Universal Health Coverage: From Promise to Practice

... moving to the rear end of practice:

Develop and evaluate a piece of basic secondary disease prevention,

meant to contribute to UHC

Routine screening for NCDs in rural and urban sub-Saharan Africa

Routine screening for NCDs in rural and urban sub-Saharan Africa

Ellis Owusu-Dabo, PhDGroup Leader, Non-Communicable DiseasesBernhard Nocht Institute for Tropical Medicine, Hamburg,stationed in Kumasi, Ghana

Changing Patterns of Disease Burden in sub-Saharan Africa:

Building Research Capacity

for Non-Communicable and Infectious Disease Control

through District Health Empowerment (BRIDGE)

Joint venture

of the Ministry of Health, Ghana,

Kwame Nkrumah University, Kumasi,

and Bernhard Nocht Institute, Hamburg,

Designed as a research platform

to support joint Ghanaian-international projects

Based

on a State Agreement of 1998,

which has recently been extended beyond 2018

Kumasi Centre for Collaborative Research (KCCR)

Situation

• Twenty years from now, NCDs will causethe major disease burden in sub-Saharan Africa

• The causes of the increase are hypothetical

• In sub-Saharan Africa, disease prevention and health care are designed for IDs – acute intervention (except HIV)

• NCDs require long-term follow-up of patients

• NCDs are in high-income countries predominantly diagnosed by opportunistic health visits

Routine screening for NCDs in rural and urban sub-Saharan Africa

Routine screening for NCDs in rural and urban sub-Saharan Africa

• Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

• University of Ghana, Accra, Ghana

• Hospital Engineering Ltd, Tuttlingen, Germany, and Accra, Ghana

• University Medical Center Hamburg-Eppendorf, Hamburg, Germany

• Hamburg Institute of International Economics, Hamburg, Germany

• Technical University Dresden, Dresden, Germany

• Université d‘Antananarive, Madagascar

• Institut des Recherches en Sciences de la Santé, Ouagadougou, Burkina Faso

Partners

Routine screening for NCDs in rural and urban sub-Saharan Africa

• Ensure support of MoH and local health administration (District Health Management Teams)

• Ensure availability of 4 essential drugs (Glibenclamide, Metformin; Lisonopril, Nifedipine)

Proposed Study Design (I)

DH

PHC

CentralLab

rural, poor urban, rich urban districts

PrivateHospital?

Routine screening for NCDs in rural and urban sub-Saharan Africa

Recruit one District Hospital (DH) each and associated Primary Health Centres (PHCs) of ...

Proposed Study Design (II)

ManagementTeam

Routine screening for NCDs in rural and urban sub-Saharan Africa

• Introduce in PHCs- simple NCD tests, i.e. for blood glucose, blood pressure, height and weight, spirometry- simple and user-friendly documentation, incl. secured cloud, anonymisation option- SOPs for consultations, treatments and DH referrals

• Ensure/introduce in DHs- the same diagnostics as in PHCs and access to Central Lab- the same documentation as in PHCs- SOPs for consultations, treatments and follow-ups- under discussion: ultrasound, ECG, exercise ECG

• Establish Central Lab and introduce- improved NCD routine of fasting glucose, GPT, cholesterol- improved ID routine of bacterial culture and antibiotic resistance- antibiotic stewardship for DHs

Proposed Study Design (III)

Routine screening for NCDs in rural and urban sub-Saharan Africa

• Establish Management Team incl. officers to co-ordinate training, technical development with link to engineering, manufacturers

• Establish Central Lab incl. biochemistry, bacterial culture

• Continuously train district health staff, introduce incentives

• Monitor staff compliance, evaluate and possibly adopt suggestions for improvement

• Negotiate with Ghanaian MoH screening (as treatment) to be covered by National Health Insurance

Proposed Study Design (IV)

Routine screening for NCDs in rural and urban sub-Saharan Africa

• Evaluate usefulness of introduced devices (diagnoses with/without)

• Replicate and evaluate set-up in two more urban centres outside Ghana

• Approach an evaluation of the cost-effectiveness of introduced devices

• Compare NCD prevalences in the rural, poor urban and rich urban districts

• Have expert team search data for neglected/disregarded diseases

• Search for potential causes for changing disease patterns by estimating- physical activities by interrogation - dietary habits by interrogation- infection histories by serology- environmental toxin loads by HPLC and GC-MS- social stress histories by hair cortisol layers

• Verify evidence by randomized studies based on 2010/2011 Ghana census

Proposed Study Design (V)

Routine screening for NCDs in rural and urban sub-Saharan Africa

• Addresses relevant issues, NCDs in SSA and antibiotic resistance

• Development of standard equipment and SOPs may facilitate quality management

• Development of standard equipment may reduce implementation costs

• Set-up esp. documentation may facilitate clinical trials

• Research component might hint at causes for change and, thereby, at prevention

• Research component might reveal additional targets for prevention in the North

Potential

Thank you