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 Table of Contents  
REVIEW ARTICLE- PLENARY SESSION
Year : 2017  |  Volume : 2  |  Issue : 4  |  Page : 102-106

Partnerships in noncommunicable disease prevention and control


Senior Operational Research Fellow, International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India

Date of Web Publication22-Feb-2018

Correspondence Address:
Jaya Prasad Tripathy
Senior Operational Research Fellow, International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_50_17

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  Abstract 


The World Health Organization (WHO) Noncommunicable Disease (NCD) Global Action Plan 2013–2020 and the WHO Action Plan for NCD in South-East Asia, 2013–2020, have identified advocacy, partnerships, and leaderships as a key strategic action area. The paper describes the proceedings of the plenary session titled “Partnerships in NCD Prevention and Control” which was held at the World NCD Congress at Chandigarh, India, in November 2017. Besides, a review of various data sources and literature was also carried to search for case studies related to successful partnership models in NCD prevention and control. This review describes the role of multiple partners such as the civil society, research organizations, private sector which includes the private health-care sector, pharmaceutical and the food industry, and other national and international experiences in multistakeholder partnerships to combat NCDs. Civil societies play a range of roles from generating evidence to advocating policies, providing technical support, partnering in implementation to monitoring commitments' direct provision of services, and ensuring accountability. Research organizations provide the much-needed evidence for informed policy-making. The key challenges in building a partnership are lack of clarity in roles and responsibilities of each partner in the alliance, resource constraints, imbalance of benefits and power between the partners, organizational difficulties, and differences in philosophies. A clear understanding of roles, responsibilities, interests and incentives of each of the partners, regular communication, and give-and-take philosophy are required to create effective partnerships. A mechanism of feedback channel is essential to monitor the progress and relevance. Communities should remain the central stakeholder in any partnership.

Keywords: Civil society, noncommunicable disease, partnership, private sector


How to cite this article:
Tripathy JP. Partnerships in noncommunicable disease prevention and control. Int J Non-Commun Dis 2017;2:102-6

How to cite this URL:
Tripathy JP. Partnerships in noncommunicable disease prevention and control. Int J Non-Commun Dis [serial online] 2017 [cited 2018 Sep 22];2:102-6. Available from: http://www.ijncd.org/text.asp?2017/2/4/102/225981




  Introduction Top


The United Nations General Assembly (UNGA) High-Level Meeting on noncommunicable diseases (NCDs) in 2011, called for a concerted action by the governments and the entire global society in order to counter the global pandemic of NCDs.[1] The inclusion of NCDs in the UN Agenda 2030 for Sustainable Development Goals firmly establishes NCDs as an urgent global health and development priority.[2]

With the World Health Organization (WHO) Global NCD Action Plan 2013–2020 in place, the responsibility for action has shifted to the regional and national level.[3] However, progress at the national level has been dismal and highly uneven. According to the recent WHO NCD Progress Monitor, only 33% of countries have a national NCD action plan or strategy, and only 31% have set national NCD targets and indicators.[4] The situation is far worse when it comes to resources for NCDs.[5] The pandemic cannot be tackled at the health system level; it requires the joint engagement of various government agencies (finance, trade, transport, agriculture, and education), nongovernmental organizations (NGOs), academia, and the private sector. Translating global commitments into national action will require decisive political will and a whole-of-society approach that engages all partners in the response. The WHO NCD Global Action Plan 2013–2020 and the WHO Action Plan for NCD in South-East Asia, 2013–2020, have identified advocacy, partnerships, and leaderships as a key strategic action area wherein it says that “functional alliances are needed within the health sector and with other sectors…involving multiple stakeholders including governments, civil society, academia, the private sector and international organizations.”[3]

Keeping in mind these international developments, a session on “Partnerships in NCD Prevention and Control” was organized at the World NCD Congress which was held during November 4–6, 2017, at Chandigarh, India. This review paper describes the proceedings of the session. Here, we have discussed the role of various partners in the battle against the silent pandemic and some case studies under each section. We also explored the challenges in building a partnership and the lessons learned.


  Methods Top


To prepare the background paper on 'Partnerships in noncommunicable disease prevention and control' a review of various data sources and literature was carried to search for case studies related to successful partnership models in NCD prevention and control. Websites of the Government of India and state governments, research institutes, UN agencies, NGOs, and health professional associations were searched for relevant documents. In addition, general web searches were undertaken in Google Scholar and PubMed search to identify relevant documents. Additional information was sought through personal contacts with other senior public health professionals in the country.

The following subjects were discussed in details

  1. Building strategic partnerships and raising resources for NCDs
  2. WHO Perspective on Partnership
  3. Civil Society and NCD control
  4. HeartRescue India Project.


