Chronic conditions such as heart disease and cancer are a growing threat in the world’s poorest countries and public health experts from around the world met November 29 to explore ways of tackling this silent epidemic.
Participants at the event, organized by Novartis, discussed an array of solutions that will likely be needed to mount an effective response.
In the 80s/90s hospitals in #Africa were full of AIDS patients, now a silent hypertension epidemic has taken over - Peter Piot #talkingNCDs
Some of the most important steps could include improving access to affordable medicines, supporting better education about chronic diseases, using technology in new ways to aid awareness and treatment, and building effective partnerships between the public and private sectors.
The new enemy
The scale of the challenge was outlined by Peter Piot, Director of the London School of Hygiene & Tropical Medicine. A few years ago he revisited the African hospitals where he worked when AIDS was at its height in the 1990s, and found very few patients who were suffering from the disease.
“Now they’re treated as outpatients, thanks to antiretroviral drugs. Instead the hospitals were full of men in their 40s and 50s with stroke – the result of hypertension that’s out of control.”
As death rates from infectious diseases have fallen, the populations of low-and middle-income countries are growing older and more vulnerable to chronic illnesses, which may have no immediately apparent symptoms, making them harder to diagnose. They also typically require years of treatment and monitoring.
Just one of these diseases – hypertension, or high blood pressure – now kills as many people as all infectious diseases combined. That’s one reason the Novartis Foundation has focused on finding new ways to help people with hypertension in its work in Ghana and Vietnam.
One fundamental need is for wider access to affordable medicines that can treat chronic ailments. Novartis is helping to address this through an innovative program to supply a portfolio of 15 medicines at a monthly cost to governments and other public-sector customers of USD 1 per treatment.
The program, called Novartis Access, was launched just over a year ago and today operates in Kenya and Ethiopia, with Rwanda just getting underway. The aim is to expand the program to about 30 countries in the next few years.
Harald Nusser, Head of Novartis Social Business, said the program was designed to be financially self-supporting over time and stressed: “This is a long-term commitment.”
Richard Laing, Professor of International Health at Boston University, said it was also the first drug access program to be rigorously evaluated, with a study in progress to assess its impact in Kenya.
However, health experts at the conference agreed that providing low-cost drugs was only a small part of the solution to such a complex problem.
Focusing on education
Education is crucial, since patients have sometimes never heard of the diseases they are suffering from, and even healthcare professionals may have limited knowledge.
Truong Bui, Project Director of the Communities for Healthy Hearts project in Ho Chi Minh City, Vietnam, explained how their program, run jointly with the Novartis Foundation, is focused on better training for community health workers and volunteers. The goal is to teach them about personalized care, and encourage them to provide better quality screening and support for hypertension patients.
Celina Schocken, whose organization Pink Ribbon Red Ribbon seeks to improve the treatment of breast and cervical cancer, said they faced an even more fundamental problem because patients were often ashamed to admit they had these diseases. “We need to address the stigma for the women and their communities, so that their husbands and families support them to come forward for testing and early diagnosis.”
The Novartis Access program also offers capacity-building activities to support healthcare systems in preventing, diagnosing and treating chronic diseases.
A friend in technology
Many participants said they believe innovative use of technology has an important role to play in addressing the challenges of chronic diseases.
Edward Kelley, Director of the Department of Service Delivery and Safety at the World Health Organization, said: “In this idea of providing more care that’s better tailored to people and their needs, we have a friend in technology.”
In particular, a number of speakers said the widespread availability of mobile phones, even in relatively poor communities, provides a ready platform for gathering and sharing information.
Alma Adler of the London School of Hygiene & Tropical Medicine said mobile phones played an important role in ComHIP, another project supported by Novartis Foundation, which aims to improve the management of hypertension in Ghana. Patients are encouraged to manage their condition through regular voice or text messages reminding them to take their medication, attend appointments, exercise regularly, and avoid fatty or salty foods.
Another approach was outlined by Paddy Partridge from microinsurance specialists BIMA, who provide low-cost health insurance to 25 million people worldwide using mobile phones to collect subscriptions and pay claims to customers, even if they have no bank account.
Technology can help transparency, its time to learn from fragmented pilots,let's come together to make something happen - HN #NovartisAccess
Given the scale and complexity of the threat posed by these long-term diseases, it is clear that no single organization, company, or even national government is capable of tackling them alone.
Most of the projects described at the event were the result of collaboration between multiple groups, each contributing their own skills and resources.
Harald Nusser said this was vital for the success of a project such as Novartis Access: “A multiplicity of partners need to come together, not only from the pharmaceutical industry but also from academia, from NGOs, and particularly from government and the public sector.”
Novartis Chairman Joerg Reinhardt summarized the challenge: “All stakeholders need to participate if we want to stand a chance of achieving universal health coverage, and help developing nations ease the pressure from the double disease burden of infectious and chronic diseases.”
Akudo Anyanwu: the global commitment to NCDs is very powerful. Global partnerships are vital to keep NCDs a high priority #NovartisAccess