasing among low-income populations. Three-quarters of all deaths due to NCDs are in low- and middle-income countries.
The financial burden for NCDs treatment is also immense. According to the WHO, cumulative economic losses to low- and middle-income countries from the four NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases – including prolonged disability) are estimated to surpass US$ 7 trillion over the period 2011-2025 (an average of nearly US$ 500 billion per year).
This yearly loss is equivalent to approximately 4% of these countries’ current annual output. On a per-person basis, the annual losses amount to an average of US $25 in low-income countries, US$ 50 in lower middle-income countries and US$ 139 in upper middle-income countries.
Scaling-up interventions for non-communicable diseases in South East Asia
The burden of non-communicable diseases, such as hypertension and diabetes, is increasing in south-east Asia. New strategies to prevent, detect and treat hypertension and diabetes are the need of the hour. The European Union funded ‘Scaling-up NCD Interventions in South East Asia’ (SUNI-SEA) project is one such effort to evaluate and determine the effectiveness (including cost-effectiveness) of the evidence-based, high-risk diabetes and hypertension management programmes in three countries of Southeast Asia–Indonesia, Myanmar and Vietnam–to enhance sustainable action to achieve the Sustainable Development Goals (SDGs).
The SUNI-SEA project was started in 2019. I had the opportunity to join its launch meeting in Chiang Mai, Thailand, in March that year. A room full of researchers from various countries – Germany, Indonesia, Myanmar Netherland, Slovak, Vietnam interacting with development workers and planning for the execution of the project- discussing the sample size, locations and ways to engage communities and health workers. It was an exciting moment that shone light on one of the most important public health concerns in the modern era-NCDs.
The aim of the SUNI–SEA project is to inform governments for scale up of cost effective, feasible and effective NCD control interventions to reach larger number of people, on the basis of the evidence based research data collected during four years of the project’s operation. In addition, at the end of the project an updated package of NCD guidelines, training materials and job aids will be available to support health workers and community volunteers.
During the first year of the project, a retrospective study was completed in Myanmar, Vietnam and Indonesia, after which the project interventions were designed. Since the COVID-19 pandemic began in early 2020, the SUNI -SEA teams in all three countries have faced delays in project implementation. Due to travel restrictions they have adopted new ways of working, such as holding meetings and conducting training events using online platforms.
In 2020, the project’s research team conducted a review of existing literature on NCDs prevention and control in South East Asia. The review clearly shows that major causes of NCDs are tobacco use, alcohol consumption, unhealthy diet and lack of physical activity; while screening, health education and patient support are necessary intervention elements. With these learnings, the team will ensure that the project focuses upon these important findings (read more about the literature review here).
The project has now moved into the– all hands-on deck – implementation phase, which includes conducting baseline data surveys, training of community based Older People’s Association volunteers to conduct community screening for diabetes and hypertension, health promotion sessions, physical exercise groups and referrals to the local health facilities. During this phase, the local health staff will also be trained by government trainers for patients’ counselling, communication skills and community mobilisation to build upon and advance prevention and management of NCDs.
Connecting the dots: health facilities and communities
One of the important aims of the project is to increase the linkages between health facilities and communities. In Myanmar and Vietnam Older People Associations, also called Inclusive Self-Help Groups, are playing a key role in implementing this part of the project and engaging with older people through these clubs. I have visited numerous Older People Associations in many countries and I am confident that older people can be game changers for the prevention of NCDs and increased well-being of the communities where they live.
Indonesia took a different approach by working through local primary health care facilities (Posbindu) to strengthen the quality of NCD services and scale up. Interventions include skill- building for healthcare staff and development of a telephone app for screening and health promotion of patients. Indonesia plans to reach the younger segment of the population as well.
In South East Asia the COVID-19 pandemic had shown us that an efficient healthcare system, and the role of health workers and community groups is critical in getting us through these difficult times. It is a pivotal moment for leaders and policy makers to strengthen their countries’ health systems and ensure that health workers are supported and equipped with tools and knowledge that will allow them to do their work effectively.
NCDs intervention cannot be a stand-alone effort. It must be integrated into the overall healthcare system. The linkage between community and health facilities is very vital to ensure healthy lifestyles and prevent unnecessary and untimely deaths. Together we can prevent NCDs and improve wellbeing and access to healthcare for all.
Written by: Baralee Meesukh, Communications team lead
Firstly published: 28 May 2021