Tackling Noncommunicable Diseases in Bangladesh: Now Is the Time (Directions in Development)

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midwestdiscountprinting.com/wp-includes/borymuv/8181.php Our messaging needs to be clear, succinct, and bold. These interventions need to be sustainable. There needs to be collaboration between public healthcare agencies and industry. We need to engage industry in a productive and positive manner. Educating the population in a way that creates demand for healthier products, lifestyles, and work environments are imperative. In low-resource settings it is critical not to duplicate prevention efforts. There are many examples of cost-effective projects, programs, and policies - yet these are not often shared. Creating visibility, sharing information of these successful, low-cost, sustainable interventions are important.

Creating policies that address both population strategies and personal strategies are essential. Utilizing and developing preventive technologies and tools, rather than reaching for the most recent high tech treatment often most expensive strategies, will be important. We need to educate governments and policy-makers that following models of sick care systems like that in the US are not effective and we should instead create systems that are health focused.

One of the most valued resources of low- and middle-income countries is their intellectual assets. Brain drain has contributed to the impediment of improving healthcare.

Funding is necessary to ensure that the public sector healthcare providers are sufficiently reimbursed to prevent movement to private sectors and emigration. Funding is necessary for public health training, policy development and then implementation, information technology, and health communication. It remains illogical that healthy behavior and healthier foods are more expensive and more difficult to obtain than the unhealthy alternatives.

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In difficult economic times, donors are strapped, governments have fewer funds, and the personal out-of-pocket expense for the individual makes discussions and forums such as these essential and timely. My fellow panelists have done a terrific job initiating the conversation around questions , so perhaps I will focus my initial comments on question 4. When we talk about integrated service delivery, I find it immensely helpful to be quite precise about definitions. As Rifat Atun and his colleagues have illustrated quite elegantly, disease-focused programs are often integrated within health systems at some levels and in some ways and not at others.

Should we be attempting to integrate NCD services with primary care services? Or with each other? It probably goes without saying that not all NCD services can or should be integrated with primary care services. Providing integrated wellness counseling at the primary care level makes a lot of sense. Having non-specialists prescribe radiation treatment for cancer, or perform valve replacement surgery for mitral stenosis is obviously a less sensible approach. Similarly, providing integrated services for chronic conditions such as diabetes and hypertension is considerably more feasible than providing integrated services for, say, chronic lung disease and road traffic accidents.

Similarly, local context is key. From a programmatic perspective, the challenge of providing continuity care over a lifetime is quite similar, no matter which chronic disease you are treating. And in many countries, HIV scale-up has created the first large-scale chronic care program in history - something that can be adapted and built upon to provide services for other chronic diseases. And we have taken this one step further in Ethiopia, adapting HIV systems, tools, and approaches for use in diabetes care and treatment. I can describe some of this work in more detail in later posts, if people are interested.

Building on what Brian Bilchik noted above, a major impediment has been the limited focus on identifying the major risk factors for NCDs among the poor in developing countries. I also am a faculty at the Foundation. Should global health donors alter their priorities and strategies to include NCDs, or are there ways to address the NCD needs in developing countries within existing priorities and strategies? I can talk with India as an example of a developing country.

The situation is particularly grave in rural areas, where more than 70 percent of the country's 1. Yet expenditure on health care is paltry- a mere 1. The Lancet NCD Action Group and the NCD Alliance proposed five overarching priority actions for responding to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies.

Currently there is no department or Ministry for ensuring all these interventions categorically. We must also build up a much more powerful partnership between the generators of the research and the generators of policy.

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National Drug Policy. In recent years, non-communicable diseases NCDs , such as cardiovascular diseases CVD , diabetes, chronic obstructive pulmonary diseases COPD and cancers have become an emerging pandemic globally with disproportionately higher rates in developing countries [ 1 ]. However, there is little serious effort in properly implementing the said policy. Roemling C, Qaim M. The estimated pooled prevalence of hypertension was State-society relations and citizenship in situations of conflict and fragility.

At present, there is no regular consultative mechanism. Dr Srinath Reddy had suggested in one of his interviews that the health ministry could have an informal committee of experts broadly for the area of public health which can meet once a month and take a view on critical challenges. And this committee come up with suggestions that could be considered by policy makers.

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This group represented by officials from ministry, private sector, academicians, medical professionals, etc, have discussed several issues on Universal health care as a part of coming up with the recommendations for the next 5 year plan for the Indian Government. This complimentary service would aid the policy making decisions, plays a role in the advisory capacity and can also shoulder responsibilities assigned by stakeholders for public health action. One more example is from the field of higher education and research. We need to utilise our existing resources much more efficiently.