The proceedings of the session were audio taped, and lecture notes were also taken by note takers. Content of these audiotapes and notes were reviewed and proceeding was finalised (JPT)..


  Results Top


Civil society partnerships for noncommunicable disease prevention and control

The UN Political Declaration on NCDs highlights that the critical role civil society plays in the prevention and control of NCDs and pushed for fostering partnerships between government and civil society.[1] They play a range of roles from generating evidence to advocating policies, providing technical support, and partnering in implementation to monitoring commitments. Civil societies can contribute toward generating and utilizing evidence-based data to bridge the gap between research and policy-making by formulating policy options, suggesting directions, and communicating them through multiple stakeholder networks. They can also assist in ensuring that government policies and practices are in public interest as well as contribute toward empowering the public with knowledge to make informed decisions. In the 1990s, civil society successfully led the advocacy for HIV/AIDS globally. We believe that a vibrant and proactive civil society movement is capable of delivering three primary functions – advocacy, accountability, and direct provision of services which ensures sustained progress at the national and regional and global level.

The Noncommunicable Disease (NCD) Alliance is a civil society network of 2000 civil society organizations (CSOs), scientific and professional associations, and academic and research institutions to drive the NCD agenda forward and improve NCD prevention and control worldwide.[6]

The global NCD alliance (led by seven international NGO federations) and WHO South-East Asia Regional Office convened a consultation of CSOs giving birth to the “Healthy India Alliance” (HIA) for the prevention and control of NCDs in India through partnerships and fostering engagement of multisectoral CSOs. HIA is also an institutional member of World NCD Federation (WNF) through HRIDAY SHAN which is the secretariat of HIA.[7]

World Noncommunicable Disease Federation (WNF) is a professional association working toward a global health agenda for universal health care for NCDs which is accessible and acceptable to all and at an affordable cost. It advocates for evidence-based public health interventions for optimal utilization of scarce resources in developing countries.[8]

The Partnership to Fight against Chronic Disease (PFCD) is an international organization of patients, providers, community organizations, business and labor groups, and health policy experts committed to raise awareness about chronic disease among the general public and position them as an issue of concern among the policy-makers through a multistakeholder partnership approach. PFCD acts as a catalyst to bring together relevant stakeholder groups to bring forth the much needed policy interventions for tackling the challenge of NCDs.[9]

To make an important contribution toward countering the pandemic of NCDs, innovations developed and tested in research settings need to be scaled up. Only a miniscule number of effective research innovations are scaled up. Fostering a partnership between researchers and policy-makers will facilitate evidence-based policy-making and reduction of “research waste.”

Global Alliance for Chronic Disease is a collection of the world's biggest public research funding agencies that support research activities addressing prevention and treatment of NCDs on a global scale.[10]

The Global Burden of Disease (GBD) Study is a consortium of more than 2300 researchers from 130 countries that assesses mortality and disability from more than 300 diseases and injuries in 195 countries, by age and sex, from 1990 to the present. The GBD estimates can be used at the global, national, and local levels to understand the health challenges and health trends over time and is a critical resource for informed policymaking.[11]

Role of private sector

Globally, private sector enterprises such as the pharmaceutical, food, transport, entertainment, advertising and infrastructure influence health through promoting commodities detrimental to health, as well as lobbying and marketing activities. These are otherwise known as “commercial determinants of health.”[12] As globalization further strengthens the role of the private sector as a major driver of the NCD pandemic, engaging with them has become increasingly important. Taking cognizance of this fact, the 2011 UN High-Level Political Declaration on NCDs called on the private sector to promote healthy workplaces, improve affordability and access to medicines, and reformulate unhealthy food products.[1]

Private health-care sector

In India, majority of the health-care services are provided by the private health sector comprising of both qualified health-care providers (pharmacists/chemists, paramedical staff, Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy providers, and practitioners of modern medicine [Allopathy]) and unqualified health-care providers. The private health facilities range from single stand-alone clinics to a chain of multispecialty tertiary care hospitals each competing with one another in providing patient care. Despite the large network of public health facilities in India, they are not the first point of contact as nearly 80% of the general population visit a private health-care provider.[13] It is mainly due to their widespread presence and easy accessibility. With a large network of practitioners and diagnostic facilities, private health-care sector has a vital role to play in NCD control although regulation of the sector and quality of care are the challenges which need to be tackled.

Pharmaceutical industry

The pharmaceutical industry has the potential for development of effective newer medicines and vaccines and also ensuring wider access to safe, affordable, and quality medicines and technologies for NCDs in resource-limited settings. Partnership with the pharma sector is essential to achieve the two relevant voluntary NCD global targets: at least 50% of eligible people receive drug therapy and counseling (including glycemic control) to prevent heart attacks and strokes and 80% availability of the affordable basic technologies and essential medicines is required to treat major NCDs in both public and private facilities.[14]

Case study: International federation of pharmaceutical manufacturers and associations

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) is an alliance of research-based biopharmaceutical companies and other regional and national associations across the world.

