This report responds to a commission by Scottish Government (SG) to design a new international development health programme providing support to the Governments of Malawi, Rwanda and Zambia with a specific focus on non-communicable diseases (NCDs). Findings were informed by a review of the literature and policy documents; semi structured interviews with colleagues working in development in health and NCDs at global, regional and national levels. These included colleagues from respective Ministries of Health, the World Health Organisation and other United Nations (UN) partners, third sector organisations and academic institutes. A workshop with Scottish Government colleagues provided feedback on the proposed theory of change and next steps.
Globally NCDs are the leading cause of death and disability, killing around 41 million people each year. This number is likely to rise with the World Health Organisation (WHO) predicting that NCDs will be the main cause of death and disability in sub-Saharan Africa (SSA) by 2030. Indeed, many countries are facing a ‘double burden’ with increasing rates of NCDs coupled with ongoing high mortality from communicable disease. NCDs are inextricably linked to poverty, and amongst the poorest billion, more people under 40 years old are dying from NCDs, than HIV, tuberculosis and maternal deaths combined.
The challenge of NCDs in low-and middle-income countries including Malawi, Rwanda and Zambia is well recognised. The WHO Global Action Plan provides a roadmap for Member States to work towards with the intent of supporting them to reduce premature mortality by one third from NCDs and meet Sustainable Development Goal 3.4. Alongside this, WHO has published “Best Buys” which provide a summary of the most cost-effective interventions able to help control and manage NCDs. The WHO Package of Essential NCD Interventions for primary health care (PEN) and the WHO Package of Essential NCD Interventions Plus (PEN Plus) for chronic and severe NCDs outline minimum service delivery standards for Member States to work towards. Pen Plus was ratified by Member States of the World Health Organisation Regional office for Africa (WHO AFRO) in August 2022. Despite this, NCDs are underfunded receiving less than 2% of development assistance for health. Very little change has been seen in the amounts allocated towards NCDs.
A significant proportion of the populations of Malawi, Rwanda and Zambia live in poverty with dependence on external finance to support delivery of healthcare. Around 35-50% of deaths are a consequence of NCDs with each country developing and publishing national policies and plans including for the delivery of Pen and Pen Plus. Despite the increasing burden of NCDs and reliance on development partner support for delivery of health services, support for prevention and management of NCDs remains very low. This leaves an important opportunity for Scottish Government to share their skills and expertise globally and at country level to raise awareness of the importance of NCDs across the region with a specific focus on the three priority countries.
The proposed design of the programme includes three components. The first is focused on raising awareness and attention to NCDs at global level through work with international partners. The second is on the national scale up of PEN and Pen Plus (Malawi and Zambia) and support for the expansion of PEN Plus to include palliative care (Rwanda). The third component focuses on peer-to-peer learning and support.
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