‘We had to ask a trader going across the border to China to buy insulin. This was animal insulin, it was very hard to get and very expensive,’ shared Sai Sam Noon, a 49-year-old public health officer in Myanmar, describing the lengths his family would go to find insulin for his elder brother. This brother died from sepsis aged 44, followed by the death of a sister, also due to diabetes-related complications.
Fast-forward 32 years and Noon, now diagnosed with diabetes himself, is living in Myanmar’s largest city, Yangon. Huge improvements in medical training and supply chains mean he is now easily able to secure the insulin he needs.
‘There is definitely more awareness of diabetes in the big cities. More screening is being conducted, but there is still a lot to do. The situation in border villages now is not very different… insulin shortages are common and many people do not know what it is. That is still the reality for many,’ added Noon.
Insulin, a life-saving drug for people with diabetes, was discovered nearly 100 years ago but high costs and precarious availability mean millions of deaths are attributed to the disease every year. Diabetes is just one of many non-communicable diseases (NCDs) with rising prevalence in recent years. Responsible for more than 40 million deaths every year, NCDs account for seven out of every 10 deaths globally. The top four NCD killers are cardiovascular diseases, chronic respiratory diseases, cancer, and diabetes.
Ways of reducing NCDs are proven and well established. Lacking are the resources commensurate with the size of the challenge and bringing everyone together in effective public-private-people partnerships to practically address it. In response to widespread call for action on NCDs, The Defeat-NCD Partnership, anchored in the United Nations, was launched at the General Assembly in September 2018. In 2020, The Leona M. and Harry B. Helmsley Charitable Trust joined other private and public sector donors to support the Partnership in its core mission to assist 90 low-resource countries. The stage is set and the time to act on NCDs is now.
Low-resource countries are looking for comprehensive assistance to tackle gaps and constraints to make major headway in reducing their burden of NCDs. Alongside technical assistance, budgetary support is required for robust, evidence-based identified projects at country-level and enhancement of NCD services like private laboratories, clinics and diagnostic tools.
Securing insulin, or other NCD medicines, diagnostics and equipment, needs to be simpler and more cost-effective. A fair and competitive marketplace environment is being developed, with buyers and sellers invited to join. Start-ups innovating telemedicine and digital health that can be harnessed to tackle NCDs are seeking backers.
Private insurance companies can play a role in growing insurance markets in low-resource countries, helping to reduce catastrophic out-of-pocket NCD expenses. In Myanmar, 82 percent of spending on NCD treatment and care in 2018 was out-of-pocket, totalling $621 million.
Various financing developments that create optimal conditions for government and private sector collaboration to tackle NCDs were announced at the recent World Health Summit. Presenting Myanmar’s newly developed costed operation plan to prevent and control NCDs, the Union Minister for Health and Sports, Dr Myint Htwe, shared the launch of a pooled funding facility to finance the plan. The World Bank’s Multilateral Investment Guarantee Agency presented its commitment to support the Defeat-NCD marketplace with contractual guarantees, the International Finance Corporation, Asian Development Bank and Islamic Development Bank declared their interest in working with the Partnership on structured products and social impact bonds.
Based on 2010-2016 trends, just 15 countries are currently on track to reach Sustainable Development Goal (SDG) target 3.4: reducing premature deaths from NCDs by one-third by 2030, according to analysis by The Lancet. The picture is not dismal though, as further pathway analysis showed that every country has options for achieving SDG 3.4. Listed above are just some of the ways this can be done.
Rwanda was recently highlighted as an example of a low-income country that, despite health budget limitations, was able to progress towards universal health coverage and the SDG for health. As reported in BMJ Global Health, this was done by maximising the efficiency of its resources and emulating more efficient peers. Rwanda is on an upward trajectory, with an ambitious national strategy and costed action plan for addressing NCDs between now and 2025.
With investment and support, low-resource countries can make major strides in preventing and controlling NCDs within just a few years, and not be overcome with the ruinous expense of treating late diagnosis, complex NCDs.
Noon did not need to lose his brother and sister to diabetes. A further 15 million premature deaths from NCDs can be averted with action taken now.
Mukul Bhola is CEO of The Defeat-NCD Partnership, hosted at the United Nations Institute for Training and Research. He can be reached at email@example.com.