Noncommunicable diseases (NCDs) are chronic conditions, which are preventable and avoidable. Yet, their prevention and control is complex and needs to be looked at through a systems approach. The successful management of NCDs requires not only medical and public health interventions but also a thorough the understanding of the health system. The health system has six building blocks: (1) leadership and governance, (2) health information systems, (3) health financing, (4) human resources, (5) essential medical products and technologies, and (6) service delivery. Each of these building blocks demands a strong sense of direction and serious commitment, and they are closely linked with prevention and control of NCDs.
Health authorities need to take responsibility for steering the entire health sector, while engaging in transparent, inclusive and accountable practices and dealing with health problems. The way the leadership and governance is exercised is often based on the specific context and history of the country. Good quality health information enables possibilities of good governance and sound decision making. Therefore, it is important to invest in health information systems as a solid foundation for health systems management. Health financing is instrumental for the improvement of health with a primary focus on facilitating universal health coverage and protection from financial hardship.
Although governments acknowledge the importance of health financing, the budget allocation for health can be quite limited and poorly managed in many developing countries around the world. This, in turn, brings high out-of-pocket payments leading to catastrophic health expenditure for individuals and communities.
The next three building blocks are directly related to health care. In order to provide proper health service, there must be an adequate amount of human resources with appropriate training and skills. Moreover, access to affordable essential medical products and technologies will dictate universal health coverage. Financially, medical products and staff salaries comprise the largest portion of the health budget. Lastly, delivery of health services will express the effectiveness of the health system.
Development of health systems, responsive to the challenges of the prevention and control of NCDs, is the priority in almost all countries. Today, many developing countries face a double burden of communicable and non-communicable diseases, added with the economic and social burden of these conditions. Oftentimes, co-morbidities or combinations of several diseases disproportionately affect those most vulnerable. This will be particularly challenging in countries with weak health systems characterised by fragmentation of healthcare services, competing programmes, disproportionate focus on specialist curative care, health commercialisation in poorly regulated systems and so forth. As we see the complexity of the overall picture, what will be the solution?
It is obvious that countries faced with these challenges would want or need a rapid response in tackling NCDs. However, a long-term view with clear and logical steps is crucial for the sustainability of action going into the future. The first step is the inclusion of management of NCDs and co-morbidities in national health plans and strategies. This will ensure government’s commitment and relevant budget allocation. The second step is to find ways of integrating services across health system functions whenever possible, while using existing platforms or developing new ones. The third step is to strengthen community and primary care services through the gradual integration of all health programmes. Together, these actions will open a window of opportunity for universal coverage in regards to prevention and control of NCDs.
The role of donors is crucial in the journey of combatting NCDs, as this is otherwise a huge and daunting task for any single government in resource-limited settings. Needless to say, it is best to avoid fragmentation of health services and competing projects whic