health, care and tech institute (HCTI)
institute for continuous health transformation
Joaquim Cardoso MSc*
Chief Researcher & Editor, and Advisor
December 6, 2022
MSc* from London Business School
MIT Sloan Masters Program
ORIGINAL PUBLICATION (excerpt)
NCDs 2030: Accelerating Change through Innovation
World Economic Forum
In collaboration with Duke Kunshan University Global Health Research Center
November 2022
Foreword
Shyam Bishen
Head, Shaping the Future of Health and Healthcare,
World Economic Forum
Yunguo Liu
Co-Director, Global Health Program, Duke Kunshan University Global
Health Research Center
The COVID-19 pandemic has exposed the vulnerabilities of global and national health systems.
Already-struggling healthcare systems have shifted their resources to the pandemic response, which has exacerbated the burden on people with noncommunicable diseases (NCDs) by delaying and disrupting their diagnosis, treatment and care.
NCDs, also known as chronic diseases — including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes — remain the number one killer globally, causing nearly threequarters of deaths worldwide.
Every year, 17 million people under the age of 70 die from NCDs, 86% of whom live in low-and middle-income countries.[1]
Every year, 17 million people under the age of 70 die from NCDs, 86% of whom live in low-and middle-income countries
The 2030 Agenda for Sustainable Development recognizes NCDs as a major challenge for sustainable development.
As part of the Agenda, global leaders have committed to developing ambitious national responses by 2030 to reduce premature mortality from NCDs by one-third through prevention and treatment (SDG Target 3.4).[2] [3]
At the time of writing, in November 2022, as the pandemic appears to be in transition, it is the optimal moment to reflect on lessons learned.
More importantly, it is now time to consider what practices could be adopted from the pandemic response to create more resilient health systems in developing countries in the long term. COVID-19 offers a chance to reset health system priorities, providing a leapfrogging moment for health system transformation through innovation.
As COVID-19 transitions, developing countries will have an opportunity to improve the equity, accessibility, quality, efficiency and resilience of their health systems.
Non-communicable diseases present an urgent global health challenge. Governments, private-sector industries and international organizations must work together to strengthen their collaboration, with learning and sharing at the heart of this ethos.
There is no better time for the world to unite and align efforts under these principles.
As COVID-19 transitions, developing countries will have an opportunity to improve the equity, accessibility, quality, efficiency and resilience of their health systems.
Non-communicable diseases present an urgent global health challenge. Governments, private-sector industries and international organizations must work together to strengthen their collaboration, with learning and sharing at the heart of this ethos.
There is no better time for the world to unite and align efforts under these principles.
EXECUTIVE SUMMARY
Kelly McCain
Head, Healthcare Initiative,
World Economic Forum
Carrie Liu
Lead, Health and Healthcare,
World Economic Forum
For this report, in-depth consultations with policymakers, industry leaders and leading academics from G20 countries were conducted to uncover lessons learned, effective methodologies and innovation strategies — and the results inspire optimism.
Developing countries have reacted rapidly to NCD management challenges by increasing health service provision and strengthening medicine supplies in response to the multifaceted knock-on effects of COVID-19.
The paper examines how, with thoughtful planning and careful implementation, some of these rapid responses can, and should, be made permanent to improve the equity, accessibility, quality, efficiency and resilience of health systems.
Examples of replicable responses include
- the many promising examples of people-centred integrated care models across the disease spectrum;
- innovative attempts to enable and mobilize community-level primary care for early screening and diagnosis; and
- smart integration with digital and technological advancements to increase health access and improve diagnosis and treatment.
There is still room for optimization, …
… but we already see trailblazers identifying cost-effective and globally applicable NCD intervention and treatment pathways from which every country — no matter its income level — can and should benefit.
As the report sets out, to achieve progress and the goal of universal health coverage, we must reflect openly and honestly on the lessons learned so that gaps can be identified and new priorities set.
We should move towards a people-centred integrated care model and create an ecosystem where digital and technological advancement can be integrated into each patient’s journey and into primary care institutions to improve access and quality of care.
We should move towards a people-centred integrated care model and create an ecosystem where digital and technological advancement can be integrated into each patient’s journey and into primary care institutions to improve access and quality of care.
Taking an ecosystem approach will require global public and private collaboration.
Only by doing so can we save lives, reduce health system burdens and collectively achieve SDG Target 3.4.
Taking an ecosystem approach will require global public and private collaboration.
Only by doing so can we save lives, reduce health system burdens and collectively achieve SDG Target 3.4.
1.Introduction
COVID-19‘s long-term and detrimental impact on NCD management has necessitated active health system reforms in developing countries.
