The development of national multisectoral action plans for the prevention and control of noncommunicable diseases: experiences of national-level stakeholders in four countries

Concordance of three point of care testing devices with clinical chemistry laboratory standard assays and patient-reported outcomes of blood sampling methods

Background

Point of care testing (POCT) devices have been developed to facilitate immediate results with the potential to aid screening for new disease and enable patients to self-monitor their disease. Non-communicable diseases (NCDs) are the major cause of mortality globally and are increasing in prevalence as the population ages. Allied health care professionals (AHPs) are skilled in undertaking risk assessment and delivering preventative advice, providing opportunities to access large proportions of the population who may not visit their doctor, within non-traditional community settings. There is evidence of high levels of support from public, patients and health professionals for engaging AHPs in risk-targeted early case detection of certain NCDs. Thus, POCT devices offer a potential alternative to traditional venous blood collection, as novel care pathways for increasing early case detection and access to preventative care. The objectives of this study were to: (i) determine the concordance of the specific POCT devices with laboratory-based standard assays employed within clinical biochemistry laboratories. (ii) compare the sampling experience of both methods via patient-reported experiences.

Methods

A prospective, two-centre study was undertaken involving 158 participants who provided informed consent. Venous blood was collected for traditional assays of HbA1c, creatinine/ estimated Glomerular-Filtration-Rate (eGFR) and vitamin-D. Capillary blood was collected by finger prick test and also assayed for the same biochemical indices (Nova StatSensor (creatinine/eGFR); Siemens DCA-Vantage (HbA1C); CityAssays (vitamin-D)). All users were provided with device training. Participants reported any discomfort experienced by each simultaneously applied method (randomised in order) via a 100 mm Visual-Analogue-Scale.

Results

Results for each POCT device and the laboratory standard were analysed by Bland-Altman plots to determine assay concordance. POCT devices demonstrated good concordance with laboratory testing, with at least 95% of all samples being within two standard deviations, for each of the devices tested. The majority of participants reported less discomfort with POCT than venepuncture, with the average reported discomfort being 17/100 mm less for POCT compared to venous blood sample collection on the visual analogue scale.

Conclusions

The POCT devices demonstrated acceptable concordance with laboratory-based assays, and patients reported lower levels of discomfort compared to traditional means of blood collection. This study demonstrates the potential of using these devices as acceptable methods for opportunistic testing of “at-risk” individuals within non-traditional community care settings.

A Comparative Policy Analysis of the Adoption and Implementation of Sugar-Sweetened Beverage Taxes (2016-2019) in 16 Countries

Taxes on sugar-sweetened beverages (SSBs) are recommended as part of comprehensive policy action to prevent diet-related non-communicable diseases (NCDs), but have been adopted by only one quarter of World Health Organization (WHO) Member States. This paper presents a comparative policy analysis of recent SSB taxes (2016–19) in 16 countries. This study aimed to analyse the characteristics and patterns of factors influencing adoption and implementation of SSB taxes and policy learning between countries, to draw lessons for future SSB taxes. The data collection and analysis were informed by an analytical framework that drew on ‘diffusion of innovation’ and theories of policy learning. Qualitative data were collected from policy documents and media, in addition to national statistics. Qualitative data were thematically analysed and a narrative synthesis approach was used for integrated case study analysis. We found adaptation and heterogeneity in the approaches used for SSB taxation with a majority of countries adopting excise taxes, and consistent health framing in media and policy documents. Common public frames supporting the taxes included reducing obesity/NCDs and raising revenue (government actors) and subsequent health system savings (non-government actors). Opposing frames focused on regressivity and incoherence with other economic policy (government actors) and posited that taxes have limited health benefits and negative economic impacts on the food industry (industry). Evident ‘diffusion networks’ included the WHO, predominantly in middle-income countries, and some regional economic bodies. We found indications of policy learning in the form of reference to other countries’ taxes, particularly countries with membership in the same economic bodies and with shared borders. The study suggests that adoption of SSB taxation could be enhanced through strategic engagement by health actors with the policy-making process, consideration of the economic context, use of consistent health frames by cross-sector coalitions, and robust evaluation and reporting of SSB taxation.

