By Peter Piot, Director of the London School of Hygiene & Tropical Medicine
Throughout my career I have been at the frontline in the fight against some of the toughest health emergencies of our times. In the 1970s I was working to quell the outbreak of the then-unknown Ebola virus. In the 1990s I was leading the newly-created UNAIDS to tackle one of the greatest pandemics of modern times – the HIV/AIDS epidemic.
Today we have a similar emergency on our hands, but one that is largely silent and failing to secure the necessary global attention and funding. The prevalence of non-communicable diseases (NCDs) is comparable to the greatest global health challenges we have had to confront in recent history.
When I stepped down from my role as UNAIDS director in 2008 I went on a farewell tour that took me to Africa. Walking through the wards of hospitals on the continent I was struck by a worrying sight. The AIDS patients that previously filled hospital beds were gone. Many were back in their homes and communities receiving antiretroviral therapy and managing their condition. In their places at the hospitals was now a staggering number of young men and women who had suffered strokes.
Hypertension, or high blood pressure, is a chronic condition – meaning treatment is often for life. It doesn’t present symptoms or necessarily impede life, but if unmanaged it can lead to fatal consequences like strokes. Cardiovascular diseases like hypertension are the leading cause of deaths worldwide. And contrary to what most of us might think, these deaths occur disproportionately in low- and middle-income countries. Almost half of Africa’s population suffers from hypertension, yet many of those affected don’t know they have it.
The picture is very similar when it comes to diabetes. The number of people with diabetes worldwide has quadrupled since the 1980s, surpassing 400m in recent years. But in contrast with common perceptions, much of this increase has happened in low- and middle-income countries.
Health systems in these regions are ill-equipped to address this emergency. They are stretched under the pressure of fighting infectious diseases like malaria and tuberculosis, which still make up a majority of deaths in much of the developing world. It will take decades before sufficient health coverage is achieved that can adequately address the scale of the NCD epidemic. We need a new approach.
We can draw some useful lessons from how HIV/AIDS patients were empowered to manage their condition. AIDS was the first experience of managing a ‘chronic’ condition that many low-and middle-income countries had. With the introduction of antiretroviral therapy from the mid-1990s the life expectancy of many AIDS patients increased. Many were able to return to their lives and families instead of being hospital-bound.
Faced with the prospect of having to care for these patients for potentially a very long time, public health systems mobilised to empower AIDS patients to self-manage their condition with appropriate support from their physicians. This shift to a patient-centered approach – taking chronic care outside of the formal healthcare system and hospitals, and into the community and families – has eased the burden of tackling the epidemic and led to precious resources reaching more people.
It is hardly controversial to acknowledge that the way health systems are structured, both in advanced economies and beyond, is costly and not as efficient as it could be. So as health systems strive for greater efficiency, why not take advantage of the opportunity to innovate how we deliver healthcare? Why not develop a system that is built around patients instead of following a pattern that is known to be unfit for the challenge?
I recently chaired a Dialogue event in Basel, the third of a series hosted jointly by the Novartis Foundation and the London School of Hygiene & Tropical Medicine, during which we looked precisely at how innovation in healthcare delivery can help the resources we have go further for patients with chronic conditions.
One example of how this works in practice is the Community-based Hypertension Improvement Project run by the Novartis Foundation and FHI360 in Ghana, with support of the London School. Licensed chemical sellers, which sell over-the-counter medicines, lie outside of the formal health system, but often serve as the first point of access to health advice for members of their local community. Our goal with this project is to involve these private business owners as well as nurses and other local agents, and to provide them with basic training in blood pressure screening and management.
Crucially, patients taking part in the project are empowered to manage their condition with information, access to blood pressure monitoring within the community and automated mobile phone reminders about treatment and lifestyle changes that will benefit their condition. This looks to have better outcomes for patients, who would otherwise have to rely on crowded hospitals often located many hours’ travel away, and in a more efficient use of formal health facilities.
Similar innovations in healthcare delivery will make a big difference in the outcome of the global fight against the NCD epidemic. In the face of the challenges that stand in the way of achieving universal health coverage, innovation is our best asset. We must never stop looking for new solutions to the world’s health problems and learning from our collective experiences.
This article was originally published by the Financial Times BeyondBrics. Read the original article
Hypertension mangement project in Ghana. Credit: Novartis Foundation
Peter Piot. Credit: Heidi Larson