Shaping Equitable Noncommunicable Disease and Injury Priorities
The PGNCDSC recently hosted the Secretariat for the Lancet Commission on Reframing Noncommunicable Disease and Injuries for the Poorest Billion (NCDI Poverty Commission). The NCDI Poverty Commission was launched in September 2015 to investigate the pattern of NCDIs among the world’s poorest billion people and to analyze options for intervention in this population. The Commission was comprised of 23 members with a balance of geographical experience and expertise in policy, advocacy, ethics, delivery platforms, health system design, and a spectrum of disease specialties. Commissioners met in January 2016 in London to discuss objectives. In September 2016, the Commissioners met in Kigali, Rwanda with representatives from 11 countries organizing National NCDI Poverty Commissions/Groups. These national groups carry out research on NCDIs in their poorest populations. The Commissioners reconvened in March 2017 to review a first draft of the Commission Report. The Commission’s work culminated in publication of the Commission’s Lancet Report and a launch event on 15 September 2020.
Gene Bukhman, the PGNCDSC Director, is the Co-Chair of the Commission. A team of Harvard administrators, research fellows, associates, and assistants supported the Commission’s research from Boston.
A major recommendation from the Lancet publication was the official formation of the NCDI Poverty Network, a group of 22 low- and lower-middle-income countries (and growing) that was formed in December 2020 to implement the recommendations of the Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion.
Developing a Science of Integration for Global Health Equity
The PGNCDSC partners with implementers around the world to develop and evaluate innovative strategies for NCDI control. In 2011, the PGNCDSC collaborated with Partners In Health (PIH) to publish The PIH Guide to Chronic Care Integration for Endemic NCDs based on five years of initial experience with NCD program development in Rwanda.
Since that time, investigators affiliated with PGNCDSC have evaluated the outcomes of integrated service delivery models for complex chronic conditions such as rheumatic heart disease, sickle disease, and type 1 diabetes in resource-poor setting in Rwanda, Haiti, Malawi, Liberia, and Sierra Leone.
In 2022, the Program in Global NCDs and Social Change at Harvard Medical School, the Division of Global Health Equity at Brigham and Women’s Hospital and the NCD Synergies project at Partners In Health founded The Center for Integration Science for Global Health Equity (CIS). The mission of the Center for Integration Science is to accelerate the just redistribution of resources in the interest of global health equity by identifying integrated units of operational effectiveness in health care delivery and scaling their implementation through collective action. The Center is a platform for clinicians, researchers, and academics to collaborate in applying integration science to design, implement, evaluate, and bring to scale models for decentralizing services progressively and integrating those services to optimize both health system resources and patient outcomes and well-being.
Together with the Universidade Eduardo Mondlane in Mozambique, the Center also serves as the Co-Secretariat for the NCDI Poverty Network, a group of 22 low- and lower-middle-income countries (and growing) that was formed in December 2020 to implement the recommendations of the Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion.
Supporting Global Knowledge Exchange and Taking Interventions to Scale
The NCDI Poverty Network, which is made up of national commissions from countries representing the poorest billion as well as policy, advocacy, and technical partners, was formed to support countries as they implement the recommendations of the Lancet NCDI Poverty Commissionto reduce the death and suffering of the poorest people, primarily children and young adults, who live with severe, chronic NCDs.
The NCDI Poverty Network has developed a four phase theory of change which guides national NCDI Poverty Commissions as they accelerate domestic efforts to reduce the death and suffering of those doubly afflicted by extreme poverty and NCDIs. During this process, national NCDI Poverty Commissions apply equity-driven principles to prioritize interventions that address severe conditions that disproportionately impact the poorest children and young adults and utilize integration science to turn prioritized NCDI interventions into actionable delivery strategies. Member countries also work to train providers to deliver groups of prioritized services through integrated delivery models; provide these services to groups of patients at facilities in multiple regions of the country; prepare these facilities to serve as training sites for other providers; and develop the policies and plans needed to scale these delivery models nationally.
PEN-Plus is an example of a proven integrated delivery model that is decentralizing priority interventions for severe, chronic NCDs including type 1 diabetes, rheumatic heart disease, and sickle cell disease, in Haiti, Liberia, Malawi, Rwanda, Chhattisgarh State, India, Sierra Leone, Ethiopia, Zambia and Zimbabwe. PEN-Plus addresses the NCD service gap in low-income countries by bringing lifesaving chronic care for severe NCDs to first-level rural hospitals for the first time. PEN-Plus trains mid-level providers such as nurses and clinical officers in the skills needed to provide integrated chronic care services for a group of severe NCDs, including diagnosis, symptom management, psychosocial support, palliative care, and referral for surgical and other specialty care when necessary. If scaled nationally, PEN-Plus would greatly improve access to care for people living with some of the most severe and most difficult to manage NCDs.
The NCDI Poverty Network Secretariat also hosts several Knowledge Exchange series annually to bring together national commission members, disease-specific advocacy groups, health professionals, people living with NCDs (PLWNCDs), and technical experts to discuss how we can lead with equity by prioritizing severe NCDs that impact children and young adults.
Training the Next Generation of NCDI-focused Researchers and Clinicians
The PGNCDSC supports Research Fellowships in Cardiovascular Disease and Global Health Equity, Type 1 Diabetes and Global Health Equity, and Integrated Health Service Delivery for NCDs and Injuries. In addition, it has periodically offered a Harvard CME course on Cardiovascular Disease and Global Health Equity while also providing regular mentorship to Harvard students and postgraduates. The PGNCDSC also co-hosts a monthly journal club with the Center for Integration Science.
In collaboration with the Ministry of Health Liberia and Partners in Health Liberia, the Program has supported cardiology fellowships for two Liberian physicians at the Uganda Heart Institute to build cardiology capacity within Liberia.