Tackling non-communicable diseases after a devastating year

Summary

How do you care for non-communicable diseases in a pandemic? We met with Prof. Jean-Marie Dangou, head of the programme for non-communicable diseases at WHO Africa to reflect on an unprecedent year and the outlook for 2021. We talked about humility, public health strategies, research and innovation, universal health coverage and the fight against diabetes.

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Last year, when you were considering your plans for the year 2020, what did you have in mind?

Very good question!
Since the inception of the administration of our current regional director, Dr Moeti, in 2015, the African Regional Office of WHO has committed to transforming into an organization that meets the expectations of populations in the region, of governments, of partners, but also of its staff.
As part of the process of planning for the biennium (2020 -2021), the leadership at the regional office committed to restructure the department that hosts the programme on non-communicable diseases (NCDs) as well as to restructure the programme itself. This included the recruitment of several experts who were going to support the countries of the region in tackling the NCD burden. Unfortunately, the COVID-19 pandemic occurred and disrupted our programme.
We were thus not able to achieve what we had planned. The disruption was further compounded by the redeployment of all the regional and sub-regional office NCD programme staff to support the response to the pandemic. In our member countries, the situation was similar. Added to this was the fear around COVID-19, which meant that patients suffering from non-communicable diseases could no longer travel to get the care they needed. In many ways, 2020 has been a devastating year and we certainly hope this year will be much better.

What lessons have you drawn from the past year?

With all its difficulty, 2020 has been rich with lessons. The first thing that my colleagues and I take away is humility. We now know that nothing can be taken for granted, simply because despite all our preparation, the pandemic came, and everything has been disrupted.
We have learned that we need to have a good capacity for adaptation, that we can retrain and bounce back despite difficulties. This pandemic has reminded us of the importance of teamwork, and of the resilience of people and systems. It has also highlighted two very important elements: humanism and solidarity.

What do you think you will be able to achieve in 2021?

I would like to start this year with the lessons learned from the pandemic, build on the achievements, and of course resume what we had planned for 2020, that is: carrying on with our transformation and restructuring our programme.
We will have to double our efforts to achieve our goals and reduce mortality from non-communicable diseases, in particular: diabetes, cardiovascular disease, cancer, chronic respiratory diseases and mental illness. This is how we will contribute to reducing the suffering of population on the African continent.

What do you think is missing in current policies and public health strategies to effectively address diabetes and chronic disease? Is it just a matter of money?

This goes beyond financial matters, although funding is a critical part of the problem.
When we look at the situation at the country level, health systems in the region are still very much oriented towards communicable diseases, maternal and child diseases, which means that the non-communicable disease aspect is not accorded the attention and priority it should get. We have found out that the contribution of NCDs to the entire disease burden differ from country to country, so what is missing today is integration. Many countries have developed vertical plans for each of the NCDs, while the overall financial resources to treat these diseases remains the same. In addition, there is no corresponding increase in the staff capacity both in terms of number and technical competency.
We must also adopt a multi-sectoral approach because we have realized that with non-communicable diseases, the health sector cannot fight these diseases alone: it is necessary to involve several other relevant sectors such as the IT and trade sectors, as well as urban planning. If you want people to practice sport, we must provide the space and facilities to do it. Such an approach will allow us to effectively fight the five main risk factors for non-communicable diseases: unhealthy diet, tobacco use, alcohol consumption, lack of physical activity and pollution.
So here is what is still lacking, without counting of course the ammunition of this war: finance. We will require national and international resources, like development aid, to support the plans. The plans are made, the staff are there but there is a lack of financial resources to implement these plans.

Which structural change in health systems do you think is most likely to yield rapid results? Universal health coverage, public-private partnership, high-speed internet?

The three things you mention are part and parcel of universal health coverage, which has three dimensions: the first dimension is to provide essential quality care to all people who need it. This is of primary interest to non-communicable diseases such as diabetes.
The second dimension of universal health coverage is to avoid catastrophic expenditure for people who need care. We know that for non-communicable diseases, this is a big concern because care for these conditions is expensive. In some countries NCDs are called ‘costly diseases’ because they are conditions, like diabetes, with which people must learn to live with until the end of their life. We will always need to have medical examinations; we will always need to buy drugs and therefore it is expensive.
The third dimension of universal health coverage is multi-sectorality. This is about bringing together several sectors so that all contribute to the fight against the social determinants of health. In order to achieve these three dimensions of universal health coverage, we need public and private partnerships, but we also need innovation, which includes high-speed internet, and the means to promote these innovations. The COVID-19 pandemic has further highlighted the importance of ICT as part of the new way of working.

Talking about innovation, research is underway to bring about cost reduction in diabetes diagnosis and care. What is your take on this?

Research and innovation are crucially important today, as was demonstrated with the COVID-19 pandemic. In less than a year we have managed to find several vaccines for this disease that we did not know a year ago.

In Africa, we have a fertile ground for innovation because all the ingredients for research and innovation are in place. There are a lot of innovators across the continent but unfortunately, they do not always get the visibility and attention they deserve. An example of innovation with great potential is M-Medicine (mobile medicine); the use of mobile phone to reach a greater number of patients, with methods of diagnosis that are constantly being upgraded.   

What role does WHO play in supporting research and innovation?

WHO has recognized the importance of research and innovation early on. In our general programme of work, we have been given the specific goal to shape and scale up innovation. It is also one of our priorities in the Africa region.
In 2018 we launched the WHO Africa Innovation Challenge, the WHO-level innovation challenge in the African region, which received over 2,500 applications. The best innovators received financial support and the initiative was carried forward in 2019. The challenge did not take place in 2020 due to the pandemic. This notwithstanding, a number of innovative solutions have been brought to the fore: innovation in products and technologies (including mobile phone); innovation in services; and social innovation, dealing with how people should or should not behave in order to improve their health and improve their quality of life.
Beyond this challenge, we have set up a platform where we support innovators by putting them in contact with potential investors so that, based on their prototype, they can be helped to the next level. Some of these innovators have received small scholarships to enable them to implement their idea.

Brain drain is one of the many problems facing the health sector. What advice would you give as a doctor to young people and professionals who are considering leaving Africa?

It is generally difficult to put oneself in the shoes of those who make such decisions. They must know that despite all the difficulties and obstacles that we face here in Africa, the continent is full of potentials and possibilities. We must demonstrate our genius and adapt to what is happening across the continent.

It is important that we raise the profile of healthcare workers and that we improve their remuneration. I also think that the job satisfaction of health workers in Africa is immeasurable. When you work under these conditions and you achieve good results, you are very, very, satisfied.

As Africans, we must contribute to improving the health and quality of life of our brothers and sisters. And for this reason, I urge my colleagues, my sisters and my brothers who plan to leave the continent, to reconsider their decisions.


 

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