Bangladesh is undergoing a double transition—demographic and epidemiological. fueling a shift in the disease burden toward noncommunicable diseases (NCDs). and its program managers—to develop and implement effective and timely Tackling Noncommunicable Diseases in Bangladesh: Now Is the Time. Tackling noncommunicable diseases in Bangladesh: now is the time (English). Abstract. This report is organized in such a way that the key.

For example, medical colleges in India are grossly underutilised. We can initiate short term skill building courses or training programs— on NCD epidemiology, public health, community nutrition, etc for interested students or professionals. Forums of young professionals where dynamic youth bring fore the energy, passion and multiple disciplines together should be encouraged. How much does it cost to address NCDs in resource-limited settings, and what is the right contribution for donors to contemplate?

I am not sure of the numeric costs and I am sure it will vary a lot depending on which country are we talking about.. However, I think one comment which I can make is that both direct and indirect costs should be considered while computing these. Costs which donors should contemplate while contributing need to encompass: 1. Costs for providing treatment for the ones already inflicted with NCDs 2.

Costs for putting prevention mechanisms in place including knowledge generation activities 3. Costs for preventing and treating Risk factors for NCDs Are there good examples of integrated service delivery or innovative partnerships to address NCDs? We have no method of telling how many Indians suffer a heart attack each year. I see Surveillance at national and global levels to play a critical role in addressing or at least mapping out trends, vulnerable areas, incidence of disease, risk factors etc. This quality information is required urgently to tackle this huge burden of NCDs.

We can definitely triangulate information from other national surveys like NFHS but a sustainable and quality surveillance mechanism in place can really act as a great health index for any country.

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Another area I feel needs innovative partnerships and inter-sectoral participation is improving the health education curricula and delivery. A recent commission of global experts from various fields also recommended designing new instructional and institutional strategies to combat multiple looming health challenges Lancet publication Frenk et al, The recommendations include aligning national efforts through joint planning, especially in the education and health sectors, engaging all stakeholders in the reform process and developing global collaborative networks for mutual strengthening.

They also advocate developing competency-based curriculum of globally recognized high academic standards. Courses and thereby professionals on public health, NCD epidemiology, public health nutrition, physical activity and lifestyle management are virtually nonexistent in a country like India where they are needed the most. Should external funding from the private sector be utilized to address NCDs in poor countries? We at PHFI are also a public-private partnership working towards nurturing and producing a pool of professionals who could contribute in bettering the public health current scenario in India.

But if by private sector you mean industry- my personal view would be to refrain any technical involvement of industry especially the food industry. We all recognize that unhealthy diet is one of most important risk factors for NCDs. Thus I feel that allowing industry to openly blur our objectivity is a waste of resources.

There are several arguments put forward by Jeff Koplan, Kelly Brownell and others against food industry being allowed to influence decisions for public health. An option however could be accepting blind donations without any obligation to announce where the money came from. So if the industries genuinely feel like endorsing improved public health, they should give the money in a blinded fashion. Other ways to help tackle NCDs could be announcing public health scholarships for bright students from resource-constrained countries to pursue their passion in this field.

Thanks so much for the invitation to participate and to my fellow panelists for getting this discussion going.

Tackling Noncommunicable Diseases in Bangladesh: Now Is the Time

And domestically, or within countries globally, it seems fairly certain that overall spending, both private and public, will increase. What does this mean for NCDs? Yet as the need grows within countries, I see financial spending on NCDs increasing. The challenge is going to be figuring out what integration actually means, and ensuring that integration both leads to better health impacts and does not have negative implications for the poor and vulnerable.

But these statistics are not going to change overnight. It will take time for the donors to shift. There are some low-hanging fruits. There are some big and quick policy wins around tobacco, alcohol and food and nutrition that governments can begin to enact. New York City is also pioneering some of the more innovative policies around food. Finally, I think there are great opportunities to leverage the huge investments in NCD research invested in countries like the US and view this research as a global public good.

Answering this question representing a donor is somewhat fraught; however, I would stress that donors need to spend time to better understand the NCD challenge and should play to their strategic strengths where and when they can add value. Obviously this means different things for different donors. At the Rockefeller Foundation, we are focusing our current efforts on supporting health systems as they are transformed by new technologies and improving economies with an aim for universal health coverage UHC.

The question for us is and will be how do NCDs fit into this? These are some great, and I think the right, questions. We probably need more research to illuminate proven interventions, and then sustained efforts to ensure that policymakers get this information. This research should help policymakers not only become aware of these interventions, but assist them in scoping possible pathways to overcome the challenges that become obstacles in the implementation of these interventions.

Alongside researchers and think tanks, there is certainly a role and a need for civil society too. There seems to be a need to convene policymakers, researchers and activists. Miriam, I would certainly be interested to hear more about your experience and work in Ethiopia and any other relevant examples. I am currently part of a larger team, led by Dr. David Bloom at Harvard, that aims to estimate the global cost of illness of NCDs see below for some teaser estimates , and am hoping that my thesis will build on this work regarding NCDs.

