Africa’s to-do list for reducing chronic disease is long

WASHINGTON—A study on the global burden of disease published in The Lancet last month suggests that non-communicable diseases (NCDs) are fast becoming the biggest health problem in middle- and low-income countries, especially in Africa. The rise of chronic illnesses such as cancer and cardiovascular disease was a heated topic of discussion at a gathering of US and African leaders in Washington DC earlier this week.

There is no dearth of warning signs that NCDs are taking over as leading causes of death in Africa. For every death due to HIV in 2005, cardiovascular disease killed five others in Africa. We know now that by 2015, chronic diseases will account for a quarter of deaths in Africa, according to World Health Organization estimates.

GlobalPost spoke with Tom Achoki, a physician and panelist at the Corporate Council on Africa event held on Monday, to understand what needs to be done to handle the alarming increase of NCD deaths in Africa.

Achoki is the Botswana-based director of African Initiatives at Institute of Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington.

GlobalPost: What is the first step towards tackling the challenge of non-communicable diseases in Africa?

Tom Achoki: The big issue is of availability of data. We don’t have health information systems methodically collecting information on NCDs.

From the information available now we can see that NCDs are a problem, but there’s no way of quantifying what that is, and that needs effort. We need to make it clear to policy makers who want to start looking at the problem that it’s very difficult to manage anything that you cannot measure.

There has to be a systematic effort in investing in collecting appropriate information. Then we can start figuring out the problem and what we need to do to address it.

GP: What are the barriers to get this information at the moment?

TA: There hasn’t been sufficient investment in the health information system in terms of collecting the right information. The data collection process is being done in a very piecemeal way. Most data in different health systems has not been sufficiently digitized.

The quality of the information is poor. It isn’t very timely – information comes very late and is not very accurate.

Most of the efforts for data collection are made for communicable diseases but given the health landscape in Africa we need to give equal importance to non-communicable diseases.

GP: What would be an effective strategy for investment and who should be doing it?

TA: The mantra seems to be public-private partnerships, but the government needs to take leadership in this. My suggestion would be that governments use data collected in the private sector. No real investment is needed for this – just political will.

GP: Are there any countries making these efforts?

TA: Some countries are making significant effort. Rwanda has made a substantial attempt in improving its health information system. I think Botswana is also in the process of doing that.

There are a number of countries who have these challenges and we have to see how we can support them. We are looking at engaging countries – in a very simple way – to share information and see how we can help each other to generate evidence that can be useful to decision makers.

GP: In which manner would you be able to support them?

TA: We can give guidance in terms of what kind of information they need to collect for them to understand the magnitude of the problem. We can also identify quality gaps that need to be addressed. We can assist governments in coming up with a framework of what they need to do to generate useful information and integrate it with the surveillance system.

GP: Is there any information available on which are the ‘hot zones’ for these non-communicable diseases?

TA: South Africa, Namibia and Botswana certainly make the list. There’s a definite rise in the countries that are well off. Among other things, they don’t walk enough and have a more Western diet, leading to NCDs.

At the same time, the upward trend of NCDs is even true for lower- and middle-income countries like Kenya, Ghana, etc.

GP: Then would you categorize NCDs as a problem for wealthier African cities?

TA: That is a very big conundrum – we don’t know yet. Small studies have been done on this and they show very conflicting information. There’s need for better data at a granular level for us to know what’s the problem.

GP: What solutions do you suggest, beyond better data collection?

TA: We primarily need better preventive interventions and a firm understanding of the risk factors that cause NCDs. For example, if alcohol consumption is killing people, you need better alcohol control measures.

We also need the right curative measures in place. Early detection of NCDs puts you in a better position to manage that. So we need to have very strong investment in that area.

But the overall need is for a policy recognition on the part of the government. They need to identify that this is a problem, bring in private partners in a conducive environment to address these issues. We’ve seen this in being done in HIV/AIDs and other areas. We need to take a leaf out of that book to tackle non-communicable diseases.

GP: So how do we shift the focus to NCDs?

TA: The response to NCDs is not going to be a mutually exclusive deal between communicable and non-communicable diseases. It has to be a dual-burden approach and we have to integrate the two platforms of care in such a way that we can respond to both problems.

There are mutually exclusive approaches to the two at the moment because of the verticalization of the disease programs. There are efforts in a number of countries – like Botswana – to integrate the two platforms of care. This way we can harness the resources that have been committed to communicable diseases and make them available for NCDs too. We need to treat the patient as an integrated whole.

This interview has been edited and condensed for clarity.

More from GlobalPost: Q&A: Africa’s high blood pressure problem