To reduce diabetes and hypertension risks among vulnerable populations and to expand their access to effective treatment requires focused action at country level. We start with a strategic partnership with government ministries of health alongside the WHO.
Countries should have national policies and costed plans based on analysis of their prevalent NCD disease burden and epidemiological patterns and trends; for example, the incidence, prevalence and distribution of diabetes and hypertension. They should also have information systems (such as diabetes registers) that track treatment provision and monitor quality of care outcomes using indicators as recommended by the WHO. The management of NCDs should be part of an overall health system that includes arrangements for the timely procurement and distribution of essential medicines, diagnostics, and equipment. The Partnership can arrange to support the provision of technical assistance to national health authorities, in co-operation with the WHO, to identify and address the gaps or constraints that are identified in national health systems.
At the same time, quality of care relies on sufficient numbers of trained personnel utilising WHO-recommended protocols for treatment. The Partnership helps to boost the training of healthcare providers (doctors and nurses) for the early detection and treatment of hypertension and hyperglycaemia, including antenatally. This is done in conjunction with medical and health training institutions and professional associations and includes private health practitioners and pharmacies as they are a major provider of services.
The prevention, screening, and treatment of raised blood pressure and blood sugar is most cost-effective at the community and primary healthcare level, and only complicated cases should go to hospitals for specialist attention. Therefore, working with community service providers such as clinics, pharmacies, and school health services is vital.
Ultimately, self and family care are central to effective treatment. Thus, outreach is promoted through community-based voluntary organisations such as the Red Cross and Red Crescent which are present in all countries and whose unpaid volunteers operate from branches in towns and villages everywhere. They specialise in “walking the last mile” and can do much to magnify risk reduction and prevention messaging, and to boost the day-to-day quality of care.
Elements from this menu of strategies are selected according to specific country contexts. This is done through studying available country needs assessments (or conducting them where the analysis is not available) including understanding the local epidemiology, reaching agreements with national health authorities, mapping key actors and making local partnerships. The networks that are established in this way for diabetes and hypertension can then be easily used and extended for other NCDs.
Scaling-up needs a new way of working. The Defeat-NCD Partnership is incentivising the development of programming models that are innovative in terms of technology and communications tools as well as in organisational and financial approaches that “de-mystify, democratise and, where appropriate, de-medicalise” the management of NCDs. Thus, people benefits are maximised and unnecessary constraints and costs stripped out of the system.