Noncommunicable Diseases Prevention Policies and Their Implementation in Africa: A Systematic Review

Objectives: To synthesize the existing evidence on NCD policy equity, policy practices, and policy implementation gaps to prevent NCDs in African countries.

Methods: Following the PRISMA-Extension for equity-focused review guidelines, the authors systematically searched documentary evidence from seven databases (BMC, CINHAL Plus, Cochrane, Google Scholar, PubMed, Web of Science, and Scopus) to identify studies conducted and published on African countries between April 2013 and December 31, 2020.

Results: From identified 213 records, 21 studies were included in the final synthesis. Major results showed inadequate studies on NCD policy, unsatisfactory NCD-related policy development, poor policy implementation, lack of policy equity to combat NCDs, and lack of data recorded on NCDs’ prevalence, morbidity, and mortality.

Conclusion: The rigorous WHO-endorsed NCD policies and prevention strategies on the African continent might debar African policymakers and leaders from developing and implementing indigenous NCD-combating strategies. Continent-wide innovative and indigenous NCD-prevention policies and policy equity to effectively prevent, control, and manage NCDs must be developed by African scientists and policymakers.

Unleashing implementation research to accelerate national noncommunicable disease responses

Noncommunicable diseases (NCDs) are the leading cause of death and disability worldwide. They exact a disproportionate toll in low and middle-income countries, and the world is not on-track to meet international targets for reductions in premature NCD mortality. Largely, we know which policies work for tackling NCDs, and the World Health Organization (WHO) has developed a package of 'best buy' policies that are highly cost effective. However, we don't necessarily know how to adapt and implement these policies in new populations and cultures. Implementation Research (IR) is emerging as a potent tool for gearing the international response, providing a scientific approach to study the processes used to implement policies and interventions and the contextual factors that affect these processes. Amidst growing interest from policymakers, we identify four main areas for action: high-level engagement with IR among international NCD leaders; domestic investment in technical capacity-building; the creation of new financing streams for IR research; and the development of multi-stakeholder engagement mechanisms that can convene and leverage the perspectives and resources of multiple actors with overlapping aims.

A stakeholder analysis of noncommunicable diseases' multisectoral action plan in Bangladesh

Evidence shows that noncommunicable diseases (NCDs) are highly preventable by addressing the common risk factors embedded within and outside the health sector. Bangladesh's Ministry of Health and Family Welfare has adopted a multisectoral action plan for NCD control and prevention. This research aims at examining to what extent was the multisectoral engagement achieved. The stakeholder analysis method comprises two steps: (1) identifying the actors and (2) determining their roles, power, and positions to the policy. The study revealed seven main NCD stakeholder categories: policymakers, development partners (DPs), service providers, industry, research and academia, the media, and civil societies. The government, DPs, and civil societies hold the highest power and supportive position. However, the tobacco and food industries have an opposing position. Furthermore, there was a clear gap in the participation of nonhealth ministries.

Addressing the double burden of the COVID-19 and noncommunicable disease pandemics: a new global governance challenge

Purpose

As the coronavirus disease 2019 (COVID-19) continues to spread across countries, it is becoming increasingly clear that the presence of pre-existing noncommunicable diseases (NCDs) dramatically increases the risk of aggravation in persons who contract the virus. The neglect in managing NCDs during emergencies may result in fatal consequences for individuals living with comorbidities. This paper aims to highlight the need for a paradigm shift in the governance of public health emergencies to simultaneously address NCD and noncommunicable disease (CD) pandemics while taking into account the needs of high-risk populations, underlying etiological factors, and the social, economic, and environmental determinants that are relevant for both CDs and NCDs.

Design/methodology/approach

The paper reviews the available global frameworks for pandemic preparedness to highlight the governance challenges of addressing the dual agenda of NCDs and CDs during a public health emergency. It proposes key strategies to strengthen multilevel governance in support of countries to better prepare for public health emergencies through the engagement of a wide range of stakeholders across sectors.

