Country-Level Decision Making for Control of Chronic Diseases Workshop Summary (2012) / Chapter Skim
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6 Summary of Considerations for Developing a Toolkit for Country-Led Decision Making
6 Summary of Considerations for Developing a Toolkit for Country-Led Decision Making
Pages 69-82
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From page 69... ...
SCOPE AND GOALS FOR THE TOOLKIT "Health is emerging as something that countries identify as both a human right and a development goal," one discussant said, "and if those two things are really to be taken seriously, chronic diseases can't be ignored." However, the range of possibilities for addressing chronic diseases can seem overwhelming, another participant observed. Health systems in low- and 69
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From page 70... ...
One discussant commented that it is "useful to take a step back and ask ourselves, what is the key factor that is impeding the implementation of NCD programs at the country level that the toolkit should address? " The discussant suggested several possible impediments: the difficulty of getting a line item for specific chronic disease activities in the budget, the need for assistance with how to estimate costs for interventions, or the need for costeffectiveness evidence for chronic disease interventions that can be used in national dialogue.
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From page 71... ...
Another suggestion was that a toolkit could include model plans for addressing noncommunicable diseases that could be adapted to local needs, but still allow countries to move forward "without starting from scratch." There was even a suggestion that the ability to adapt the tool for regional planning could be useful. For example, one participant noted, among Caribbean countries the greatest need is for regional high-tech centers because individual countries in that region are too small to sustain such expertise.
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From page 72... ...
The tool cannot be effective if the infrastructure to apply it is insufficient, she added. In summary, over the course of the workshop the participants discussed the many questions that countries might seek to answer and the many different uses of information that could comprise the scope and goals for a toolkit -- setting priorities, decision making, advocacy and mobilizing resources, deriving or shaping questions, elucidating the options to meet a specific implementation goal, promoting dialogue about alternatives, stimulating a thought process about innovation, generating a report card or score card for accountability.
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From page 73... ...
The level of awareness and recognition of the growing burden of chronic diseases is variable across countries -- in some countries this may still be a key first step in any control effort, while in others there may be a high level of awareness already among policy makers to serve as a starting point for the planning process. Similarly, in some countries there is currently little technical expertise for chronic diseases, with very few health or policy professionals working in this area.
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From page 74... ...
For example, some countries have some chronic disease data from employing WHO-STEPS, from large-scale international research studies, or from the addition of chronic disease information to demographic and health surveillance, as is being done in Bangladesh. Other examples of usable data sources from the country presentations include hospital admission, discharge, and mortality data; small-scale surveys; research studies; and regional data from countries with similar demographics, epidemiological profiles and current status in terms of control efforts as well as capacity, infrastructure, and resources.
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From page 75... ...
As a result, alternatives discussed by the workshop participants included reallocating resources or finding ways in which current expenditures can be applied to include chronic disease control, such as opportunities for services to be added on to existing programs and infrastructure with minimal additional marginal costs. A related theme that emerged across the country representatives at the workshop was the urgent need for health economists who understand the country context and the issues around chronic disease planning and implementation and who have the skills to use these kinds of costing and economic analysis tools.
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From page 76... ...
The converse of this is opportunities for synergistic investments that benefit multiple health issues, such as strengthening health services including primary care, improving health insurance and other financing mechanisms, and providing more well-trained and motivated health care workers. A similar consideration is opportunities for services to be added on to existing programs and infrastructure with minimal additional marginal costs.
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From page 77... ...
One participant commented, "It's not simply choosing a menu of programs and implementing them; it's thinking about how that's going to play out over time, how capacity will be built, how expectations for results may evolve over the long term." Therefore, tools for prioritizing interventions need to include a way to highlight choices that will build on current strengths in the existing system to develop chronic disease control efforts and that while being implemented will also increase capacity. Thus, short-term efforts can also serve as a basis for successfully scaling up or expanding the scope of interventions in the future.
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From page 78... ...
There's advocacy, there are donors, there's the prime minister's cancer -- lots of factors that will cause some things to be privileged and other things to be penalized." These preferences and values do not just come from government leadership but also other sectors of society with a stake in the priorities for health care and for government investment, including nongovernment sectors, professional societies, academic communities, advocacy groups, civil society organizations and even external donors, discussants noted. Many of the country representatives said that decisions about investments in health must also be responsive to the concerns of the public and the community at large, as was done explicitly in the examples from Grenada and Chile.
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From page 79... ...
He noted that he had seen some communications that "looked like the Yellow Pages." Instead, he said, the "at-a-glance publications, or the one-pagers, or the one-card, or the electronic pieces, are the pieces that make a difference." He cited his experience with the Institute of Medicine's Roundtable on Health Literacy in recommending a simple scorecard approach that would highlight the "the 5 to 10 things that we all need to do, or know, that on an individual, community, and systemwide basis can help make a difference for noncommunicable disease." There might be debate about what those 5 or 10 things are, he commented, but if those are in place, "we can measure and build on those indicators and really make a difference." In this way, communication tools can also serve as mechanisms to allow for basic information to be tracked over time as an indication of progress in the implementation of chronic disease control efforts. Another area of discussion that emerged at the workshop was that to truly support evidence-based decision making, this communication needs to work in both directions -- as one discussant put it, there needs to be not only evidence-based policy making, but also "policy-based evidence making." In other words, policy makers need to use evidence and therefore there is a need to find ways of effectively communicating that evidence to them.
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From page 80... ...
Final Reflections This workshop took place in the lead-up to the September 2011 United Nations High Level Meeting on Noncommunicable Diseases, a milestone event in the increasing recognition that chronic diseases represent a major health and economic burden in low- and middle-income countries. These countries face many competing demands on their available resources, from basic development priorities to a range of important health needs.
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From page 81... ...
The workshop initiated a conversation about these questions, and in their final reflections the participants expressed the hope that this dialog will be taken up and expanded at the global and country level to help advance chronic disease control worldwide.
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