In 2011, IFPMA launched a framework for action on NCDs, contributing to the WHO's Global Action Plan on the Prevention and Control of NCDs. It aims to promote innovation and research for new drugs and vaccines, better access to medicines, patient empowerment (bridging the gap between awareness and behavioral changes), and capacity building (preparing health systems to manage life-long conditions).[15]

Food industry

Case study: International Food and Beverage Alliance

The food industry has been heavily criticized for contributing to the rise in overweight and obesity.[16] The WHO's Global Strategy on Diet, Physical Activity, and Health made several recommendations for the food industry to address the issue.[17] To answer the WHO call for action, the International Food and Beverage Alliance was established which formulated a set of five global public commitments: (1) food reformulation; (2) consumer information; (3) responsible marketing; (4) promotion of healthy lifestyles; and (5) public–private partnerships. These goals are signed by the leaders of top multinational companies. This was the first such attempt by the food industry demonstrating its commitment toward addressing nutrition issues. Similarly, at the UNGA meeting in 2011, heads of government called upon the food industry to work toward reducing the use of salt.

Finland's community-based cardiovascular disease prevention project (North Karelia Project) is a well-published comprehensive population-based intervention that successfully lowered risk factors associated with CVD at the population level, utilizing a multisectoral approach.[18] This holistic intervention involved active participation of the community and local organizations, prevention efforts in multiple settings (schools and workplaces), media partnership, and greater involvement of CSOs. With the cooperation of the food industry, North Karelia's nutritional environment was modified considerably to make healthy food available and affordable.

Success of global movement in tobacco control under World Health Organization Framework Convention for Tobacco Control

The example of tobacco control demonstrates the potential impact of multisectoral action in NCD prevention and control. The WHO Framework Convention for Tobacco Control (FCTC) provides and its guidelines provide directions for countries to implement and manage tobacco control.[19] The WHO also introduced MPOWER measures which not only addressed individual-level interventions (preventing use by individuals, helping users to quit) but also employed multisectoral approaches to address production, trade, taxation, and implementation of tobacco control laws. India also enacted the Cigarettes and Other Tobacco Products Act in 2003 to implement the FCTC obligations. The National Tobacco Control Programme was also launched in 2007–2008 under which a national level interministerial task force has been set up with stakeholder ministries and representatives from other states and civil societies. Tobacco control cells at national, state, and district levels also demonstrate multisectoral partnerships for the implementation of tobacco control laws.

Heart Rescue India

Heart Rescue India focuses on working with health-care and community partners to improve access and quality for acute CVD care. It engages multiple stakeholders, including government agencies, medical professional societies, local health-care providers, community groups, patients, and families. It aims at strengthening acute CVD care by improving quality of care and access to prehospital and hospital care for acute CVD patients with ST-elevation myocardial infarction and sudden cardiac arrest, which are among the leading causes of mortality and morbidity in India.[20] Ministerial participation is critical for addressing Global NCD Agenda in order to place NCD higher on the global and national political agendas, ensure policy uptake \and implement effective interventions at a national level.

Challenges in building partnerships

The key challenges in building a partnership are lack of clarity in roles and responsibilities of each partner in the alliance, resource constraints, imbalance of benefits, and power between the partners, organizational difficulties, and differences in philosophies.


  Conclusions Top


Given the complexity of the problem, the NCD pandemic requires structural and policy-level interventions, which address issues that lie outside the health domain. The “whole-of-government” approach recommended under the WHO 2008–2013 Action Plan for the Global Strategy for Prevention and Control of NCDs requires partnerships within the health sector and with other departments within the government such as education, trade, agriculture, industry and commerce, taxation and revenue, and intergovernmental organizations.[21] Several stakeholders have resources to leverage and contribute to forming strategic partnerships. A clear understanding of roles, responsibilities, interests and incentives of each of the partners, regular communication, and give-and-take philosophy are required to create effective partnerships. A mechanism of feedback channel should be established to continuously monitor progress and relevance, and communities should remain the central stakeholder in any partnership. Communities provide the context and feedback mechanism that appropriately tailor and sustain public health interventions.

Resoure person/ Contributors

Dr. Arun Chockalingam, Professor of Epidemiology, Medicine and Global Health & Director of Public Health Education and Training, University of Toronto, Canada; Kalyanashish Das, Country Technical Advisor Health and Nutrition, Plan International, India; Dr RK Saboo, Past Rotary International President; Dr. Prabodh Bhambal, Deputy Executive, Director and Chief Financial Officer, International Union, Against Tuberculosis and Lung Disease; Dr. Aman Gupta, Country Director, Partnership to Fight Against Chronic Disease; Dr. Thaksaphon Thamarangsi, Director, Noncommunicable Diseases and Environmental Health, WHO Regional Office for South-East Asia Region; and Dr. Aruna C Ramesh, Program Director, HeartRescue India.

