Address The Gaps In Integrated Healthcare ln Ghana Now Stakeholders In Non-Communicable Diseases Urges Government
Stakeholders in the health sector in the country have expressed concern about the gaps in integrated healthcare and called for urgent action to integrate non-communicable disease services into Established Disease-Specific Programmes and the Universal Health Coverage (UHC).
Freeman Koryekpor Awlesu Greater 
Stakeholders in the health sector in the country have expressed concern about the gaps in integrated healthcare and called for urgent action to integrate non-communicable disease services into Established Disease-Specific Programmes and the Universal Health Coverage (UHC).
They stressed that: “The COVID-19 pandemic has been catastrophic for people living with non-communicable diseases (NCDs) and it is clear that we need health infrastructure in low- and middle-come countries like Ghana that is fit for purpose if we are to build back better.”
This was in a joint statement issued at a national stakeholders meeting organized by the Ghana NCD Alliance (GhNCDA) in Accra on the integration of NCDs services into Established Disease-Specific Programmes and the Universal Health Coverage.
The meeting was attended by representatives from various institutions, including government, civil society actors, academic/research institutions.
The institutions are HIV/AIDS Program, Tuberculosis Programme, Reproductive, Maternal, Newborn and Child Health Programme, the Malaria Control Programme, Ghana Non-Communicable Diseases Alliance, Hope for Future Generation, Concern Health, and PATH Ghana.
The rest are World Vision – Ghana, Alliance for Reproductive Health Right, Plan Parenthood Association Ghana, Vision for Alternative Development Ghana, Media Alliance on Tobacco Control and Health, Arklifestyle Foundation, Generational Youth Foundation, Revenue Mobilization Africa, Sharecare Ghana, Stroke Association Support Network
The statement said, “Ghana is facing a combined affliction from communicable diseases, and NCDs, which threaten the health of the populace and further compromise the already stressed health systems. Today, more people are living with multiple chronic conditions, and this needs to be better recognized in the health systems.”
Below is the statement from the Stakeholders in the health
At the National Stakeholders Meeting on Integrating Non-Communicable Diseases (NCDs) Services into Established Disease-Specific programs and Universal Health Coverage (UHC) held in Accra on Thursday, 10th March 2022, stakeholders from various institutions including government, civil society actors, academic/research institutions, have noted with concern the need to address the gaps in integrated healthcare.
The participatory institutions which are HIV /AIDS Program, Tuberculosis Program Reproductive, Maternal, Newborn and Child Health Program, The Malaria Control Program Ghana NCD Alliance, PATH Ghana World Vision– Ghana, Hope for Future Generation, Concern Health Alliance for Reproductive Health Right, Plan Parenthood Association Ghana, Vision for Alternative Development Ghana, Media Alliance on Tobacco Control and Health, Arklifestyle Foundation, Generational Youth Foundation Revenue Mobilization Africa, Sharecare Ghana, Stroke Association Support Network and SDGs CSOs platform on Heal in a statement called for an urgent and concrete action to integrate NCD Services into Established Disease-Specific Programs and UHC.
THE NEED FOR INTEGRATION/ MAINSTREAMING NCDS INTO OTHER DISEASE CONDITIONS
Ghana is facing a combined affliction from Communicable Diseases, and NCDs, which threatens the health of the populace and further compromises the already stressed health systems.
Today, more people are living with multiple chronic conditions and this needs to be better recognized in the health systems.
The COVID-19 pandemic has been catastrophic for people living with NCDs and it is clear that we need a health infrastructure in Low- and Middle-Income Countries (LMICs) that is fit for purpose if we are to build back better.
Despite all the challenges in integrated care, Ghana has made some significant strides in integrated care, particularly for HIV/AIDS, Tuberculosis (TB), Maternal, Newborn, and Child Health (MNCH).
However, it is important to align with the idea that health systems need to adapt to a clearer focus on the person and their health throughout their life course, not only on the single health crisis or condition that leads them to seek care elsewhere. This is however lacking in many respects.
Silo mentality has been in existence for a long and it forms part of our corporate culture. However, the time has revealed that this has had a major hurdle in the attainment of impactful health outcomes which will enhance economic and medical gains.
WORLD LEADERS’ AFFIRMATION TO PROVIDE INTEGRATED SERVICES TO INCLUDE NCDS
2011:
The Political Declaration at the UN High-Level Meeting on NCDs (clause26) recognizes the pivotal role of maternal, neonatal, and c, child health programs in NCD prevention and care.
2014: The Grand Challenges in Global Mental Health Initiative and the UNAIDS Strategy 2016-2017 call for a stronger commitment towards integration of HIV and NCDs, including mental illness and drug dependency.
2015: Sustainable Development Goal 3.4, aims to, by 2030: “reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.”
2018: The United Nations High-Level Meeting on Tuberculosis 2018 (para 29) which commits to coordination and collaboration between tuberculosis and HIV programs, as well as with other health programs and sectors, to ensure universal access to integrated prevention, diagnosis, treatment, and care services, and (para 31), which commits to systematic screening, as appropriate, of relevant risk groups…for active and latent tuberculosis, to ensure early detection and prompt treatment in groups disproportionately affected by tuberculosis, such as people living with diabetes and people living with HIV.’
