Towards Operationalizing Multi- Sectoral Approaches in NCD Prevention in Africa Dr. Pamela Juma & Dr. Catherine Kyobutungi If MSA is the medicine for NCD prevention, what is the dose?
Background Global increase in prevalence of NCDs and their risk factors Several international policy declarations emphasize prevention WHO Action Plan on NCDs (2013-2020) Emphasis on actions beyond the health sector -hence MSA Best Buys interventions for NCD prevention
Goal To promote multi-sectoral approaches to policymaking for NCD prevention in SSA
Project Design: Three Interlinked Components 1. Research 2. Research Capacity Fellows 3. Policy Engagement
Component 1: Research
Component 1 - Research Country Togo Nigeria Cameroon Kenya Malawi South Africa Geo-Political Francophone Anglophone Franco/Anglophon e Anglophone Anglophone Anglophone Objectives 1. Determine the extent to which MSA was employed in NCD prevention policy development 2. Understand the enabling/ constraining factors for MSA in policy processes 3. Document best practices in the application of MSA in formulation of NCD prevention policies 4. Assess the effect of MSA on the subsequent implementation of NCD prevention policies
Methods Case study Approach Document review Key Informant Interviews
Data Analysis Cases: Single policy in a country Within country case comparisons Cross-country case comparisons
Findings
Existence of NCD Prevention Policies National Policies Kenya South Africa Nigeria Cameroon Malawi Tobacco X Alcohol X Nutrition and Diet Physical activity X X X National NCD strategic plan
Contextual Factors International Influence Global policies and commitments E.g. WHO FCTC, UN summit on NCDs, Global Action Plan for NCD prevention 2013-2020
Contextual Factors National/Local Influence Epidemiological factors (High NCD prevalence) High production of tobacco and alcohol including traditional brews (Kenya, Cameroon, Malawi, SA ) Health sector reforms (Cameroon, Kenya) Social, economic and political influence
Extent of MSA by Policy Policy Kenya South Africa Nigeria Cameroon Malawi Tobacco High High High medium None Alcohol Medium Medium None low Medium Food and Nutrition Low (Salt) Medium Medium none Low Physical activity None low None low None National NCD strategic plan Low Low Low medium Low
Sector Participation Consultations and input on draft policy Meetings and workshops Technical working groups (MOH) Interagency coordinating committees ( E.g. Nutrition in Kenya) Coordination units within sectors Issues integration in sector policies (E.g. Education)
Facilitators to MSA Evidence on impact of NCDs and their risk factors Wider policy and political context Championship, advocacy and coalition building Coordination boards and committees NGO/Donor support and advocacy
Barriers to MSA Differences in interests and priorities Resources challenges Political will Coordination challenges Lack of awareness by some relevant sectors Competition among government sectors
Expert Working Group
Expert Working Group : Third Components 1. Research 2. Research Capacity Fellows 3. Policy Engagement
EWG- Goal Interrogate the evidence on MSA in NCD prevention policy making in order to identify actionable recommendations on how to operationalize MSA in NCD development
Approach 1. First Meeting 2. Further inquiry on emerging issues to improve understanding MSA in NCD policy development in African region 3. Second Meeting Distill findings from country case studies and areas of further inquiry to identify actionable recommendations
Recommendations on operationalization MSA in NCD Prevention
1. Strong Coordination and Governance structures: Coordination needed across sectors and by levels Identification of roles and action that can be taken by each actor. Strong political backing to ensure that ministries with conflicting mandates (e.g. Trade and Health) work together WHO Toolkit : Approaches to establishing country-level multi-sectoral coordination mechanisms for the prevention and control of noncommunicable diseases
2. Utilize existing mechanisms to operationalize the global agenda on NCDs Existing country structures on operationalizing SDGs E.g. WHO recommended multi-sectoral steering committees Build coalitions with other actors (e.g. UNICEF, WHO, WB.) Identify entry points and commonalities with other agendas being pushed by key allies in coalitions Advocate for the incorporation of NCDs into existing HIV/AIDS bodies to form National chronic** diseases commission may shift the conversation
