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By 2030, 7 in 10 deaths globally will be due to noncommunicable diseases; health systems must be strengthened to respond to this growing crisis

Lancet

Many cost-effective interventions and new technologies now exist to tackle chronic diseases in low-income and middle-income countries. But weak national health systems often make it impossible to deliver and sustain interventions effectively and equitably.

In this fourth paper in The Lancet Series on Chronic Diseases and Development, the authors review how weaknesses in national systems for health financing, governance, the health workforce, health information, medical products and technologies, and health service delivery are preventing an effective response to the growing burden of chronic disease in many low-income and middle-income countries. They argue that chronic disease programmes are particularly dependent on well-functioning health systems because they need long term, coordinated and intersectoral responses that can be sustained across a continuum of care.

A new global agenda for health-systems strengthening is arising from the urgent need to scale up and sustain efforts to tackle select health priorities such as HIV, tuberculosis, malaria, and vaccine-preventable diseases. But the authors say: "Most chronic diseases are neglected in this dialogue about health systems, despite the fact that non-communicable diseases (most of which are chronic) will account for 69% of all global deaths by 2030 with 80% of these deaths in low-income and middle-income countries." New estimates show that only 2 - 3% of overall development assistance for health was allocated to chronic non-communicable diseases in 2007.

The authors also find that chronic disease advocates are not doing enough to promote health-system strengthening. They say: "Efforts to scale up interventions for management of common chronic diseases tend to focus on one disease and its causes, and are often fragmented and vertical".

The authors identify some examples of best practice where interventions to deliver services for chronic conditions have included investment in health system strengthening.. In these cases there is evidence that the consequent improvements in the health system as a whole have also produced benefits for other health services.

The authors identify five areas for action: i) embed the discourse on chronic diseases in the emerging agenda for health-systems strengthening and promote the needs of health systems to chronic disease advocates ii) avoid fragmentation of the response to chronic disease (by single condition or subgroup). iii) agree on targets for measurement of progress in health-systems strengthening using criteria related to chronic diseases as key indicators. iv) broaden ownership of responses to chronic disease and of health-systems strengthening. V) increase funding for health that is oriented towards a health-systems response to the growing burden of chronic diseases.

They conclude: "If a national health system is designed so that it can respond effectively to chronic diseases, that country will also be well equipped to respond to a wide range of other population-health needs, including acute conditions. Investment in a systems approach to chronic diseases in low-income and middle-income countries could therefore represent a strategic focus for a new, post-2015 global health agenda."

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Badara Samb, World Health Organization: tel +41 22 791 4452 (desk), +41 79 477 1741 (Mobile) E) sambb@who.int

For full Series paper 4, see: http://press.thelancet.com/cdd4.pdf

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