WHO Open call for interest: Discussion papers on NCDs and development cooperation agendas

Introduction:

• According to Dr Ala Alwan – Assistant Director General of WHO, noncommunicable diseases will have their greatest increase in the African Region (27%) in the next ten years.

• Noncommunicable diseases have an impact on all societies. They undermine social and economic development throughout the world. In Senegal, a lower middle-income country, they currently represent 34% of total deaths.

• A WHO comparative study country by country 1 shows that around 30% of the Senegalese population is suffering from cardio-vascular diseases. The main risk factors are bad nutrition, a lack of physical exercise, and the use of tobacco and alcohol.

• According to Professor Abdoul Kane, Head of the Cardiology Department at the Grand Yoff Teaching Hospital in Senegal, a survey conducted in 2010 on one sample representative of the population of Saint-Louis shows prevalence of the risk factors which get closer to that of the developed countries which register 46 % of arterial high blood pressure, 10.5 % of diabetes, 18.4 % of smoking among the men and 23 % of obesity. According to the published results of the survey the representative sample of Senegal shows a prevalence of 46% of arterial high blood pressure, 10,4 % of diabetes, 5,8% of smokers, 23% of obesity and 44% of physical inactivity.2

• According to the National Health Development Plan of Senegal 2009-2018, one of the sectorial objectives is the prevention and the fight against illnesses. The eleven strategies under this objective include health promotion. Regarding noncommunicable diseases the report mentions: ”Today, Senegal faces the double load of morbidity due to communicable and the non communicable diseases. Because of their dimension, incapacities which they bring about and of their very expensive coverage, the non -contagious diseases require an increased attention of the Ministry in-charge of Health.“3

                                                                                                               1  Non  Communicable  Diseases  –  Country  Profiles,  2011,  Geneva.  WHO.  2  Cardiovasc J Afr. 2013 Jun; 24(5): 180–183/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748453/  3  Plan  National  de  Développement  Sanitaire  –  PNDS  2009-­‐2018,  Janvier  2009.  

                   

ADVENTIST DEVELOPMENT AND RELIEF AGENCY SENEGAL RUE 11, ANGLE 10, AMITIE II – B.P. 1382, DAKAR – SENEGAL TÉL/FAX: + 221 33 825 49 31 – E-MAIL: INFO@ADRA-SN.ORG - WEB: WWW.ADRA.ORG

 

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• While trying to contribute to the achievement of the objective of the World Health Organization (WHO) to reduce by 25 % the mortality by chronic diseases by 2025, 4 the International NGO Adventist Development and Relief Agency (ADRA) Senegal with the support of its Africa Regional International Offices implemented a 6- month pilot project; the Dakar Urban Community Health Awareness (DUCHA I) project (June 1st to November 30th 2014).

• In collaboration with the local authorities, project sites were found in the suburbs where the vulnerable population (in Djiddah Thiaroye Kao, Malika, Tivaoune Peulh, Grand Yoff, Medina, Ouakam, Rebeuss and Grand Dakar) had access to free medical check-ups regarding hypertension and glycaemia followed by 8 sensitizations sessions focusing on young people and adults.

• The project aimed to contribute to efforts by the government of Senegal to reduce current and future impact of non-communicable diseases on the vulnerable population in the urban suburbs of Dakar - Senegal through creative nutrition and health sensitization activities. Nutrition Cooking demonstration on preparation of nutritive food based on local food items were included. Cooking classes focused on cooking with very little or no oil and sugar and how to diversify food on the family menu. Health professionals (doctors, nurses and dietician) conducted health checks on selected target population and data recorded as baseline and end line for purposes of evaluation of the effect of the project on a direct beneficiary population of approximately 2,936.

Which population-based and health service NCD interventions contribute to poverty reduction?

• The ADRA Senegal DUCHA I project targeted the vulnerable and poor suburbs of Dakar. The target population was composed of young people and young adults (9 to 25 years) and adults (above 25 years). The adults target group were offered free access to health checks on hypertension and glycaemia, body mass index (BMI) followed by the personal advice of a medical doctor and a dietician that helped vulnerable people that ordinarily do not have the means to consult a doctor or a medical professional to have an idea about their risk to develop a NCD. The free health and nutrition education sensitization that followed the health check was more then simply a transfer of knowledge, it was capacity building as the beneficiaries learned how to manage their own health capital in an to all affordable way.

                                                                                                               4  Draft  action  plan  for  prevention  and  control  of  noncommunicable  diseases  2013-­‐2020,  WHO.  http://www.who.int/nmh/publications/ncd_action_plan2013.pdf    

                   

ADVENTIST DEVELOPMENT AND RELIEF AGENCY SENEGAL RUE 11, ANGLE 10, AMITIE II – B.P. 1382, DAKAR – SENEGAL TÉL/FAX: + 221 33 825 49 31 – E-MAIL: INFO@ADRA-SN.ORG - WEB: WWW.ADRA.ORG

 

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• The capacity acquired will enable the beneficiary population to manage their

own health capital and thereby reduce the risk behaviors that might expose them to noncommunicable diseases. The project has strengthened the beneficiaries’ resilience to NCD’s and by this reduced strain and stress that health expenses could bring to bear on household budget. By their nature NCDs are not infectious but their effects on household financial security are can be very contagious, especially for low-income families. There have been many situations where children have had to drop out of school because the mother or father was incapacitated after developing stroke and or diabetes. Such children often end up on the streets with limited opportunities for social and economic mobility, thereby perpetuating a cycle of poverty in a household.

