NCDs are the first key
Ambassador Rajiv Kumar Chander, the Permanent Representative of the Mission of India to the United Nations office and other international organizations in Geneva, talked recently about how many companies are using reverse innovation to develop new healthcare tools in India at a conference at the Graduate Institute, Geneva.
He invokes a Google-invented app to diagnose diabetic retinopathy which is now going through trials in India. He said that the government and IT are the ones who can enable these steps forward, but that the sector needs to be treated as a public good with some coherent legislation. All stakeholders need to come together. This would take cultural and political leadership.
Leadership is key
Leadership is almost always the answer when talking about treating or preventing non-communicable diseases (NCDs) in an efficient and cost-effective manner. The first people that have to be convinced that an innovative practice, like programmes that enable patients to manage their own condition or have community health workers give guidance with little or no clinical supervision, are clinicians themselves. Though this is likely to be difficult, given that community health care workers can be seen as a threat, national and local governments will need to create new strategies to calm objections and make a scientifically based case to clinicians, the public and other stakeholders.
Low- and middle-income countries have been the worst hit by the lack of prevention and treatment of NCDs, both economically and socially. The estimates are clear – by 2030, diabetes, cardiovascular disease, cancer, chronic respiratory disease, and mental illness will cost low- and middle-income countries about US $21 trillion in costs of illness and lost production.
The Defeat-NCD Partnership has created an operating model that centres around “demystifying, democratising, wherever possible digitising, and demedicalising” the management of NCDs. Self-management of NCDs, including diabetes and hypertension, would help to save low- and middle-income countries money and lives.
Infrastructure – whether roads or health systems – need financial but also planning support from governments, and community buy-in. When people don’t see a doctor regularly, and don’t know they have hypertension or any of the other NCDs that get diagnosed too late to be treated, this shows inattention to NCDs – whether because they have not made the headlines, have been continuously underfunded, or both. Along with a lack of training around diabetes, cancers or other NCDs, healthcare professionals are unable to help prevent NCDs by talking about lifestyle or environmental risk factors. They are also not able to help the patient through the cycle of a chronic disease without the proper training.
Primary care, focused on patients along with their community, can promote healthy lifestyles and help to prevent complications in people with chronic illness. This is where, in most systems, HIV/AIDS set up screening, management and coordination of care and where NCDs could do the same by piggybacking on the same systems.
The opportunities to improve the effectiveness of care should also include self-management. Though doctors tend to say that proper care requires oversight, and in the best-case scenarios this is the reality, patients gain the freedom and responsibility to live fuller lives when they are given the ability to be solely responsible for their care. But this does require training, of both the community and the patient. Given that in rural areas there is a shortage of doctors and nurses – with 45% of the world’s population living in rural areas and 25% of doctors practicing there, getting training in these areas is still problematic. Using mhealth or mobile apps in healthcare could save a patient a visit to the doctor but could also lose the doctor his income. So to get this to work, communities would need to be convinced, regulations would need to developed, and systems would still need to be put in place. Technology may be part of the answer but seeing innovation and how it spreads may hold more of the answer to the question of how we defeat NCDs.