Priority Setting for Research and Capacity Building_NCDs in sub-Saharan Africa

							Priority Setting for Research and Capacity
 Building for NCDs in sub-Saharan Africa


         Jared Odhiambo Owuor, BSN
                    AIHD
AIHD/CNCD-Africa
         African Institute for Health and
                   Development (AIHD)


                  Consortium for NCDs
              Prevention and Control in
                                  SSA

         2nd Floor Wood Avenue Court,
             Wood Avenue Off Lenana
            Rd. P.O. Box 45259- 00100,
                         Nairobi, Kenya.
NCDs are projected to be the leading cause
           of death 2002-2020
    The macro-economic impact of NCDs




                                                                                          http://www.weforum.org/pdf/globalrisk/globalrisks09/global_risks_2009.pdf
                              Oil and gas price spike
                                                  Retrenchment from globalization
                                                                   Asset price collapse

                                                                   NCDs
                                                                   Fiscal crisis
                                                                   Flu pandemic
World Economic Forum:                                              Food crisis
Global Risk Assessment 2009


                                                                   Infectious disease
      The risk transition-modern risks




Global health risks: mortality and burden of disease attributable to selected major risks. WHO 2009
                        Shared Risk Factors




Diseases once associated with abundance are now heavily concentrated in poor and
disadvantaged groups
Demographic ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles
are quickly becoming universal trends
The “best buys” for tackling NCDs
  Slaying the dragon-what WHO has done
 2007 Prevention and control of NCDs:
  implementation of the global strategy
 2008 Mental Health Gap programme
 2009 Policy documents on harmful use of alcohol
  and curbing the marketing of unhealthy foods and
  beverages to children
• 2008-2013 Action Plan for the Global Strategy for
  the Prevention and Control of NCDs
• 2009 NCDnet, New network to combat
  noncommunicable diseases (Partnership)
         Priorities for the African Region
                Primary Prevention
 To promote interventions to reduce the main   shared
           modifiable risk factors for NCDs


Tobacco control: FCTC

Promoting healthy diet &
physical activity: DPAS


Reducing the harmful
use of alcohol
                                                        16
          Priorities for the African Region
       NCD Prevention & Management at PHC
Implement and monitor cost-effective approaches for
 the early detection of NCDs and establish standards
        of health care for common conditions

Ouagadougou Declaration

NCD Management at PHC

WHO-PEN


                                                       17
              WHO PEN Guidance
•   Priorities
•   Integration
•   Interventions
•   Assessment
•   Costs/Resource planning
•   Technologies
•   Medicines
•   Training
•   Protocols
•   Evaluation
         Priorities for the African Region
                Monitoring & Evaluation

Progress indicators
   Monitor availability and effective implementation
   of NCDs policy, legislation, regulations and
   programmes
Outcome and impact indicators
   Measure the reduction of NCDs incidence,
   mortality, trends of morbidity and reduction of
   risk factors
Program Evaluation

                                                       18
          NCD research priorities
A prioritized research
agenda for prevention and
control of
noncommunicable
diseases (WHO 2011)
Regional prioritization fora on NCDs



                                                                National NCDs stakeholder's Forum 6th July,
                        NCD Partner and Expert Group, Entebbe       2010, Lenana Mount Hotel, Nairobi
                                        2009




 PASCAR, Kampala 2011
   IDRC-CNCD-Africa workshop Nov 2011,
                 Nairobi
• To build on the momentum       The specific objectives of the
  generated by the United          technical workshop were to:
  Nations High-Level Meeting    • Deliberate on regional NCD
  (UN-HLM) on Non-                 research priorities
  communicable Diseases         • Map NCD-related activities
  (NCDs) in September 2011,        and events in the region in
• Technical workshop with key      the short and medium-term
  experts and institutions in   • Discuss a process of
  the region in November           strengthening research
  2011, Nairobi, Kenya. The        partnerships in the region
  workshop theme was NCD           with a view to having a
  research and capacity            reference point for regional
  building prioritization in       and global efforts.
  Africa.
Objectives I and II: NCD Research Activities and Priorities in
                      sub-Saharan Africa
• Some countries in the region have considered other
  NCDs in their health sector strategies such as
  mental health and injuries (Kenya) and sickle cell
  disease (Ghana)
• WHO has developed tools to combat NCDs;
• Guidelines and protocols on specific NCDs exist in
  the national health sector strategies of most
  countries in SSA while policies exist on specific risk
  factors
Objectives I and II: NCD Research Activities and Priorities in
                      sub-Saharan Africa
• At least 20 countries in SSA have completed the
  WHO STEPS survey. In Seychelles, like South Africa,
  adequate structures responsive to NCD
  interventions exist
• Tobacco has received greater attention in control
  efforts
• Most of the countries in the region have ratified the
  Framework Convention on Tobacco Control (FTCT).
Objectives I and II: NCD Research Activities and Priorities in
                      sub-Saharan Africa
• There is some NCD related research which
  rarely get published in high impact journals
  hence ends up as grey literature in various
  research institutions
• Most countries have not prioritized the NCD
  agenda
• The scarce funding and lack of incentives for
  NCD research also hamper potential gains in
  NCD fight
           NCD Research Priorities
• Establish links between diseases and the economic
  impact of interventions such as taxation for tobacco
  control
• Disease burden need to be highlighted in terms of
  Disability Adjusted Life Years (DALYs), costs of NCD-
  related hospitalization, psychosocial readjustments, co-
  morbidities and their impact to individuals, families,
  communities and the state
• Alcohol control - there is virtually no data on alcohol
  from SSA. This is a research vacuum compounded by
  the difficulty in quantifying the local consumption of
  alcohol, which are traditional brews and are essentially
  difficult to quantify
           NCD Research Priorities
• On tobacco and alcohol, figures and data clearly
  linking them to ill-health are needed, especially in
  view of under-development, human rights abuses,
  market forces, legislation and the need for
  innovative financing mechanisms for related
  research in the region.
            NCD Research Priorities
• A research agenda for diet and physical activity is
  critical - the main drivers of both the epidemiological
  and the nutritional transitions that Africa is undergoing
  simultaneously
• Generating locally relevant evidence would inform
  interventions that meet local needs
• Understanding barriers to access to healthy foods and
  enabling environments for physical activity is a research
  priority
• It is important also to focus research on cross cutting
  issues between the two, such as the role of policy in
  diet and physical activity interventions
           NCD Research Priorities
• Economic studies on cost-effectiveness of health
  system allocations (preventive, curative, promotive);
• Impact of NCDs in magnifying socio-economic
  inequities and understanding the differential impacts of
  interventions on different SES groups;
• Inter-sectoral action to document what works and
  advanced political mapping to understand how it could
  work and/or barriers to inter-sectoral action;
• Surveillance and data systems (sentinel and routine) -
  strengthening and customization of the Health
  Management Information Systems (HMIS) for NCD
  indicators; and
                  Way Forward
• The meeting highlighted some of the key areas of
  research but noted the need for multiple approaches
  with a wide range of partners for effective
  interventions
• Grey literature can be repackaged, even without having
  to publish in reputable journals and still get the
  attention of the policy makers.
• Regional platforms can be used to showcase what is
  being done locally.
• However, to influence policy NCDs actors need to stop
  ‘medicalizing’ messages but rather present NCDs in
  terms of economics so as to get policy makers’
  attention
                Way Forward
• Application of lessons from communicable disease
  management e.g. integration of NCD services into
  routine primary health care (PHC).
• Innovative funding sources for NCD research
• Africa must welcome support from other partners
  who have NCD agenda for the region but the
  process must be driven by African stakeholders