Monthly Archives: March 2014

Study Tour: NCDs Crossing the Development Divide

By: Christine Sow, Global Health CouncilCross-posted from the Global Health Council Blog

GHC Executive Director Christine Sow accompanied US Senate staffers to Uganda and Rwanda on a study tour organized by the Livestrong Foundation and Management Sciences for Health. We will be featuring blogs and pictures from Christine on the tour – read on to hear about the trip, NCDs, and global health challenges.

The Uganda Cancer Institute. Photo credit: Sally Canfield.

The Uganda Cancer Institute. Photo credit: Sally Canfield.

One particularly striking thing I have noticed on this trip is that the challenges health officials face in tackling NCDs in low and middle income countries are not so different to the challenges the U.S. and other Western countries face in addressing these same diseases.  This is an area where our similarities are more significant than our differences; quite unlike most global health challenges today. “Tropical” diseases that ravage low and middle income countries were typically considered the unique purview of the “developing world.”  Not so, in the case of NCDs today.  In fact, top research and treatment institutions such as the Uganda Cancer Institute and the Joint Clinical Research Center are doing ground-breaking biomedical work on challenges such as Epstein-Barr Virus and antiretroviral therapy roll-out, and are returning findings and recommendations that have applications far beyond Uganda’s borders.

An interesting aspect of this research is their attention to the development of effective treatment regimens for low resource settings – the reality of their national context means that they will not have high-tech solutions on hand to treat their patients. This work is promising both for what the identification of low resource solutions means for patients in Uganda and elsewhere in the global South. But it is also promising because it can challenge high income countries – that have cost limitations and resource contraints of their own – to consider alternate approaches to how they address diseases that have traditionally “merited” high cost solutions. But while trying to continue their work, they also spend much of their time and energy on piecing together the funding to keep it going. This is not a new story, but one that deserves to be repeated – the efficiency and impact of cutting-edge programs, whether they be focused on research or implementation, need and deserve long-term funding commitments in order to be truly functional and achieve optimal impact. And this is true whether the funding is coming from external donors or from an institution’s own national government.

Christine Sow is the Executive Director of the Global Health Council.

Study Tour: Lessons Learned from the HIV/AIDS Epidemic

By: Christine Sow, Global Health Council
Cross-posted from the Global Health Council Blog

GHC Executive Director Christine Sow accompanied US Senate staffers to Uganda and Rwanda on a study tour organized by the Livestrong Foundation and Management Sciences for Health. We will be featuring blogs and pictures from Christine on the tour – read on to hear about the trip, NCDs, and global health challenges.

A group of children in Uganda. Photo credit: Sally Canfield.

A group of children in Uganda. Photo credit: Sally Canfield.

I come from a professional background focused squarely on reproductive and maternal health, child survival and HIV/AIDS. Most if not all of my career until now has been oriented towards saving young lives and the mothers who give birth and care for them.  Truth be told, I had never spent much time thinking about non-communicable disease control and management, except to acknowledge how far off we were from introducing anything resembling cancer screening or dialysis when there was no treatment available within the countries where I worked.

But today I am struck by the rapidly changing epidemiological profile of those same countries where I spent so much time on child survival. It’s true that the causes of child mortality continue to be a burden and still require high priority attention and resources. But at the same time, rapid urbanization and changing social norms and diet mean that NCDs are a growing threat to the economically-active segment of the population.

Here in Uganda, health authorities note that the rising prevalence of obesity, alcohol and tobacco use are contributing to a ballooning NCD problem, one that hits the most economically active segment of the population. Twenty-five percent of deaths in Uganda are currently attributed to NCDs and WHO estimated that deaths from NCDs in Africa will increase by 24% over the next decade. Worldwide, NCDs account for 29 million deaths annually, and of these, more than 9 million are “premature” deaths – meaning the deaths of people in the prime of their lives, who are wage-earners and caregivers. And of these, over 8 million deaths occur in low and middle income countries that have the least capacity to provide prevention, screening and management services to their rapidly growing populations.

When I reflect on where we are with regard to NCDs in 2014, I am reminded of the early years of the AIDS epidemic when we were just starting to address the economic impact of the disease, particularly in terms of what it meant as loss to GDP and corporate profits. While it’s still early, the same can be said of the growing burden of NCDs – premature mortality and morbidity due to these diseases also means the slowing of economic growth and the need for increased investment in the social safety net. Those lessons of the HIV epidemic present a rich reference point for consideration in tackling this next threat to global economic, social, and physical health and well-being.

Christine Sow is the Executive Director of the Global Health Council. This blog is part 3 of 4, stay tuned for the final post tomorrow.

Study Tour: Combating NCDs with Limited Resources

By: Christine Sow, Global Health Council
Cross-posted from the Global Health Council Blog

GHC Executive Director Christine Sow accompanied US Senate staffers to Uganda and Rwanda on a study tour organized by the Livestrong Foundation and Management Sciences for Health. We will be featuring blogs and pictures from Christine on the tour on the blog – read on to hear about the trip, NCDs, and global health challenges.

Hospital in Mulago. Photo credit: Sally Canfield.

Hospital in Mulago. Photo credit: Sally Canfield.

We visited a sub-district health referral center as well as Mulago hospital, the largest hospital in Uganda. The scale of services provided was vastly different across the two facilities – the referral center offered mostly primary care services along with some basic tertiary care while Mulago Hosptial offers a wide range of complex tertiary care to a patient population of more than 5,000. However the two have several important commonalities – both are under-staffed, over-used and lacking in the basic supplies and equipment necessary to allow staff to properly do their jobs. The referral center had little or no capacity at the current time to integrate NCD prevention, screening or treatment into its remit.

The question has to be asked: how will it be possible to add on yet another (and another and another) service to their mandate without providing additional resources in the form of staff, commodities and equipment to take on this additional burden?

A promising initiative, the Uganda Initiative for the Integrated Management of NCDs (UINCD) was launched to begin looking at how this might be accomplished. A partnership between Mulago Hospital and Yale University, the initiative will begin establishing a model this year for the integrated management of NCDs within existing health structures, starting with Mulago Hospital and rapidly extending out to lower-level health centers. Through the establishment of a center of excellence on NCD programming at Mulago Hospital, the initiative hopes to establish best practices and recommendations for the scale up of integrated NCD management within the Uganda health system.

Dr. Christine Sow is the Executive Director of the Global Health Council. This blog is part 2 of 4, stay tuned for the next two posts.