Trends in the underlying risk factors and behaviours that influence health outcomes take a long time – perhaps a generation or more – to manifest themselves. Furthermore, diabetes and hypertension management require the permanent provision of medicines and risk factor modification inputs. Thus, long-term programming is essential to achieve sustained and sustainable impacts. Therefore, this Partnership is envisioned up to at least 2030, coinciding with the remaining period of the SDGs. There would be regular reviews as NCD epidemiology evolves, and adaptations will be necessitated by advances in scientific knowledge and new medicines and technologies.
This Partnership is targeted at poorer countries. It is not possible to meet the essential health needs of poor people/countries without external subsidisation until the point that they can afford to pay for themselves, either individually (out-of-own-pocket expenditures) or through pooled cost-sharing arrangements e.g. health insurance schemes and employer or taxpayer-funded national health systems. Additionally, NCD programming for populations of humanitarian concern are likely to need external financing until a crisis moves into rehabilitation and recovery.
In general, the sustainability for diabetes and hypertension programming depends on increasing the affordability of essential products and services. With this in mind, this Partnership fosters longer-term sustainability by:
- First, pursuing affordability through the Essential Supplies Procurement and Distribution Facility, through seeking maximum reductions in the costs of providing medicines and diagnostics through economies of scale that are negotiated centrally or through marketplace mechanisms that drive down costs. Pharma has incentive to do so, not just as part of their CSR commitment but also because of the expanded market that is created for their products as greater treatment coverage is achieved. Over time, this would more than make up for initial discounts or subsidies, especially when the country graduates to higher income status. Meanwhile, the market for pharmaceuticals in less developed countries is already growing at about 50% faster than the market in mature economies.
- Second, the Partnership engages with developing country governments and assists them through technical assistance and capacity building so that their health policies incorporate NCD costs into national health budgets, in a progressive manner. The Partnership engages actively with national health financing debates, for example, with the World Bank, in finding context-specific options for sustainable financing e.g. employment based and social security based health insurance schemes.
- Third, with the gap between total health needs and available resources (of at least $40 per capita), the Partnership’s Financing Facility aims to attract additional innovative investments into NCD programming supplemented by some greater transfer of resources from richer countries (e.g. OECD donor nations), and rich entities (e.g. CSR contributions from private sector companies, philanthropies) to poorer ones as part of the shared commitment to universal health coverage.
However, the Defeat-NCD Partnership is not conceived as a ‘charitable’ project. It’s progressive business model seeks financing diversity and long-term sustainability. This is defined as the ability of programme countries to finance their own long-term NCD-handling requirements.