As of 20 September 2022, the global COVID-19 pandemic had resulted in 618,155,539 cases of the disease around the world, leading to 6,533,516 deaths.[4]
Since its emergence, COVID-19 has produced widespread social and economic uncertainty on a global scale.
Health systems have been under enormous pressure, notably due to the impact of the virus on people living with non-communicable diseases (PLWNCDs) and the difficulties it caused for the management of NCDs (cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, as well as mental health disorders).
Health systems have been under enormous pressure, notably due to the impact of the virus on people living with non-communicable diseases (PLWNCDs) …
… and the difficulties it caused for the management of NCDs (cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, as well as mental health disorders).
Developing countries, which account for more than 80% of the global disease burden of NCDs,[5] are exposed to the exacerbated impact of COVID-19 as they often suffer from a lack of health service resources and capacity.[6]
- 1.1 PLWNCDs are more vulnerable to COVID-19
- 1.2 Challenges of service provision for NCD management
- 1.3 Strengthening health systems with NCD management
1.1 PLWNCDs are more vulnerable to COVID-19
PLWNCDs are more likely to be infected with COVID-19 compared with healthy people;[7] in addition, the disease progresses faster, and the long-term health effects are more severe, in these people. Some 60–90% of COVID-19 deaths can be attributed to one or more NCD comorbidities.[8] [9] [10]
PLWNCDs are also affected by the pandemic in terms of their mental health, showing a higher probability of concurrent anxiety and depression.[11]
On top of this, some chronically ill patients voluntarily reject treatment because they fear that going to the hospital will increase the risk of infection.
1.2 Challenges of service provision for NCD management
In addition to the direct impact of COVID-19 on individuals’ health, PLWNCDs also face challenges relating to health service accessibility.
Many countries and regions have established closed and isolated control measures to prevent susceptible individuals from being exposed to infection and to help stop the spread of COVID-19.
In May 2020, the World Health Organization (WHO) conducted a rapid assessment of service delivery for NCDs during the COVID-19 pandemic.
The results showed that, out of 163 countries and regions surveyed, 122 countries or regions reported chronic health service interruption; cardiovascular emergency services were interrupted in 31% of the countries, cancer treatment services were interrupted in 42% and treatments for hypertension were interrupted in 53%.[12]
survey results (may 2020) out of 163 countries and regions surveyed, 122 countries or regions reported chronic health service interruption; cardiovascular emergency services were interrupted in 31% of the countries, cancer treatment services were interrupted in 42% and treatments for hypertension were interrupted in 53%.[12]
On top of this, pandemic prevention and control measures have had a knock-on effect on medical resources for NCD management services, leading to insufficient capacity in primary healthcare institutions, and issues with the supply of drugs for NCDs.
1.3 Strengthening health systems with NCD management
As one of the Sustainable Development Goals adopted by all United Nations member states in 2015, SDG 3.4 seeks to reduce premature mortality from NCDs by one-third by 2030 through prevention and treatment and to promote mental health and well-being.[13]
As yet, few countries have succeeded or even come close to reaching this target.[14]
It is clear, however, that improving the capacity and efficiency of NCD management and transforming health systems are vital objectives for developing countries, both for their inhabitants’ health and for global sustainable development.
Fortunately, the practices involved in improving NCD management capacity also contribute to the strengthening of health systems in general.
At the macro level, NCD management requires interdisciplinary collaboration, which provides an anchor point for health systems to implement comprehensive and high-quality development strategies.
Specifically, NCD management begins with enhancing community healthcare services; this helps to solidify the “cornerstones” of a health system[15] — healthcare delivery, health information systems and medicine supply security — enabling it to cope with the double threat of communicable and non-communicable diseases[16] and better prepare for a future pandemic.
2.Responding to NCD management challenges during the pandemic
Health systems have adopted flexible response methods to mitigate the impact of the COVID-19 outbreak.
In order to minimize the impact of the pandemic, developing countries and regions have developed rapid response plans to maintain regular in- and outpatient services, as well as secure drug accessibility for PLWNCDs.
- 2.1 Increasing temporary facilities to mitigate the impact on hospitalized NCD patients
- 2.2 Improving efficiency to meet PLWNCD outpatient needs
- 2.3 Adopting flexible measures to ensure the accessibility of NCD medications
2.1 Increasing temporary facilities to mitigate the impact on hospitalized NCD patients
Certain countries or regions have adopted a system whereby some hospitals have become designated centres for treating COVID-19 while others maintain normal operations as much as possible, treating patients with NCDs who are not infected with COVID-19.
