BHW Report 2016 on NCDs: challenges and recommendations

Non-communicable diseases (NCD) constitute a major challenge for the low- and middle-income (LMIC) countries.  Globally, the NCDs are receiving increasing attention from the policy-makers and practitioners, as reflected in the new 3.4  Sustainable Development Goals (SDG) target (“reduce mortality from NCDs and promote mental health”). The LMICs like Bangladesh are fast undergoing “epidemiological transition”, thanks to the spectacular success of modern medical science, substantial control of the communicable diseases from improved water and sanitation, and economic development. So far so good! But, the flip side of the coin is that these countries are becoming “old before they are rich”, and burdened with the rapid rise of non-communicable diseases (NCDs). Bangladesh is no exception. This is posing a major challenge to its existing health systems (primarily geared to address communicable diseases of women and children) as the government is yet to pick up the momentum for the ever expanding needs for policies and plans, services, and infrastructures for preventing NCDs.

Bangladesh Health Watch, a civil society initiative since 2006, is producing analytical reports on issues related to improvement of the health system from a critical perspective, and do the relevant advocacy activities. So far, five reports on equity (BHW, 2006), health workforce (BHW, 2007), governance (BHW, 2009), universal health coverage (BHW, 2011), and urban health (BHW, 2014) have been published. In 2016, this emerging problem of NCDs for health and health system of Bangladesh in the era of the SDGs is taken up for analysis and discussion. We limited our inquiry to the four major NCDs responsible for major chronic disease burdens e.g., cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases. Each NCD is discussed critically around four central themes: current epidemiology and prevalence of risk factors, existing policies and strategies including challenges of implementation, inventory of ongoing NCD programmes and finally, an assessment of the current health infrastructure preparedness vis-a-vis addressing the challenge of NCD management in the coming years. Based upon these, challenges are identified and recommendations made for addressing the NCD agenda in Bangladesh in the context of universal health coverage and SDGs.

Given the current scenario regarding the policies, strategies and programmes on NCDs, the following challenges are identified for a comprehensive approach to address NCDs in future:

1) Mainstreaming NCD service provision at the PHC level: emphasizing prevention based on modifiable risk factors through lifestyle changes

2) Absence of regulatory framework and lack of coordination at the national level

3) Lack of robust database at national level for NCD surveillance and monitoring, incorporating common data from rural and urban areas as well as public, for-profit private and other non-state sectors

To address these challenges, five recommendations/action points are made for immediate action:

1) Build awareness on the extent and importance of the NCDs at present and in near future and its linkage to poverty alleviation, economic development and achieving UHC at the policy, practitioners, and the community level.

2) Develop an integrated, multi-sectoral approach to prevent and manage NCDs, with government, especially the MoHFW, in the stewardship role.

3) Strengthen the current health systems at all levels to address NCDs with a focus on developing human and physical capacity at the PHC level for preventive services to affect modifiable NCD risk factors, and screening for early diagnosis and treatment including follow-up services for identified cases.

4) Establish a comprehensive surveillance system and registry for the four major NCDs at the national level including monitoring and evaluation of NCD programmes, both on-going and the future ones.

5) Generate evidence for delivering preventive and curative NCD services effectively and efficiently, keeping equity and universal coverage in focus.

In conclusion, a ‘concerted, strategic, and multi-sectoral policy approach’ is essential for dealing with the emerging epidemic of NCDs in Bangladesh. The quicker we understand and appreciate this, and mobilize our energy for actions, the better for the health of the country.

Source: forthcoming Bangladesh Health Watch Report 2016 on NCDs