Second, the answer to addressing NCDs meaningfully, comprehensively, and sustainably is not simply found in increased funding for NCDs based on big donors writing a check to countries. The answer to the question is much more complex than that. As a starting point, my recommendation to donors would be to investigate how to fund the integration of NCD prevention and treatment components for existing ID projects, a solution that perhaps elegantly circumvents the notion of DAH as a zero-sum game.

Secondly, prioritizing NCDs does not necessarily mean increased funding. It could mean country-support to draft and implement tobacco, salt, and trans-fat policies, or it could mean advocacy support to negotiate affordable drug and technology prices. While ideally, the DAH agenda should reflect the burden and greatest health needs of countries, any change in that direction will have to ensure that existing programs are sustained and improved along the way.

However, that does not always mean that there is actual NCD funding, despite a project description in reported funding that refers to NCDs. Over a thirty year time period, the cost-of-illness for all NCDs is in the double-digit trillions. Therefore, the cost of inaction, given the projected rise in disease burden, and factors such as the strong global tobacco lobby, could be as much as six times higher than these estimates. As we all know, there are parts of the private sector that have been essential to treatment and care delivery on a global scale, ranging from the production of vaccinations, to cell phone companies for new technology diagnosis networks, as well as simple private contractors that build hospitals.

Then again, there are sections of the private sector that have contributed, and perhaps substantially so, to the burden of chronic diseases: this is especially true for the tobacco industry, to a lesser extent, global mining companies and the poor working conditions that workers are subjected to , and to a lesser degree, global food companies, ranging from Nestle to Monsanto to several fast food companies. In the middle of that spectrum are companies that employ large part of the global work force, which can both be a threat as well as an opportunity to tackle NCDs on a global level.

An opportunity, since large global employers are awakening to the fact that absenteeism and large health insurance premiums can be averted by better working conditions and work wellness programs. This increased awareness about NCDs affecting the workforce among business leaders is evidenced by the results of the latest World Executive Opinion survey, which showed that the majority of global employers are deeply concerned about absenteeism due to NCDs in their workforce.

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Further, the private sector is already funding several global health initiatives, with funding coming from both the for-profit as well as the non-profit private sector think: MedTronic and PepsiCo vs. Private funding as a form of DAH is still a relatively novel scenario, and looking into the future, the question will be how to ensure that private sector funding is best leveraged to reach those in need at the same time as ensuring that upstream business and policy approaches are more closely aligned with the NCD and global health goals for a healthier society.

FSG is a nonprofit consulting firm that provides strategy and evaluation services to foundations, nonprofits, companies, and governments. We were founded in and, since that time, have worked with a number of organizations on program development for NCDs in resource-limited settings.


Thanks for the opportunity to provide some thoughts to this interesting set of questions. Q1: What are some of the financial challenges for governments and international institutions in addressing NCDs? Before the mids, the Government of Bangladesh had entered into a number of individual PPP transactions.

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However, marked the first time that a policy framework was introduced for PPPs in order to enable private sector partnerships in power generation [6]. Through this policy, Bangladesh witnessed early success in PPPs. To build on this success in other areas of infrastructure, the Government of Bangladesh introduced the Private Sector Infrastructure Guidelines in This marked the start of the program-based PPP initiatives in Bangladesh. However, the results during this period were more modest, with only a handful of projects coming to fruition.

The Plan focuses on the enhancement of infrastructure investment from approximately two to six percent of GDP, using PPP as a key tool in meeting this infrastructure gap. With strong political support and enhanced institutional capability, underpinned by real financial commitment and a PPP Act in the final stages of enactment in the parliament, the key fundamentals are in place for an enabling PPP environment in Bangladesh.

The first signs of success are there, and a clear path has been laid out for this success to continue and grow in the years ahead. As PPP projects are delivered one after another, as lights get switched on in homes, as industries get powered, as new roads mitigate transport bottlenecks and as new health services save lives, it is worth sparing a thought for the one who introduced PPPs.

Through PPPs, developing countries now have an additional delivery mechanism to meet their public service commitment and drive increased prosperity.

Tackling noncommunicable diseases in Bangladesh: now is the time : NCD Synergies

PPPs have provided an enhanced opportunity to make a real difference in the delivery of public services. Perhaps we will never be able to identify who introduced PPPs. Publication does not imply endorsement of views by the World Economic Forum. Image: Workers sew prayer caps, which are high in demand during the holy fasting month of Ramadan, at a factory in old Dhaka.

Syed Afsor H Uddin. The views expressed in this article are those of the author alone and not the World Economic Forum. I accept. New Report: Are we saving enough for retirement?