Please No Mega-Funds: Let’s Harness the Universal Health Coverage Movement to Address NCDs

Please No Mega-Funds: Let’s Harness the Universal Health Coverage Movement to Address NCDs

In June 2011, the CSIS Global Health Policy Center asked bloggers around the world, Do you think it's possible to create a unified social movement for NCDs, akin to the movements that already exist for individual chronic diseases?  If so, why?  If not, what initiatives can we implement in the place of an effective social movement to move an NCD agenda forward? Dr. Jonathan D. Quick was one of our four finalists.

For three years, Lucy Sakala has counseled people seeking HIV tests at a District Hospital in Malawi. A year ago, she was diagnosed with uterine cancer. She has had chemotherapy and surgery, which are sometimes painful and tiring, but are extending her life.

During the counseling sessions, she sometimes tells her patients about her illness: “I tell them they should live positively. There are several conditions more serious than HIV. I tell them I have cancer. It’s difficult, but I live positively."

The day before she said this, she had journeyed seven hours to the nearest city to see her doctor. He told her he had no more chemotherapy and she must buy it in a pharmacy. The cost was roughly $180. Insurance would only pay half.  The remaining half is a month’s salary, which she didn’t have.

Sadly, with the epidemics of heart disease, cancer, diabetes, and other chronic non-communicable diseases (NCDs), there are millions of Lucy Sakalas in low-income countries. It seems a strange paradox that those caring for patients with AIDS – for which so much was done in the last decade – should themselves suffer and die from diseases around far longer than AIDS.

In low and middle-income countries (LMICs), 28 million people die each year from NCDs, at least 8 million deaths of which are preventable with changes in lifestyle and access to quality, affordable health care services. While low-cost generic medicines are available for most chronic diseases, availability is poor and actual prices vary widely among LMICs. Insulin, life-saving for many diabetics, is unavailable or the price unaffordable in many parts of LMICs. In the Congo, for example, the price is the fourth highest in the world ($47.50/vial). The direct out of-pocket payments for services and medicines currently each year thrusts 100 million people worldwide into poverty.

Rather than call for a new “mega-fund” for NCDs, we need to use the growing focus on NCDS to build a global social movement for Universal Health Coverage (UHC) to address all health needs according to national and local epidemiology and priorities.

The UHC movement calls on nations to reform their health plans and financing structures toward access to essential diagnostics, prevention, and treatment for all. Strong equitable health systems are the tipping point for universal health coverage.  As demographics change and people with communicable diseases live long enough to develop chronic diseases, a responsive, performance-driven, integrated health systems approach will have the greatest health impact.

A strong health system grounded in UHC, working to address NCDs must:

  • Be coordinated and integrated to reach people who may otherwise go undetected.
  • Deliver integrated care and include all players in the health system—governments, pharmacists, healers, health workers, and community health workers.
  • Have strong information systems and an educated health workforce.
  • Support local private sector health providers.

An essential milestone in the UHC movement was reached at last month’s World Health Assembly, when the world’s ministers of health unanimously adopted a resolution urging that UHC be put on the UN agenda for in 2012 and that countries work to “transform their health systems” for universal coverage. This is a necessary step to ensure UHC is a topic on policymakers’ minds. The UHC movement will move the NCD agenda forward.

(Cross-posted at

Jonathan D. Quick, MD, MPH is President and Chief Executive Officer of Management Science for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.

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