2021: The United Nations High-Level Meeting on HIV/AIDS commits to the provision of 90% of people living with, at risk of, and affected by HIV; with people-centered and context-specific integrated services for HIV, other communicable diseases, NCDs, mental health, and other services by 2025.
NCDs in global health priority areas – at a glance People living with HIV
People living with HIV have nearly a two-fold increased risk of cardiovascular disease (CVD), compared to their HIV-negative counterparts, and women living with HIV have nearly a six-fold increased risk for cervical cancer. Globally one in four people ( representing about 24% between ages 20-30) living with HIV are estimated to have moderate to severe depression and Type 2 diabetes prevalence amongst people living with HIV range from 1.3% to 1.8%, depending on the setting. CVD risk factors are 21% more likely to affect people living with HIV
People living with tuberculosis
People diagnosed with tuberculosis (TB) are about twice as likely as those without TB to be affected by diabetes, and about twice as likely to develop certain cancers.
The average global prevalence of diabetes amongst people who are being actively treated for TB stands at 16%, although there is wide variation between different areas. The dual burden of TB and mental health, often intersecting with poverty, is well established.
Maternal, neonatal, and child health populations
Hypertensive pregnancy disorders account for between 10% and 15% of maternal deaths in LMICs. Worldwide, one in six pregnancies may be associated with hyperglycemia, 84% of which involve Gestational Diabetes Mellitus (GDM).
NCDs are also believed to contribute to ongoing inter-generational transmission, with children born to mothers with uncontrolled NCDs, at higher risk for developing hypertension, chronic renal impairment, heart disease, and other conditions later in life.
Most women receiving care during pregnancy in LMICs are not systematically screened or treated for these conditions, the extent to which pregnant women globally are affected remains unknown.
IMPORTANCE OF INTEGRATION
Integrating NCD services into established funded disease-specific programs, such as HIV/AIDS, TB, MNCH among others; as add-ons or ‘service bundling’ can provide essential priority health interventions to the populace.
Our failure as a country to effectively and comprehensively integrate NCDs into Established Disease-Specific Programs over the years has been an impediment to attaining the Sustainable Development Goals (SDGs) target 3.4 and 3.8, which aimed at “reducing by 2030, one-third premature mortality from NCDs through prevention and treatment and the promotion of mental health and well-being”.
The integration of NCD into Established Disease Interventions can have very promising results on health outcomes, equity of access, user satisfaction, and trust in health programs, with strong support from in-country stakeholders to pursue this worthy cause to achieve optimum healthcare that is people-centered rather than disease-centered.
RECOMMENDATIONS TO GOVERNMENT
Seek funding for system improvements that will benefit more than one disease area.
Deliberately include the mainstreaming of NCDs into specific disease-focused areas in the Ministry’s Health Sector Medium Term Development Plan for effective implementation Provide leadership on integration and encourage coordination among a diverse range of stakeholders working across various disease areas.
Take a phased and context-specific approach to promoting the transition to UHC, considering the state of development of individual health systems, their priorities, disease burdens, as well as the availability and affordability of proven interventions towards the implementation of integrating NCD services into established disease-specific programs.
Ensure that the priorities, experiences, and capacities of local health service providers and communities are identified and taken into account in program design and adaptation.
Incorporate NCD services at all levels of health care with a particular focus on primary and community care services.
Invest in research and technologies to support the integration of NCD strategies and programs
Provide leadership for integrated care, ensuring that the full care cascade is considered before investment decisions.
Ensure that there is a ‘seat at the table’ for people living with NCD or chronic condition, community engagement/social participation, and opportunities for managers and planners including policy/decision-makers at all levels to listen to their experiences and priorities.
Incorporate multi-morbidity data and discussions into planning processes. Join forces with other countries, including donor countries, to call on funders to finance in a more holistic and integrated way.
ROLE OF CSO ACTORS
Support and actively seek to build relationships and join forces with advocates, people with lived experience, and researchers from other health areas with shared agendas (e.g. environmental health, UHC advocates. etc.).
Support people living with NCDs and multi-morbidities to share their experiences of health systems and unmet care needs.
Join with other stakeholders to advocate for improved service (reduce out-of-pocket expenses) for using primary health care, or for particular groups, such as pregnant women and children, to decrease access barriers for the poor and vulnerable people.
Advocate that people living with NCDs, including those living with multiple conditions, have opportunities for meaningful engagement in the design of integration efforts.
Support and amplify the voices of those living with multiple chronic conditions.
Continue to support the dissemination of lessons learned about the importance of NCD service provision for UHC, ensuring that messages include the diversity of NCDs and advocate for a whole-of-person approach to service re-design.
CONCLUSION
More people are living with multiple chronic conditions today and this needs to be recognized and acted upon in the health systems.
The COVID-19 pandemic has been catastrophic, especially for people living with NCDs and it is clear we need a health infrastructure in Ghana that is fit for this purpose, to build back better.
Finally, we, as participants, are hopeful that these recommendations and conclusions being brought to the attention of the Minister of Health and other key stakeholders will be highly reconsidered.
