Dear NCD Newsflash readers and friends,

Today is World Humanitarian Day. 

The United Nations Office for the Coordination of Humanitarian Affairs estimated that 235 million people would need humanitarian assistance and protection in 2021. The number of people living with NCDs in natural and human-caused disasters is growing. 

NCDs have common characteristics that make affected people more vulnerable during an emergency. Emergencies appear to increase the risk of NCD-related complications, such as heart attacks and strokes, relative to normal pre-emergency circumstances. This is particularly pertinent for people living with NCDs in Ukraine: in 2019, 92% of all deaths in Ukraine – more than half a million people – were the result of an NCD, with many more people still needing services for their NCD treatment and care.

At the same time, COVID-19 continues to have a disproportionate impact on people living with or at risk of NCDs, including disadvantaged groups such as forcibly displaced and refugee populations in humanitarian contexts. Often a consequence of health emergencies, the disruptions of essential NCD health services due to COVID-19 have been widespread.

Since 2017, WHO has deployed more than 7500 ‘NCD kits’ in over 20 countries and humanitarian hubs worldwide, including during the pandemic. Each kit covers 10,000 people for three months, helping address part of the unmet needs for NCD essential medicines and supplies during emergencies. At an annual value of US$ 3.6 million, it has become one of the most procured WHO standard emergency health kits. 

Attention to NCDs in humanitarian settings, as well as coordination among United Nations agencies, humanitarian responders and donors, is growing. Earlier this year, Member States at the World Health Assembly supported WHO recommendations on how to strengthen policies to prevent, control and treat NCDs in humanitarian emergencies.

Simultaneously, research on NCDs and COVID-19 and more broadly on humanitarian settings is increasing in scope and quality, providing a stronger evidence basis to inform policy and programme design.

In this special edition of the WHO NCD Newsflash, we share some examples of how we work at global, regional and country office level to provide health care for people living with NCDs in humanitarian and emergency settings, and the impact that collaborations can have within countries.

You can read each story in full by following the links.

Thank you, as always, for your commitment and championing of improving NCD outcomes for all. If you would like to learn more about our work on NCDs in humanitarian emergencies, please feel free to reach out, below!

Bente

ST VINCENT AND THE GRENADINES: PROVIDING NCD CARE FOR PEOPLE DISPLACED BY NATURAL DISASTERS

Last year, the explosion of volcano La Soufiere on the island of St Vincent forced the urgent displacement of 20,000 inhabitants. This led to significant disruptions in people’s lives, health and disruption to the island’s healthcare system. People living with a NCD were particularly affected as they need continuing access to care, services and medicines to properly manage their condition.  This short story features how PAHO deployed the WHO Emergency NCD Kits, working with partners and the Ministry of Health in St. Vincent and the Grenadine, to mitigate the disruption of NCD care for the people of St. Vincent.

Based on their experience with training providers around the world in using the WHO NCD kits, training was provided in St Vincent & the Grenadines on improving NCD care during and after disasters. The process highlighted several learnings, including that:

• Ensuring strong primary care to diagnose and adequately treat people with NCDs is important to prevent any health emergency from uncontrolled disease;
• Standardized NCD management guidelines and protocols are necessary for quality care;
• Planning, procurement and ensuring continuous supply of essential NCD medicines is needed, including as part of disaster preparedness;
• Sharing and delegating clinical tasks with nurses and pharmacists is an important part of NCD care;
• Ongoing supervision of personnel is an important part to ensure that appropriate interventions are being implemented;
• Patient records, both clinic- based and hand-held by the patient are needed to monitor care; and
• Health education and lifestyle counseling are important aspects of clinical NCD care.

BANGLADESH: BUILDING A MODEL DISTRICT FOR NCD PREVENTION AND MANAGEMENT IN HUMANITARIAN SETTINGS

Addressing the burden of NCDs among refugees and migrants remains a major challenge globally. While communicable diseases continue to be an overriding concern among displaced populations in humanitarian settings, the increasing burden of NCDs –which include cardiovascular diseases, chronic respiratory diseases, diabetes and cancer– is leading to a shift of focus in emergency preparedness and response interventions.

In the Rohingya refugee camps in Cox’s Bazar, the most densely populated in the world, WHO is supporting Government health authorities and humanitarian partners to better integrate NCD services into primary health care, and thus improve health and wellbeing and prevent premature deaths among the refugee population and adjacent host communities.

Thanks to training in the WHO Package of Essential Noncommunicable Disease Interventions for Primary Health Care (also known as the WHO 'PEN package'), over 260 healthcare workers are currently applying the NCD national protocol in 60 primary health care centres across the refugee camps. The successful outcomes reached within the NCD delivery programme in Cox’s Bazar have been acknowledged by external actors and partners, leading to the identification of standardized practices that can be replicated in other humanitarian settings. 

Anowara, a Rohingya refugee in Cox’s Bazar, was diagnosed with diabetes and hypertension after arriving in Bangladesh in 2019. Today, thanks to permanent access to healthcare and essential medicines her health and well-being continue to improve.

TIMOR-LESTE: PREVENTING THE RISK OF NCD COMORBIDITIES DURING COVID-19

Unprecedented public health measures, such as border closures, implemented by countries in response to the COVID-19 pandemic severely affected the global supply chain for essential medicines and diagnostics. This puts countries with no local production capacity, at higher risk. 

To prevent the additional risk of comorbidity and mortality from NCDs and strengthen essential health services amidst the pandemic, WHO provided Timor-Leste with NCD kits, to enhance the country’s response to COVID-19 as a part of WHO’s efforts to ensure restoration of essential health services. 

