Published on Investing in Health

Sub-Saharan Africa: How can we avoid the disease silos trap?

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While much of the health focus in sub-Saharan Africa has been directed toward communicable diseases, particularly HIV/AIDS, there has been less acknowledgement that non-communicable diseases (NCDs) are a growing problem. These diseases already account for about 30% of deaths and are expected to become the leading cause of ill health and death by 2030 (see chart).

In a recent article for the British Medical Journal, we focus on the complex health burden in sub-Saharan Africa, and ask how the region might respond to this challenge.

We argue that the long-term care needs of chronic diseases, both communicable (as more people benefit from antiretroviral drug treatment, HIV/AIDS is fast becoming a chronic condition) and NCDs, threaten to overwhelm fragile health systems, and propose three strategies to alter this course:

First, capitalize on the inter-linkages between conditions and on their common determinants. Not much attention has been paid to the extent that communicable diseases contribute to the onset of NCDs and to potential common interventions.  Around one-third of cancers in Africa are infection-related; for example, human papilloma virus (HPV) causes cervical cancer, a leading killer of African women, and HPV-associated cancers occur more frequently in HIV infected people. Diabetes triples the risk of developing tuberculosis (TB) and is a common co-morbidity in people with TB.

Some interventions to prevent NCDs are straight out of the communicable disease toolbox. Immunization programs could be expanded to provide HPV vaccines for young girls and protect them against HPV types which cause 70% of cervical cancer cases. Collaboration with reproductive and sexual health programs could help raise awareness of early signs and symptoms of cervical and breast cancer and increase coverage of low-cost cervical cancer screening and treatment programs.

Second, focus on common care needs, rather than disease categories. Interest is growing in how the resources, experience and models used for communicable diseases, such as scale-up of antiretroviral therapy treatment for AIDS, and the DOTS Framework for TB, can be used for the benefit of NCDs, as well as in how chronic care models commonly used for NCDs can support HIV care and treatment.

Third, capitalize on existing resources and capabilities. There is potential for redesigning the delivery of services around multidisciplinary teams to facilitate task-shifting among personnel and bringing care closer to the patient.  Other approaches include using common procurement and supply lines for getting essential drugs to remote clinics and scaling up the use of new technologies, such as mobile phones and integrated health information systems.  Linking health spending decisions to adoption of clinical guidelines for service provision would encourage coordination of care and improve the quality of services.

Much of the illness burden and inefficient use of resources could potentially be avoided.  But to do so, both governments and the international community need to prioritize building health systems that offer universal financial protection against the cost of ill health, along with improved access to quality services, to deal with the multiple health needs of the population, rather than only a few specific diseases.

An effective response should also include multisectoral actions (for example, higher excise taxes to make tobacco products less affordable) for dealing with disease-related risk behaviors in the entire population.


No more disease silos for sub-Saharan Africa

Africa’s Next Burden: Non-infectious Disease (pdf)



Patricio V. Marquez

Former World Bank Group (WBG) Lead Public Health Specialist

Jill Farrington

Former Coordinator, Noncommunicable Diseases, WHO

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