This week on PLOS TGH, we hear from Dr Fred Hersch – research fellow with The George Institute for Global Health at the UK’s Oxford University. As part of the crowd-funded NCDFREE Campaign, he and his team have just returned from Wa in the Upper West Region of Ghana, making a short advocacy film on the innovative, community-led, NCD prevention and control activities taking place there – and in particular, the inspiring work of young NCD activist, Emmanuel Sanwuok.
When we think about diabetes, high blood pressure and heart disease, we don’t generally think about Sub-Saharan Africa. And yet it is in the countries of this region, that they sit side by side with persistently high rates of maternal and child health and infectious diseases we traditionally associate with poverty and Africa – HIV, malaria and tuberculosis.
The fact of the matter is that in Sub-Saharan Africa, things are changing. Fast. Just like every other region of the world, the burden of non-communicable diseases (NCDs) is rapidly rising. According to the WHO the burden of deaths from NCDs will climb from 28% in 2008 to 46% by 2030.
The impact of this is dramatic.
NCDs place a huge strain on already under-resourced health systems. In low- and middle- income countries alone, annually, NCDs are responsible for 8 million deaths under 60 years of age. For a family, a society and an economy, this is a huge loss.
Ghana, the Star of Africa, has long been a success story of Sub-Saharan Africa. The first country in the region to gain independence in 1957, it has been relatively stable ever since. Since 2001, Ghana has experienced rapid economic growth and rising human development.
Ghana has made some impressive achievements in terms of healthcare. There is a universal health care system and a national health insurance scheme that provides access to health services and prescription medications. Life expectancy at birth is 66 years (2010). For decades Ghana has trained a cadre of physician assistants to make up for the lack of Doctors (15/100,000) – especially in rural areas.
Despite this, resources for health are still relatively scarce. Ghana spends only 5% of GDP on healthcare; a long way short of the 15% agreed to in the Abuja Declaration (2000). At this level, health systems are at risk of being overwhelmed by the emerging epidemic of NCDs.
Wa, the regional capital of the Upper West Region and some 12 hours North of Accra, is like any rural-urban centre in Sub-Saharan Africa. It is a dusty, bustling commercial hub struggling under the weight of a rapidly changing society with ever increasing demands on its meagre resources. Visiting this part of the world it is instantly evident that globalisation and its effects on society are felt everywhere.
Conventional wisdom holds that NCDs should not be a problem here. And yet since 2011, under the direction of the Regional Director for health, the Ghana Health Service has been setting up NCD prevention and control strategies. This is no small task.
Traditionally health systems in such places have been oriented towards addressing maternal and child health or dealing with common infectious diseases. NCDs are different. Prevention strategies that lead to early identification of high-risk individuals are key to curbing the impact. The goal is to prevent as many ‘events’ e.g. a stroke or heart attack, for which there is no treatment. This requires a different approach.
33 year old Emmanuel Sanwuok, the Regional Co-ordinator for NCDs is on a mission. He is driven by a passion to address the neglect for NCDs that he sees. His dream for Ghana is for a country where people are able to lead healthy lives, and for those who need it, access quality health care.
Central to their efforts has been the formation of a multi-disciplinary team of health workers, the NCD Task Force. The NCD Task Force undertakes workplace and community based screening services where adults are invited to participate in a health assessment. The aim is to identify those at highest risk of common conditions and to intervene early with either lifestyle advice or where required medication.
Sanwuok and his team believe that key to addressing the rising burden of NCDs is to raise awareness amongst the community about the risk factors and the steps that people can take to lead healthier lives – eating more fruit and vegetables, avoiding foods high in salt, and engaging in regular physical activity. They take to the air-waves on a weekly basis and run various activities to spread their positive message about leading healthier lives.
The cost of inaction is too high to ignore. In Wa, NCDs cost lives and livelihoods. For a family and society, the loss of a breadwinner is devastating. For a person with diabetes, the costs of seeking care can consume an entire households income (despite health insurance).
Seeing the work of Sanwuok and his team in this corner of the globe is truly inspiring and acts as a solemn reminder that NCDs affect everyone, everywhere. What is needed is more support to build the capacity of health workers and the health system to be able to provide comprehensive care that includes addressing NCDs.
Sanwuok and those around the world like him are in a David and Goliath struggle. Unlike malaria, TB and HIV, there is no global fund to fight NCDs. If countries like Ghana are to meet the ambitious targets that have now been set, more support for programs like these are needed. After all, in slaying Goliath, even David had a sling-shot.
Fred Hersch is a medical doctor (MD/MPH) and technologist. He is passionate about global health and the role of technology in transforming health care delivery for the better. Prior to medicine and public health he worked in the web development space implementing medium to large scale web content management projects. He was an early pioneer in the tele-medicine space co-founding MedTech Outreach Australia and developing one of the first web based tele-medicine platforms. He is now a research fellow at The George Institute for Global Health where he is involved in research around the application of technology, particularly smart phones and clinical decision support tools and how these can be used to improve access to “essential healthcare” in resource poor settings.