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Countries have a long way to go to reduce the burden of NCD (non-communicable disease)

A scorecard for tracking actions to reduce the burden of non-communicable diseases

C3 Collaborating for Health

A new method published in the Lancet of monitoring countries' performance in reducing the burden of NCD (non-communicable disease), shows that many countries have a long way to go to reduce suffering and deaths from NCD.

Scores to measure performance across four areas: governance, risk factors, surveillance/research, and health system response were gathered from 23 mostly low- and middle- income countries (including China and India). Of these 92 scores, 56 were below 50% and 23 were below 25%. Countries fare poorly in reducing the risk factors (tobacco use, poor diet, physical inactivity and the harmful use of alcohol) that feed the pipeline of NCD. Most are sub-par in researching local responses to NCD and measuring levels of disease and risk factors.

  • Governance - establishing teams, plans, and policies to reduce NCD burden -- is key to addressing the rising challenge of NCD. The Scorecard shows improvement in most countries.

  • Generally, the poorer the country the weaker the response to NCD, although there is considerable variation; in some lower income countries, notably India, Kenya and Bangladesh, there are steps toward addressing the risk factors.

"Although all countries have made improvement in their performance to prevent and control NCD, most lower- and middle- income countries have lots of work to do to reduce suffering and deaths from NCD" said Ana Victoria Roman, PhD from the Institute of Nutrition of Central America and Panama (INCAP), who led the project. "With the addition of this new tool, countries will now have the ability to see how various sectors in their country are addressing NCDs and to learn from other nations how to tackle NCD."

The NCD Scorecard was developed from the United Nations political declaration after the High Level meeting on the Prevention and Control of Non-communicable Diseases in 2011, following extensive consultation with global experts by a team from GRAND South -- a network of 11 centres conducting research, building capacity, and advising on policy in relation to NCD in low- and middle- income countries. Scores were gathered in each country for 51 indicators from representatives of government, non- governmental organisations, academia, and the private sector. "It is encouraging that representatives across sectors broadly agree about the status of NCD intervention within their country, which is reflected in the scores," Ana Victoria Roman notes.

Full results for all indicators for each country are available on an open website, and reports on each country identify areas where countries are doing well, and priorities for action.

"Accountability is an important driver for political progress. Independent monitoring initiatives by academia and civil society, such as this NCD Scorecard, will help ensure governments keep to their promises made at the UN on NCDs. The results reinforce that progress on NCDs at the national level has been patchy and uneven, a message that was central to the UN High-Level Review on NCDs last July", said Katie Dain, Executive Director of the NCD Alliance.

Full results for all indicators for each country are available on an open website, and reports on each country identify areas where countries are doing well, and priorities for action. "Policy makers will find useful the detailed information available on each country. Many actions are needed to reduce the burden of NCD, and the Scorecard results will help countries identify the gaps to be filled," said Sir George Alleyne, former director of PAHO (Pan American Health Organization), and chair of the International Policy Advisory Group that advised the GRAND South team.

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Notes to editors

1. Full results and reports from all 23 countries are available at http://www.ncdglobalscorecard.org

2. NCD comprises cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and some cancers. NCD accounts for 63% of global deaths (37 million annually) with 80% occurring in low- and middle- income countries. Deaths caused by NCD are expected to increase by 15% between 2010 and 2020 with the biggest increases in Africa, the Eastern Mediterranean and South-East Asia. In low- and middle- income countries, 29% of deaths caused by NCD occur in people under 60. Half of premature deaths from NCD are preventable.

3. The World Health Organization has set a voluntary target for countries to reduce deaths of people under age 70 from NCD by 25% by 2025.

4. The United Nations political declaration http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf was used to develop some 80 potential indicators followed by a two stage modified Delphi process with global experts to identify the final 51 indicators. The final list included qualitative and quantitative indicators divided into four domains: governance; risk factors; surveillance and research; and health systems. Field coordinators in the 23 countries sent the final questionnaire to government officials from health, finance, and education ministries; leaders of non-governmental organisations; private sector leaders; and academics. Respondents were asked to score each indicator on a four-point scale: 3 (highly adequate); 2 (adequate); 1 (present but not adequate) and 0 (not present). An overall score was calculated for each indicator for each country by dividing the total score by the total possible score and presenting the result as a percentage. Scores were also calculated for each domain for each country in the same way.

5. High level results are shown in the table below, which you are free to reproduce.

6. For further information and interviews contact Sheree Bryant collaborate@c3health.org. Interviewees are available from each of the 11 centres of GRAND South.

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