Country-Level Decision Making for Control of Chronic Diseases Workshop Summary (2012) / Chapter Skim
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3 Data Availability and Gaps in Four Countries
3 Data Availability and Gaps in Four Countries
Pages 29-40
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From page 29... ...
Reliable and accurate information is a critical resource for decision makers, session moderator Stephen Jan of the George Institute for Global Health observed. A useful toolkit would need to provide data to guide decision makers in "institutionalizing a process of rational resource allocation," Jan commented, meaning not just a process of exploring cost effectiveness but a process for using evidence to identify the optimal ways to meet the objectives for a particular country's health system.
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From page 30... ...
Also, there has also been a recent "explosion" of primary and secondary studies related to noncommunicable diseases in Bangladesh, she added. Bangladesh also has health and demographic surveillance sites run by the ICDDR,B.2 For 40 years, ICDDR,B has followed the lives of more than a quarter of a million people, collecting data about their health, employment, marriages and divorces, and other indicators, Koehlmoos said, which has helped to document the rapid growth in Bangladesh's mortality rates for noncommunicable diseases.
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From page 31... ...
Several research efforts now under way are expected to yield data on chronic diseases soon, including a national survey of risk factors for noncommunicable diseases; the WHO-STEPS research; and a study of salt intake, public beliefs about salt, and policy related to salt usage that was funded by United Health Group. Several studies funded by the U.S.
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From page 32... ...
Koehlmoos also suggested that the Ministry of Local Health and the Ministry of Health and Family Welfare devise a unified reporting system and that noncommunicable disease risk factors be included in future Health and Demography Surveys. There are models that have been shown to work well in Bangladesh that can be emulated as the country moves forward in a campaign against chronic diseases, Koehlmoos said.
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From page 33... ...
Such studies could provide useful information for determining health care policies in Kenya, but their lack of country-specific information is often very apparent. For example, one study using regional data recommended certain guidelines for risk modeling of cardiovascular disease that relied heavily on the results of laboratory tests, such as for blood sugar and cholesterol.
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From page 34... ...
For example, Yonga suggested that the Kenya Demographic Health Survey, as a regular instrument with an existing logistical structure, has the potential to be used to collect national representative data, but it does not currently include a lot of noncommunicable disease indicators. In addition, noncommunicable disease screening and intervention programs should be integrated into existing HIV and maternal and child health systems, and these programs could then be equipped with mechanisms that would make it possible to do costing and economic analysis.
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From page 35... ...
RWANDA It is not essential to have complete population-based data about noncommunicable diseases in order to act, noted Gene Bukhman of the Harvard Medical School and Partners in Health. In many countries with very low levels of current health spending, he said, "there is probably sufficient data to know we should be doing more for problems we are already aware 4 Seehttp://www.world-heart-federation.org/press/news-old/demonstration-projects/grenadaheart-project/print.html (accessed October 2011)
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From page 36... ...
"With increasing urbanization, you see very underprivileged conditions where the problem is not complete lack of food but lack of choice." One participant suggested that "unless we are able to show that the two need to be discussed at the same time, we have the risk of the entire noncommunicable disease agenda just being dropped lower on the priority list." Another source of information is the estimates of the global burden of diseases that have been produced by WHO5 (Mathers et al., 2008) , which indicate that noncommunicable diseases make up 25 percent of the disease burden in Rwanda.
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From page 37... ...
Electronic medical records and monitoring of indicators will be key "in better documenting the risk factors and disease patterns that affect Rwandans, which will make it possible to improve intervention effectiveness," Bukhman said. Some data concerning the cost of interventions are available, he said, but most of the data concern actual procurement costs -- the actual outlays for drugs, for example.
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From page 38... ...
38 TABLE 3-1 Rough Cost Data for Selected Chronic Diseases in Rwanda Average Annual Cost Case-Finding Population Condition Rate Prevalence Cases Found Total Per Patient Per Capita Cardiomyopathy 30% 0.2% 6,000 $2,009,506 $334 $0.20 Cardiac surgical follow-up 3% 0.1% 300 $3,709 $412 $0.012 Screening and follow-up for 100% 0.1% 9,000 $46,873 $5 $0.005 HIV nephropathy Diabetes 50% 0.44% 22,000 $3,806,655 $173 $0.38 Hypertension (160/90 100% 4% 400,000 $7,632,542 $9 $0.76 threshold) Chronic respiratory disease 15% 2% 24,900 $1,453,695 $57 $0.14 Chronic care integration $3,655,917 $1.50 subtotal Cardiac surgery (initial surgery)
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From page 39... ...
There are, however, many gaps in the epidemiological data -- several countries have no national registries for certain chronic diseases, others lack continuous and systematic reporting methods, some are dealing with weak communication between the government and private hospitals or companies that could provide health data, and others lack data on disease risk factors. A common theme across countries is the lack of country-specific data -- many countries are using what they can from regional studies, but the recommen
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From page 40... ...
It is clear that action for chronic disease control is needed, and the current data sources already provide some guidance for decision making on what measures should be taken. As many of the participants mentioned, data gaps should not be an excuse for inaction; however, better data will ideally lead to smarter spending and more effective programs that effectively address the chronic disease burden.
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