From siloes to synergies: Ensuring everyone living with chronic diseases has access to essential healthcare

COVID-19 has intensified the need to ensure people in low-and middle-income countries can more easily access simultaneous services that prevent and treat both infectious diseases such as HIV, tuberculosis (TB) and malaria, and noncommunicable diseases such as cardiovascular diseases, cancers, respiratory diseases, and diabetes, finds a new report launched by the Noncommunicable Disease Alliance (NCD Alliance) today.

The report by The George Institute for Global Health and the NCD Alliance, From siloes to synergies: Integrating noncommunicable disease prevention and care into global health initiatives and universal health coverage, argues that decade-long political commitments to integrate noncommunicable disease (NCD) services with services for priority groups for major global health initiatives such as HIV/AIDS, TB, malaria and maternal and child health have not translated into reality on the ground in low- and middle-income countries (LMICs). Healthcare in many LMICs does not yet respond to the needs of people living with NCDs, which have come to be the leading causes of death and disability worldwide.

LMICs are experiencing a rapid transition from population disease profiles shaped by communicable diseases and conditions impacting mothers and their children, to those dominated by NCDs and injuries. Today, 85% of people dying from NCDs between ages 30 and 70 are in LMICs.

“The funding to low- and middle-income countries for priority population health initiatives, such as HIV/AIDS, malaria, TB and maternal and child health has been pivotal in achieving substantial health gains over the past decade,” said Dr Gill Schierhout from the George Institute for Global Health, lead author of the report. “Many LMIC health systems continue to be influenced by global health funding and the shape of this has critical impacts on the health care available – or not available – for the growing number of people who are living with NCDs in LMICs.”

COVID-19 has brought about a greater recognition that the long-held distinctions between infectious and noncommunicable diseases are not as clear cut as once thought – those with chronic conditions have a significantly higher risk of hospitalisation or death from the virus. The vast majority of the millions of people to date who have lost their lives or became seriously ill with COVID-19 were living with underlying health conditions, most commonly hypertension, cardiovascular disease and diabetes. Longstanding inaction on NCDs has amplified the human and economic cost of COVID-19.   Similarly, with NCDs becoming more common in LMICs, comorbidities are now increasingly threatening the gains made against diseases such as TB and HIV.

“We urgently need a reset of healthcare delivery in poorer countries that actually reflects the needs of those who need it most,” said Katie Dain, CEO of the NCD Alliance. “Integrated care is the future of healthcare. The reality today is that ever more people are living with multiple chronic conditions. This needs to be better recognised in health systems. People living with HIV have a significantly higher risk of cardiovascular disease and some cancers. People living with TB are much more susceptible to diabetes and vice-versa.  Hypertensive disorders and gestational diabetes affect many pregnancies, risking potential lifelong health impacts for both mother and child if not effectively treated.”

Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million). These four groups of diseases account for over 80 percent of all  NCD deaths before the age of 70.

“Health centres that reflect this changing epidemiology are the future,” said Dain. “But this will also mean that we have to change the way we do business. The COVID-19 pandemic has been catastrophic for people living with NCDs and it is clear we need a health infrastructure in LMICs that is fit for purpose if we are to build back better.”

It is more than a decade since Ministers of Health at the first UN High-Level Meeting on NCDs resolved to “encourage the development, integration and implementation of vertical programmes, including disease-specific programmes, in the context of integrated primary health care”. This approach is based on the idea that health systems need to adapt to a clearer focus on the person and their health throughout the life course, not only on the single health crisis or condition that leads them to seek care. However, progress in this area has been patchy at best. World leaders have recently reaffirmed the need to provide more integrated services to include NCDs, notably in the ground-breaking commitment at the United Nations High-Level Meeting on AIDS in June 2021, which commits governments to ensure 90 percent of people living with and at risk of HIV can access NCD and mental health care by 2025.