Findings

Addressing both CD and NCD pandemics during public health emergencies requires (1) a new framework that unites the narratives and overcomes service and system fragmentations; (2) a multisectoral and multistakeholder governance mechanism empowered and resourced to include stakeholders across sectors and (3) a prioritized research agenda to understand the political economy of pandemics, the role played by different political systems and actors and implementation challenges, and to identify combined strategies to address the converging agendas of CDs and NCDs.

Research limitations/implications

The article is based on the review of available published evidence.

Practical implications

The uptake of the strategies proposed will better prepare countries to respond to NCD and CD pandemics during public health emergencies.

Originality/value

The article is the first of its kind addressing the governance challenges of the dual pandemic of NCDs and CDs in emergencies.

Barriers and facilitators to the implementation of a national multisectoral action plan for the prevention and control of noncommunicable diseases in Nepal: perspectives of stakeholders

BACKGROUND

Nepal adopted the Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (MSAP) in 2014. Implementation of the plan has been challenging, with limited participation from non-health sectors.

OBJECTIVES

The overall aim of the study was to gain the perspectives of key stakeholders involved in the Nepal MSAP on the barriers and facilitators to its implementation, through the participation of relevant sectors in the plan.

METHODS

We held face-to-face semi-structured interviews with 12 stakeholders working in sectors involved in the MSAP. These sectors included the Office of the Prime Minister and Council of Ministries; Ministry of Health and Population (MOHP); Ministry of Education, Science and Technology; Ministry of Forest and Environment; academia; and professional organizations. Thematic analysis of transcripts was used to identify themes on awareness of NCDs, awareness of the MSAP, and barriers and facilitators to participation in the MSAP.

RESULTS

Participants recognised NCDs as a growing and major burden in Nepal. However, a number of participants were not familiar with the MSAP, identifying a lack of leadership and poor dissemination. Political and systemic transformation, since the adoption of the MSAP, was seen as a key barrier to implementation. International commitments to develop multisectoral action made by the Government of Nepal were identified as drivers. The recent establishment of a separate section for NCDs and Mental Health within the Department of Health Services of MOHP and the promotion of a Health in All Policies (HiAP) approach in recent national documents, were both considered to support implementation.

CONCLUSIONS

The establishment of permanent multisectoral or multistakeholder mechanisms has been challenging despite strong political calls for their development. Moving beyond 2020, multisectoral action plans should engage with stakeholders from federal, provincial and local governments in order to develop costed action plans with specific roles and responsibilities for each sector.

Global Health diplomacy for noncommunicable diseases prevention and control: a systematic review

INTRODUCTION

The prevention and control of noncommunicable diseases (NCDs) are one of the main challenges of healthcare systems around the world. In addition to the technical level, it requires political negotiations and solutions, such as global health diplomacy (GHD), which involves the participation of a wide range of actors and stakeholders and innovative international health partnerships. This review aimed to draw lessons for strengthening linkages with a wide range of actors and stakeholders from the GHD literature for NCDs, and how policymakers and political leaders can effectively use international health partnerships to beat NCDs.

METHODS

This research was a systematic review of the literature on GHD for NCDs. All relevant articles published in English were identified by searching PubMed, Web of Science, Scopus, and Embase databases, Google and Google Scholar search engines, and the reference lists of identified articles as well as a number of special journals. 30 articles that met the inclusion criteria were analyzed using content analysis in MAXQDA 10. The Global Health Diplomacy Pyramid and Blouin and Dubé's (2010) analytical framework for examining negotiations were used to classify the data.

FINDINGS

30 articles have been published on GHD for NCDs. Five key themes, i.e. the specific problem requiring global collective action, key actors, their interests in the problem, potential negotiation process, and potential scenarios for collective action and 46 sub-themes were identified. Moreover, given the importance of collaboration on NCDs in the international arena, actors were categorized into three groups based on the GHD Pyramid: (1) core diplomacy, (2) multi-stakeholder diplomacy, and (3) informal diplomacy.

CONCLUSION

Development and adoption of a global policy to tackle the rise in NCDs in developed and developing countries require policymakers and political leaders that participate in GHD. Successful developments in global health policy depend on the performance of and respectful relationships among the stakeholders, and global health diplomats need to understand the complexities of the institutional structures and functional relationships of the international institutions involved in health.