Common Challenges for Tackling NCDs(cont..)

Economic

* Costs of NCDs put strains on budgets of government and other financiers of care because

treatments use some expensive private goods and services.

* High catastrophic spending and impoverishment among individuals is too common. This

exacerbates equity issues because most health financing is private and out of pocket.

Institutional

 Institutional units are lacking (such as government units to develop and implement policy,

oversight, evaluation, and research) or are inadequate for the scope of their responsibilities.

Adding NCDs to an existing unit’s responsibility (e.g., nutrition or environmental health) is a

limited solution but may reveal weaknesses as its responsibilities increase.

 Experienced cadres to fill NCD leadership roles are in short supply, and professional training and

postgraduate training tracks are limited.

 There is no tradition of NCD work and little institutional memory.

Technical

 Government, academic, and private institutions have limited experience in conducting burden

assessments, risk factor surveillance, developing NCD prevention and health promotion policies,

reviewing the current evidence base for interventions, evaluating new technology, or regulating

and monitoring public and private health services delivery.

 Delays in setting priorities and launching initiatives stem from limited experience and expertise

with NCDs among government staff.

 Diagnosis may require a level of technology that simply is not available, accessible, or

affordable.

 Ongoing care is needed to prevent complications and may require health system and policy

retooling.

From the individual perspective, two important factors come into play. First, patients need some

knowledge about their disease, the ability to provide self care, and attend clinics, and, in many cases,

put forth substantial funds to finance their care—usually out of pocket. Second, common risk factors

involve personal choices about behaviors and, in some situations, individuals may find the information

about these choices unclear or conflicting, or they may be overwhelmed by commercial marketing

campaigns serving other goals, as with tobacco.

Finally, engaging the business community and the private sector is important yet challenging. The poor

health of a company’s workforce can quickly affect its profits and reduce its investment in human

capital. Because of the employer–employee relationship and its vested interest to increase productivity,

the private sector can have a strong influence on employee behavior in ways that the public sector

cannot. In developed countries many successful lifestyle models have been produced for employer- and

employee-based health promotion that targets chronic NCDs. As the formal labor sector expands it will

be important to tap private sector capacity to tackle NCDs (Box 5.1).