from targets to action—implementing the global monitoring framework for diabetes
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From targets to action—Implementing the global monitoringframework for diabetes
International Diabetes Federation1
d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 0 0 ( 2 0 1 3 ) 2 8 7 – 2 8 8
Contents available at Sciverse ScienceDirect
Diabetes Researchand Clinical Practice
journal homepage: www.elsevier.com/locate/diabres
The momentum for change is gathering pace. Just six months
after a significant breakthrough in negotiations on a global
monitoring framework and targets, UN Member States are
ready to adopt this historic advance at the World Health
Assembly. In the traditional international world of political
negotiation this progress has been swift. The breakthrough
came in November last year with the agreement of a set of nine
global targets covering prevention and treatments – including
the landmark goal to achieve a 25% reduction in mortality
from NCDs by 2025 . A major success for IDF’s campaigning
was the singling out of diabetes in the pledge to ‘‘halt the rise’’
in diabetes and obesity by 2025.
These first time-bound and worldwide targets are a major
advance. They will build awareness, drive action and support
effective assessment of government progress on NCD preven-
tion and control. However, there is concern internationally
about how the targets will be measured and the costs involved
at the local level. In this editorial, IDF assesses the implications
of these targets for diabetes prevention, treatment and
monitoring and surveillance worldwide.
1. A breakthrough in the response to diabetes
For the year following the UN Summit on NCDs in September
2011, IDF and the NCD Alliance led a campaign for a
demanding set of targets to realise the ambition of the UN
Political Declaration on NCD Prevention and Control. Building
on the lessons from the UN General Assembly Special Session
on HIV/AIDs in 2001 – where bold targets drove a decade of
action – we challenged those governments and commentators
who were pressing for a limited number of targets.
The nine agreed targets finally agreed, and specifically the
standalone target to ‘‘halt the rise in diabetes and obesity’’,
demonstrated the power of evidence-based and collective
advocacy to sustain commitment and drive action. In January
2013, the World Health Organization (WHO) Assistant Director
General for NCDs, Dr Oleg Chestnov, paid tribute to that
campaigning, describing civil society’s role in defining the
global monitoring framework and targets as ‘‘one of the key
things behind [WHO’s] success.’’ .
1 [email protected]/$ – see front matter # 2013 Published by Elsevier Ireland Lhttp://dx.doi.org/10.1016/j.diabres.2013.04.001
IDF’s projection of 552 million with diabetes by 2030 – up
from 371 million people today, underscores the scale of the
ambition in the ‘halt the rise’ target. No government has yet
stabilised or reversed the epidemic . Stopping the rapid rise
of the disease requires governments to tackle the underlying
drivers of unhealthy lifestyles. Political commitment for the
‘health in all policies’ approach across government and
sectors, ranging from education, agriculture, trade, finance,
transport, urban planning and the environment, will be a
prerequisite. Leaders will have to achieve major social
structural changes by promoting physical activity through
urban design and ensuring healthy nutrition is available to all.
The target has the potential to drive significant progress
towards achieving one of the three objectives within IDF’s
Global Diabetes Plan 2011–2021 – preventing type 2 diabetes .
A clear method of measuring a ‘‘halt in the rise’’ of diabetes is
still to be established, and IDF is campaigning to ensure it does
not merely measure diabetes prevalence. Attempts to reduce
diabetes prevalence to achieve this target may create perverse
incentives for governments to reduce investment in diagnosis
and treatment for people living with diabetes now – resulting in
adverse health outcomes for people with diabetes. To meet the
ambition behind the target governments need to measure the
increase in new cases, or incidence, of diabetes in a population.
Although more challenging in terms of data collection,
measuring incidence is both feasible and crucial for ensuring
the target accurately measures progress in diabetes prevention.
2. Health system capacity for treatment andcare
Securing the balance of primary prevention and treatment
within a global monitoring framework and targets was a signi-
ficant achievement. Campaigning for the right to health, IDF and
the NCD Alliance drove the target for 80% access to essential
medicines and technologies for NCDs through the negotiations
process to protect people living with these diseases today.
The 80% access target can have a major impact. Access to
affordable and high-quality essential medicines and technolo-
gies remains unacceptably low worldwide. The Millennium
d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 0 0 ( 2 0 1 3 ) 2 8 7 – 2 8 8288
Development Goal (MDG) target for essential medicines has
achieved major progress in access to HIV/AIDs and other
infectious diseases, but has not produced progress for diabetes
. IDF estimates that millions of people with diabetes are living
without access to lifesaving treatment, and out of pocket
expenditures are pushing families into poverty and destitution.
In Mali, an annual supply of insulin costs the average family
approximately 38% of their family income . This must change.