Acknowledgments

We thank the Department for International Development, UK, for funding the Global Operational Research Fellowship Programme at the International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, in which Jaya Prasad Tripathy works as a Senior Operational Research Fellow. This paper described the proceedings of a plenary session on “Partnerships in NCD Prevention and Control” at the World NCD Congress held at Chandigarh, India in November, 2017.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases (Document A/RES/66.2). In: 2011 High Level Meeting on Prevention and Control of Non-communicable Diseases. New York: United; 2011. Available from: http://www.un.org/en/ga/ncdmeeting. [Last accessed on 2017 Oct 16].  Back to cited text no. 1
    
2.
UN General Assembly Resolution. Transforming our World: The 2030 Agenda for Sustainable Development, September A/69/L.85. United Nations; 2015.  Back to cited text no. 2
    
3.
WHO. Global NCD Action Plan 2013–2020. Geneva: World Health Organization; 2013.  Back to cited text no. 3
    
4.
WHO. Noncommunicable Diseases Progress Monitor 2015. Geneva: World Health Organization; 2015.  Back to cited text no. 4
    
5.
Dain K. Sustainable financing: The achilles heel of the non-communicable diseases response. Lancet Diabetes Endocrinol 2015;3:923-5.  Back to cited text no. 5
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6.
NCD Alliance. Available from: https://www.ncdalliance.org/who-we-are/about-ncd-alliance. [Last accessed on 2017 Oct 16].  Back to cited text no. 6
    
7.
Healthy India Alliance for Prevention and Control of NCDs. Available from: https://www.ncdalliance.org/sites/default/files/Healthy India Alliance_Brochure.pdf. [Last accessed on 2017 Oct 16].  Back to cited text no. 7
    
8.
World NCD Federation. Available from: http://www.worldncdfederation.org/about/. [Last accessed on 2017 Oct 16].  Back to cited text no. 8
    
9.
Partnership to Fight Chronic Disease. Available from: http://www.fightchronicdisease.in/. [Last accessed on 2017 Dec 07].  Back to cited text no. 9
    
10.
Global Alliance for Chronic Diseases: An Alliance of Health Research Funders. Available from: http://www.gacd.org/about. [Last accessed on 2017 Oct 16].  Back to cited text no. 10
    
11.
Institute for Health Metrics and Evaluation. The Global Burden of Disease: A Critical Resource for Informed Policymaking. Available from: http://www.healthdata.org/gbd/about. [Last accessed on 2017 Dec 08].  Back to cited text no. 11
    
12.
Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health 2016;4:e895-6.  Back to cited text no. 12
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13.
National Sample Survey Organisation (NSSO). Morbidity Health Care and the Condition of Aged. Report no. 507. New Delhi: National Sample Survey Organisation; 2006.  Back to cited text no. 13
    
14.
World Health Organization. NCD Global Monitoring Framework: Ensuring Progress on Noncommunicable Diseases in Countries. Available from: http://www.who.int/nmh/global_monitoring_framework/en/. [Last accessed on 2017 Dec 08].  Back to cited text no. 14
    
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International Federation of Pharmaceutical Manufacturers and Associations. Tackling Global Health Challenges: Non-Communicable Diseases. Available from: https://www.ifpma.org/subtopics/non-communicable-diseases/. [Last accessed on 2017 Oct 16].  Back to cited text no. 15
    
16.
Ludwig DS, Nestle M. Can the food industry play a constructive role in the obesity epidemic? JAMA 2008;300:1808-11.  Back to cited text no. 16
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17.
WHO. Global Strategy on Diet, Physical Activity and Health: WHA 57.17. Geneva: World Health Organization; 2004.  Back to cited text no. 17
    
18.
Puska P. Why did North Karelia-Finland work? Is it transferrable? Glob Heart 2016;11:387-91.  Back to cited text no. 18
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19.
World Health Organization. WHO Report on the Global Tobacco Epidemic 2017. Geneva, Switzerland: World Health Organization; 2017.  Back to cited text no. 19
    
20.
Heart Rescue Global-India. Available from: http://www.heartrescueproject.com/heartrescue-project-partners/international-partners/heartrescue-global-india/. [Last accessed on 2017 Dec 07].  Back to cited text no. 20
    
21.
World Health Organization. WHO: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Available from: http://www.apps.who.int/iris/bitstream/10665/44009/1/9789241597418_eng.pdf. [Last accessed on 2017 Oct 16].  Back to cited text no. 21
    




 

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