3. Develop strong advocacy and communications strategy on MSA for NCD prevention Strengthen capacity of NCD champions to understand the nature of NCDs and ramifications of actions in other sectors (e.g. taxation, budgeting, global policies) Sensitize other sectors Messages to be tailored to different actors in language that they understand eg Finance- Show impacts that NCDs would have on national expenditure and economic growth prospects. Focus on contribution of specific sector to identified issue not broader NCD agenda (e.g. Agric with nutrition & cancer; education with nutrition and Physical Activity) Involve people living with NCDs in advocacy for NCD prevention policies
4. Redefine the role of the Health Sector Leadership Catalyst active sensitization and engagement of other sectors Providing political leadership and oversight for policy decisions and resources mobilization for NCDs Adapt/contextualize/customize/disseminate MSA toolkits for different audiences e.g. civil society Recognize and acknowledge investments in other sectors Many solutions for NCD lie outside the prevue of the MoH itself and yet the MoH is tying itself in knots trying to solve them
Acknowledgements Study participants for sharing their time with us. The ANPPA project was implemented with generous financial support from International Development Research Centre (IDRC). Canada
So is multi-sectoral action possible? NCDs not addressed in MDGs.addressed in Embrace multi-sectoral approach..to achieve SDG targets by 20115 High-level political commitment Coordinate across sectors Build on existing mechanisms
The Expert Working Group Members 1. Gerald Yonga, (Working Group Chair) Academic and advocate 2. Catherine Kyobutungi, Working Group Co-Chair - Researcher at APHRC 3. Amelia Mia Crampin - Academic Malawi 4. Paolo Reggio D Aci Health CSO - Rwanda 5. Andre Pascal Kengne Academic South Africa 6. Joseph Kibachio MoH Kenya 7. Rachel Kitonyo Devotsu - CSO Kenya 8. Naomi (Dinky) Levitt Academic South Africa 9. Jean Claude Mbanya - Academic and advocate Cameroon 10. Vincent Onywera Academic and advocate Kenya 11. Pamela Juma Researcher Kenya 12. Samuel Oji Oti Researcher\funder, Nairobi 13. Kaushik Ramaiya Tanzania NCD Alliance 14. Shukri Mohamed - Researcher Kenya
Issues emerging from first Expert working group for further inquiry Definition of NCDs Design and implementation of MSA in an African context Advocacy and coalition building for MSA Raising awareness on MSA
3. Results: Defining NCD s Merits of lumping together It identifies diseases with similar or shared risk factors Creates an impression that NCDs are an overwhelming challenge for countries and this could potentially garner the right policy decision to address the challenge
Defining NCD s continued Disadvantages Defining it as what it is not (using a negative reference) thought to contribute to low awareness. Perception that NCDs afflicts the affluent. One umbrella term is problematic hidden epidemic that is not well understood. Finally no consensus was reached on a new definition for NCDs
Adoption of a disease specific approach Using this approach will: Help identifying those with the greatest economic and social impact as well as morbidity and mortality Policy and intervention programs would be designed for each More understanding of the risk factors for each and its disease progression Ensures appropriate treatment and management guidelines are developed
Adoption of socio-cultural approach Cultural values are important and interventions should be context driven to be effectively addressed. It is also important to know the cultural dynamics of how NCD s and its symptoms and signs play in people s understanding of these diseases.
Advancing NCD s as a national priority Requires programs that gather evidence Also important to examine and communicate the impacts of NCDs on the individual, societal and national levels. Clear compelling messages that urge MSA but also communicating to the individuals about their personal responsibility in NCD prevention and management.
Is a multi-sectoral approach possible? All participants agreed it is possible Successful examples: HIV, Malaria & TB Factors that enhance MSA in Africa: MSA system Involving implementers Leadership and governance Clearly organized structures Coordination mechanisms
Highlights from further enquiry
Is a multi-sectoral approach possible? All participants agreed it is possible Successful examples: HIV, Malaria & TB Factors that enhance MSA in Africa: MSA system Involving implementers Leadership and governance Clearly organized structures Coordination mechanisms
Ensure high-level political commitment Coordinate across sectors Build on existing mechanisms