The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion

Bukhman, Gene; Mocumbi, Ana Olga; Atun, Rifat; Becker, Anne E.; Bhutta, Zulfiqar A; Binagwaho, Agnès; Clinton, Chelsea; Coates, Matthew M; Dain, Katie; Ezzati, Majid; Gottlieb, Gary; Gupta, Indrani; Gupta, Neil; Hyder, Adnan A.; Jain, Yogesh; Kruk, Margaret E; Makani, Julie; Marx, Andrew; Miranda, J. Jaime; Norheim, Ole Frithjof; Nugent, Rachel; Roy, Nobhojit; Stefan, Cristina; Wallis, Lee; Mayosi, Bongani M.; Adjaye-Gbewonyo, Kafui; Adler, Alma J; Amegashie, Fred; Amuyunzu-Nyamongo, Mary; Arwal, Said Habib; Bassoff, Nicole; Beste, Jason; Boudreaux, Chantelle; Byass, Peter; Cadet, Jean Roland; Dagnaw, Wubaye Walelgne; Eagan, Arielle Wilder; Feigl, Andrea B; Gathecha, Gladwell; Haakenstad, Annie; Haileamlak, Abraham; Johansson, Kjell Arne; Kamanda, Mamusu; Karmacharya, Biraj; Kasomekera, Noel; Kintu, Alex; Koirala, Bhagawan; Kwan, Gene F.; Larco, Nancy Charles; Maongezi, Sarah; Masiye, Jones; Mayige, Mary; McLaughlin, Amy; Memirie, Solomon Tessema; Muquingue, Humberto; Mwangi, Kibachio Joseph; Ndayisaba, Gilles; Noble, Christopher A.; Noormal, Bashir; Olsen, Maia; Park, Paul; Aguilar, Gisela Robles; Sankoh, Osman; Saxena, Akshar; Schwartz, Leah N.; Schwarz, Dan; Shaffer, Jonathan D.; Sumner, Andy; Doe, Zoe Taylor; Upreti, Senendra Raj; Verguet, Stéphane; Watkins, David; Wroe, Emily

doi:10.1016/s0140-6736(20)31907-3

Cited by 194 publications

(207 citation statements)

References 164 publications

Supporting

Mentioning

197

Contrasting

Unclassified

Order By: Relevance

“…Beginning in the mid-1970s, WHO officials formally linked ideas of shared lifestyle-modifiable risk factors to the pragmatic inclusion or exclusion in what came to be known as the “main four” NCDs. The result of this history has been that the principal drivers of NCDs amongst the poorest populations in the world have become rendered less visible to policy makers and ministries of health, leading to very little political attention and funding ( Bukhman et al, 2020 ).…”

Section: Theorymentioning

confidence: 99%

“…This shift is also reflected in the WHO Independent High-Level Commission on NCDs ( World Health Organization, 2018 ). Finally, The Lancet Commission on Reframing NCDs and Injuries (NCDIs) for the Poorest Billion has also characterized the NCDI burden in populations living in extreme poverty and made recommendations regarding pro-poor NCD control strategies that address a broader range of severe conditions among children and young adults ( http://www.ncdipoverty.org ) ( Bukhman et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The origins of the 4 × 4 framework for noncommunicable disease at the World Health Organization

Schwartz

Shaffer

Bukhman

2021

SSM - Population Health

Self Cite

View full text Add to dashboard Cite

Section: Theorymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The origins of the 4 × 4 framework for noncommunicable disease at the World Health Organization

Schwartz

Shaffer

Bukhman

2021

SSM - Population Health

Self Cite

View full text Add to dashboard Cite

“…In many LICs, the risk factors, epidemiology and disease conditions that comprise the burden of NCDIs differs from that seen in higher income countries. 2 In these countries, harmful environments, infectious diseases and poor access to timely and high-quality health services are important factors contributing to the burden of NCDs. 3 4 Health sector interventions to address this burden have been increasingly recognised as both cost-effective and equitable, particularly for severe NCDIs affecting individuals early in life.…”

Section: Open Accessmentioning

confidence: 99%

Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries

Gupta¹,

Coates²,

Bekele³

et al. 2020

BMJ Open

Self Cite

View full text Add to dashboard Cite

Context and objectivesNon-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.DesignSecondary analysis of existing cross-sectional survey data.SettingWe used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.Outcome measuresWe defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.ResultsOverall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.ConclusionsOur findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.

show abstract

“…These four conditions are frequently linked to four behavioral risk factors (tobacco use, sedentary lifestyles, poor diet, and the harmful use of alcohol) [ 9 ]. The so-called ‘4-by-4’ approach builds upon lessons learned from addressing cardiovascular and other chronic diseases in high-income countries [ 14 ]. It seeks to reduce NCD-linked morbidity and mortality by concentrating on primary and secondary prevention, including behavior change to avoid illness and early detection and treatment to avoid the most significant morbidity [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Noncommunicable Disease (NCD) strategic plans in low- and lower-middle income Sub-Saharan Africa: framing and policy response

Boudreaux¹,

Noble²,

Coates

et al. 2020

Global Health Action

Self Cite

View full text Add to dashboard Cite

Background: Global efforts to address NCDs focus primarily on 4-by-4 interventions-interventions to prevent and treat four groups of conditions affecting mainly older adults (some cardiovascular disease and cancers, type 2 diabetes, chronic respiratory disease) and four associated risk factors (alcohol, tobacco, poor diets, and physical inactivity). However, the NCD burden in Sub-Saharan Africa (SSA) is composed of a more diverse set of conditions, driven by a more complex group of risks, and impacting all segments of the population. Objective: To document the NCD priorities identified by NCD strategic plans, to characterize the proposed policy response, and to assess the alignment between the two. Methods: Using a two-part conceptual framework, we undertook a descriptive study to characterize the framing and overall policy response of strategic plans from 24 low-and lower-middle-income countries across SSA. Results: The national situation assessments that ground strategic plans emphasize a diversity of conditions that range in terms of severity and frequency. These assessments also highlight a wide diversity of factors that shape this burden. Most include discussions of a broad range of behavioral, structural, genetic, and infectious risk factors. Plans endorse a more narrow response to this diverse burden, with a focus on primary and secondary prevention that is generally convergent with the objectives established in global policy documents. Conclusions: Broadly, we observe that plans developed by countries in SSA recognize the heterogeneity of the NCD burden in this region. However, they emphasize interventions that are consistent with global strategies focused on preventing a narrower set of cardiometabolic risk factors and their associated diseases. In comparison, relatively few countries detail plans to prevent, treat, and palliate the full scope of the needs they identify. There is a need for increased support for bottom-up planning efforts to address local priorities.

show abstract

The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion

Cited by 194 publications

References 164 publications

The origins of the 4 × 4 framework for noncommunicable disease at the World Health Organization

The origins of the 4 × 4 framework for noncommunicable disease at the World Health Organization

Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries

Noncommunicable Disease (NCD) strategic plans in low- and lower-middle income Sub-Saharan Africa: framing and policy response

Contact Info

Product

Resources

About