To meet the 80% target will require increased funding,
reform in procurement, supply and distribution within national
health systems, and the promotion of low cost generic diabetes
medicines . There will need to be more examples of progress
through international cooperation – such as the extension of the
Pan American Health Organisation’s Strategic Fund for Essen-
tial Public Health Supplies. This will now provide assistance to
governments in intellectual property regulation, procurement
and funding for diabetes and NCD medicines .
The target to ensure 50% of eligible people (including those
with diabetes) receive multidrug therapy and counselling to
prevent heart attack and stroke will test a health systems
capacity to tackle NCDs. IDF campaigned to ensure that
glycaemic control was specified in this target, critical for
reducing the burden of complications that people with
diabetes continue to suffer from a lack of basic treatment
and care . Achieving this target in many developing
countries will mean health systems have to be fully reoriented
to provide early detection of risk, on-going multidrug therapy
treatment and self-management through counselling.
Both health system response targets will require the
provision of person centered care, to improve patient adherence
to the long term treatment needs of people with diabetes and
NCDs, at primary care level . Such a response poses a major
challengefor many low incomecountries,whosehealthsystems
are only equipped to provide acute care for infectious diseases.
3. Scaling up monitoring and surveillance
The global monitoring framework will demand routine assess-
ment of outcomes, prevention and national responses for
NCDs. An obstacle will be the weakness of monitoring and
surveillance for NCDs worldwide. To overcome this a concerted
effort to improve data collection, and strengthen health and
information systems in low and middle income countries, is
vital; substantial financial and technical support will have to be
provided . Quantitative data and systemic monitoring has
been a cornerstone of HIV/AIDs success, and will enable civil
society to track and improve financial investment, treatment
outputs and health outcomes for diabetes and NCDs.
Disaggregated data that assesses underlying social determi-
nants – such as gender, age and education status – will also be
crucial for analysing how vulnerable groups are disproportion-
ately affected by these diseases, and increase equity in the
4. The civil society response
As WHO Member States unite in Geneva to adopt an historic
agreement IDF welcomes a new era for diabetes. Even before
the formal adoption, the application of the global monitoring
framework is beginning with governments in South East Asia
and the Western Pacific adapting targets to regional levels. As
the framework is translated from paper to action, the role of
IDF and our network of Member Associations in implementa-
tion and surveillance will be critical. Access to comprehensive
data on prevention, treatment and outcomes will enable
diabetes civil society to routinely monitor and compare
different governments’ progress.
Quantifiable targets are already making an impact. The
agreement of targets has bolstered IDF and the NCD Alliance’s
campaign to ensure diabetes and NCDs are included in the
future global development agenda after the MDGs expire in
2015. The High Level Dialogue on Health in the Post-2015
Agenda, held in Gaborone, Botswana in March 2013, reached
consensus that reducing the burden of NCDs, in line with the
25% mortality goal, is now a global priority . Bold targets for
progress are strengthening the case for the right to health – and
access to lifesaving treatment – for diabetes and NCDs that has
been a missing component in the global response to date.
r e f e r e n c e s
 A/NCD/2, World Health Organisation. Report of theFormal Meeting of Member States to conclude thework on the comprehensive global monitoringframework, including indicators and a set of voluntaryglobal targets for the prevention and control of NCDs, 9November 2012.
 Dr Oleg Chestnov. ADG for noncommunicable diseases andmental health in the World Health Organisation. Commentsat the 132nd WHO Executive Board, January 2013.
 International Diabetes Federation. Diabetes Atlas: 5thedition: 2012 update; November 2012.
 International Diabetes Federation. Global Diabetes Plan2011–2021. Brussels: IDF; 2011.
 United Nations. Millennium Development Goal 8 – theglobal partnership for development at a critical juncture:MDG gap task force report, New York, 2010.
 International Insulin Foundation. Fact sheet on diabetes inSub-Saharan Africa. http://www.access2insulin.org/uploads/4/9/1/0/4910107/factsheet.pdf [last accessed20.3.2013].
 Hogerzeil HV, et al. Promotion of access to essentialmedicines for non-communicable diseases: practicalimplications of the UN political declaration. Lancet,published online, February 12, 2013.
 Pan American Health Organisation. About the PAHOStrategic Fund: background and objectives. http://new.paho.org/hq/index.php?option=com_content&view=article&id=1712%3Aabout-the-paho-strategic-fund&catid=1159%3Ahss-strategic-fund&Itemid=986&lang= fr&limitstart=1[last accessed 20.3.2013].
 International Diabetes Federation. IDF submission to WHOConsultation on a Comprehensive Global MonitoringFramework, Indicators and Targets for the Prevention andControl of NCDs, October 2012.
 World Health Organization. Concept note: application ofthe global monitoring framework for the prevention andcontrol of NCDs, 1 November 2012.
 World Health Organization and the United NationsChildren Fund. High level dialogue on health in the post-2015 development agenda – meeting report, March 2013.