• This preventive public health education helps to reduce the burden of health expenses by reducing risk behaviors leading very often to NCDs and also alleviate the burden on the general health system of the country that often has to contribute to cover the expensive coverage that long lasting incapacities bring with them. (e.g. Social Security System or other types of compensations) How do we ensure that these interventions are delivered in a way that benefits the poor and contributes to poverty reduction?

• The key to assure that theses interventions are delivered in a way to benefit the poor and contributes to poverty reduction is the mobility of the sensitization. ADRA Senegal contacted and mobilized the local authorities to contribute to the project by making available a public space that the population of the vulnerable urban city parts could easily access.

• The Health and Nutrition sensitization activities have to be itinerant and move from one city part to the other so that everyone might have the opportunity to assist without adding transport costs and has an easy access to the public health sensitization and the public health education transfer of competences.

• The transfer of competences is done through sensitization with visual supports and concrete examples that help to vehicle the message and put the emphasis on the behavioral change or the reduction of risk behavior leading to NCD’s.

• Once the competences acquired the beneficiary is free to share theses competences in his/her household, neighborhood, and workplace and to become on his/her turn a sensitizer and add a multiplying effect on the transfer of competencies and sensitization.

                   

ADVENTIST DEVELOPMENT AND RELIEF AGENCY SENEGAL RUE 11, ANGLE 10, AMITIE II – B.P. 1382, DAKAR – SENEGAL TÉL/FAX: + 221 33 825 49 31 – E-MAIL: INFO@ADRA-SN.ORG - WEB: WWW.ADRA.ORG

 

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How can we effectively scale up technical assistance on NCDs without creating competition with other health and development priorities?

• A regional or national health and nutrition program needs to include education

and continuing education modules for teachers and medical professionals that will be required to become trainers. This continuing education module would also to be needed to be taught in the medical sciences at the university in order to favor the prevention and to offer an alternative to the classical medical approach that often only offer medication as solution to address the problem of NCD’s but which is not an holistic approach and excludes the benefit of prevention through lifestyle change. Life style change is a holistic and sustainable approach that benefits to the overall health of a population and therefore integrates all possible aspects of cross-sectorial health and development priorities. What else is needed to strengthen the focus on NCDs as part of the post-2015 development agenda?

• National and local authorities, the private sector and NGOs need to work together in the fight against NCDs through investments in leisure, sport and green spaces for leisure and recreation of the population. Development planning of towns and cities must ensure that spaces for green parks and sport infrastructure for the population and especially for the youth are reserved and developed. Green parks and sport infrastructure need to be available for the population to support exercise, rest and recreation aspect of the national program of health and nutrition. People need to access easily spaces where they can exercise and have recreation in nature to reduce stress and renew their energy and to strengthen families and social ties.

• Mediatization of national programs of health and nutrition with all its aspects is necessary. The media (TV, Radio, Websites, Social Media, Press) should be used to sensitize the population to NCD risk behaviors. Employers, public and private, should be required by governments through legislations and incentives, including tax incentives, to make appropriate provisions for their employees to be on regular exercise and other health enhancing programs. There is evidence employers that have done this have benefited in the form reduced medical bills and absences from work, as well as improved performance of their employees.

• Leaders at all levels; politics, sports, religion and show business should be required or encouraged to support NCD awareness campaigns.

                   

ADVENTIST DEVELOPMENT AND RELIEF AGENCY SENEGAL RUE 11, ANGLE 10, AMITIE II – B.P. 1382, DAKAR – SENEGAL TÉL/FAX: + 221 33 825 49 31 – E-MAIL: INFO@ADRA-SN.ORG - WEB: WWW.ADRA.ORG

 

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Conclusion

• We believe that the pilot Dakar Urban Community Health Awareness (DUCHA I) project implemented by ADRA Senegal has had a considerable impact on the target beneficiaries’ population.

• Through creative pedagogy and sensitization with hands-on activities (including food preparation) the beneficiaries not only acquired a knowledge, but also competencies that are helping them to take charge of the management of their health capital to reduce NCD risk behaviors.

• ADRA is seeking funding to scale-up DUCHA in poor suburbs of Dakar. This will be done in collaboration with Ministry of Health, Ministry of Education and other stakeholders. It will include large scale sensitization through curriculum development in the education system, regional and/or national fitness program and nutrition awareness campaigns, development of assessment tools to evaluate the impact of NCDs in the region and/or country, development of continuing education of education and medical professional courses, etc.

• These and many more aspects, too long to address in this short discussion paper, will be necessary to conserve development gains and contribute to reduced poverty by making NCDs a major public health issues and putting in place effective interventions to address it.