Such a two-pronged response method helps ensure the continued supply of medical services when infection cases are scattered.
However, when there is a largescale outbreak of infections, a serious shortage of hospital beds will ensue.
In 2020, China took the lead by building a new “mobile cabin hospital“ in Wuhan.
The pressure on normal medical resources was reduced by increasing the medical resources used to treat patients with COVID-19 on a large scale in a short period of time.
Serbia, India, Indonesia and others[17] [18] [19] [20] have also adopted similar approaches, building new facilities for the isolation and treatment of patients with COVID-19 to ensure that the medical needs of patients with NCDs can also be met.[21]
2.2 Improving efficiency to meet PLWNCD outpatient needs
Faced with a shortage of medical resources, health systems in some developing countries and regions have placed more emphasis on improving service efficiency.
During the pandemic, medical institutions in these areas paid more attention to the role of pre-examination and triage, optimized the process of diagnosis and treatment service provision for PLWNCDs.
Some countries have formulated guidelines or expert consensus on the diagnosis and treatment of various NCDs during the pandemic to improve the standardization of services.[22] [23] [24] [25]
Patients are encouraged to obtain appropriate services through primary healthcare institutions, while community health service centres and family doctors interact with patients or their families and provide follow-up services through social media tools.
During the pandemic, especially the period of high incidence of infection cases, the internet became an important asset in relieving the pressure on physical hospitals.
“Contactless“ healthcare services provided by internet healthcare sites reduced the risk of infection for patients who usually visited physical hospitals, as well as meeting PLWNCDs‘ home treatment and medication needs.
2.3 Adopting flexible measures to ensure the accessibility of NCD medications
PLWNCDs generally require long-term medication. Some measures to guarantee the supply of medication of PLWNCDs include:
- i.Using designated pharmacies as the main channel for medication supplies to PLWNCDs
- ii.Extending the time limits for prescriptions for PLWNCDs and implementing a “long prescription” policy
- iii.Providing door-to-door medicine delivery services to reduce social contact:
i.Using designated pharmacies as the main channel for medication supplies to PLWNCDs
Taking China as an example, Wuhan identified 50 designated retail pharmacies across the city after the outbreak of COVID-19 to serve PLWNCDs.[26]
Cities such as Shanghai, Beijing and Jilin also relieved medicine supply issues through the use of designated pharmacies for NCD treatments.[27] [28]
ii.Extending the time limits for prescriptions for PLWNCDs and implementing a “long prescription” policy:
In 2020, China’s National Medical Security Administration extended the prescription dosage for hypertension and diabetes from two months to three months to ensure the long-term medication needs of PLWNCDs were met.[29]
Some regions also encouraged physicians in primary healthcare institutions or contracted family doctors to issue prescriptions, which normally come from overloaded hospitals.
Local health commissions are responsible for developing the list of medicines suitable for “long prescriptions” and the relevant policies,[30] while pharmaceutical companies have also launched large-package versions of NCD medications, for “long prescriptions”.[31]
iii.Providing door-to-door medicine delivery services to reduce social contact:
Door-to-door medicine delivery services for eligible elderly PLWNCDs through community health service staff, community volunteers or drug delivery companies have been encouraged.
A number of internet technology companies have collaborated with pharmacy chains to launch online pharmacies, which allow patients to arrange to have medicines delivered to their homes in 30 minutes using a smartphone app.
As tools to deal with the impact of the pandemic in the short term, these measures can reduce the pressure on NCD management to a certain extent.
However, as things normalize, health systems in developing countries and regions need more proactive innovation and systematic transformation, if only to better prepare for a future pandemic.
As tools to deal with the impact of the pandemic in the short term, these measures can reduce the pressure on NCD management to a certain extent.
However, as things normalize, health systems in developing countries and regions need more proactive innovation and systematic transformation, if only to better prepare for a future pandemic.
Table of Contents [excerpt]
- Foreword
- Executive summary
- 1.Introduction
- 2.Responding to NCD management challenges during the pandemic
- 3.The transformation to integrated health systems
- 4.Recommendations
References and additional information
See the original publication (this is an excerpt version)
https://new.qq.com/omn/20210606/20210606A04CHP00.html.
Foreword
Shyam Bishen
Head, Shaping the Future of Health and Healthcare,
World Economic Forum
Yunguo Liu
Co-Director, Global Health Program, Duke Kunshan University Global
Health Research Center
EXECUTIVE SUMMARY
Kelly McCain
Head, Healthcare Initiative,
World Economic Forum
Carrie Liu
Lead, Health and Healthcare,
World Economic Forum