The NCD kit is a pre-packed set of essential medicines and medical devices to meet priority NCD health needs of at least 30,000 people for three months in emergencies when medical facilities and regular supply are disrupted. Each kit contains five sub-modules, comprising oral medicines, essential diagnostic equipment, renewables and additional products that require cold-chain, such as insulin. 

The selection of medicines in the kits is aligned with the WHO Package of Essential NCD interventions for primary health care (WHO 'Pen Package') – an effective and low-cost tool for early identification and management of NCDs and their risk factors in primary health care settings, which is being implemented in Dili, Ermera and Liquica municipalities.

The WHO Office in Timor-Leste, since the beginning of the pandemic, continues to collaborate and work the Government of Timor-Leste closely in all aspects of its COVID-19 response, including surveillance, contact tracing and management, laboratory, clinical management, public education and awareness, information system, and training of health professionals.

To respond to the continuing need during humanitarian crises to treat people for noncommunicable diseases, WHO delivers dedicated kits of medicines and equipment for caring for people living with diabetes, hypertension and related conditions.

This video follows the assembly of the kits in the Netherlands and their delivery to southern Turkey, where WHO dispatches the materials to healthcare providers working in Syria to treat people living with NCDs. WHO is also delivering the NCDs emergencies kits to other countries affected by conflicts and natural disasters.

COSTA RICA: TELEHEALTH AS AN INNOVATIVE NCD RESPONSE

Even before the COVID-19 pandemic, forms of telemedicine had begun to be tested and implemented in the Americas, with the support of PAHO. The pandemic served to accelerate this process, and is helping to overcome problems caused by the interruption of face-to-face health services, and the risks of infection for health personnel and the user population.

In Costa Rica, telehealth evolved through the pandemic to benefit people living with NCDs in many ways. This includes:

• providing users with information, counselling, and advice via telephone or video call;
• teleconsultations, providing remote patient care with a physician and a specialist;
• remote monitoring to collect medical data for NCD surveillance;
• therapeutic NCD sessions, including for physiatry, physical therapy and cardiac rehabilitation.

The national response was based on a PAHO technical document, Reorganization and Progressive Expansion of Health Services for the Response to the COVID-19 Pandemic. One of this document’s recommendations was on strengthening home care with or without telehealth, while  PAHO has also advised the Costa Rica on how to best use the telehealth system to improve integrated epidemiological surveillance at the national level.

AFGHANISTAN: INTEGRATING NCD SERVICES INTO PRIMARY HEALTH CARE TO SAVE LIVES

NCDs currently cause an estimated 109 000 deaths every year in Afghanistan. 

In order to address this burden, WHO has worked with Afghanistan’s Ministry of Public Health and other partners to deploy 27 NCD emergency kits in four primary health care centers in different provinces with declared emergencies. Each of the 27 NCD emergency kits deployed provided a regular supply of medicines and medical devices to meet the priority NCD health needs of 10 000 people for three months. NCD integration into primary health care was identified as important to bring Afghanistan closer to achieving universal health coverage, with an increase the number of people diagnosed and managed during implementation of this project, decrease in referrals resulting in better use of health services, and strengthen levels of trust achieved between patients and staff in primary health care centers.

Together, the partners managed the deployment of the NCD emergency kit in the four primary health care centers, trained staff in these centers on management of NCDs in accordance with WHO guidelines, and conducted regular visits to each of the four centers to monitor, evaluate and report on implementation of this initiative. This included a review of training outcomes, adherence to guidelines, use of medicines and registrations. The initiative showed that: 

• integration of NCD services into primary health care is feasible and acceptable;
• the NCD emergency kit can bridge gaps during emergencies; and 
• partnerships are essential to success.

EASTERN MEDITERRANEAN: DIGITAL INNOVATION TO SUPPORT PEOPLE LIVING WITH NCDs

Responding to physical restrictions necessary to contain the transmission of COVID-19, countries around the world have turned to technology to deliver health services for NCDs. 
 
WHO’s Eastern Mediterranean Region has compiled case studies from Jordan, Oman, Qatar, Saudi Arabia, Sudan and the United Arab Emirates, explaining the range of digital innovations adopted by these countries to ensure continuity of care for people living with NCDs. 

Here, you can learn more about the innovations adopted, from the scaling up of telehealth and tele consultations, web-based tools for improve NCD medicines access, remote tobacco control cessations, physical and mental health hotlines, mobile apps, and self-assessment chatbots.

ASSESSING THE NCD KIT IN HUMANITARIAN EMERGENCIES IN YEMEN AND LIBYA

The monitoring and evaluation of emergency health kits is an important process, to ensure they remain fit for purpose, while updating their usability and utility. However, there are also challenges and limitations in collecting the relevant data to do so.

A new research paper provides a summary of the key methodologies, findings and limitations of NCD kit assessments conducted in Libya and Yemen. In both countries, the kit was able to support the vital delivery of NCD patient care in some complex humanitarian settings and was appreciated by health facilities. However, there were also some challenges affecting kit use. Some kit contents were found to be in greater or lesser quantities than required, and medicine brands and country of origin affected acceptability. Supply chains were affected by the humanitarian situations, while some healthcare staff received limited NCD training.

The paper notes that more granularity in modules of the kit, the predeployment of facility assessments, increased NCD training opportunities and a monitoring system could all improve the utility of the kits.

These learnings help us to understand how to ensure the emergency NCD kits provide the best quality of care for people living with NCDs. 

HOUSEKEEPING

As part of efforts to improve WHO communications, we always want your feedback of what you like, and what you would like to see more of! Send me your feedback below.

THE TWEETS WE RETWEET

• An article from @NCDAlliance about the importance of ensuring access to essential medications and health services for people living with NCDs in Ukraine (2022)
• Follow coverage using the hashtags #WorldHumanitarianDay and #ItTakesAVillage (August 2022)