Combating NCDs in vulnerable populations

Emily Wroe, is Director of Programs at the NCDI Poverty Network, a dedicated organization striving to address the burden of non-communicable diseases (NCDs) among the world’s most vulnerable populations. With her expertise and insights, Emily sheds light on the network’s initiatives, particularly focusing on the Pen Plus program, which stands at the forefront of their efforts. Through this interview with Capital’s Groum Abate, we gain valuable insights into the challenges, strategies, and impact of their work in combating NCDs and improving healthcare access for underserved communities globally.

Capital: Could you provide an overview of NCDI programs and their goals and initiatives?

Emily Wroe: Certainly. The NCDI Poverty Network focuses on addressing the burden of non-communicable diseases (NCDs) among the world’s poorest billion people. It was established following the Lancet Commission launch in 2020. The network encompasses various initiatives, including assessing disease burdens, aiding countries in priority setting, and integrating scientific approaches. However, our primary focus today is on Pen Plus, a clinical program that stands as a cornerstone initiative of the NCDI Poverty Network. Would you like me to elaborate further on Pen Plus?

Capital: Yes, please. Could you explain Pen Plus in more detail?

Emily: Pen Plus is designed to complement the World Health Organization’s PEN model, which addresses essential NCDs like hypertension and type 2 diabetes. However, Pen Plus fills a critical gap by addressing neglected NCDs prevalent in children and young individuals, contributing to premature deaths worldwide. The program specifically targets rheumatic heart disease, type 1 diabetes, and sickle cell disease. It trains non-specialist providers such as nurses and clinical officers to deliver care in rural areas, bringing healthcare closer to underserved populations.

Capital: What are the major challenges in implementing Pen Plus?

Emily: There are several significant challenges we face. Firstly, building a skilled workforce takes time. Clinical skills for managing these conditions are complex and require hands-on mentoring and experience. We’re working on scaling up training efforts and empowering early clinicians to become educators themselves. Secondly, ensuring a reliable supply chain for essential medicines and equipment is crucial. Patients require consistent access to medications like insulin and glucometers for diabetes management, as well as ultrasound machines and hydroxyurea for sickle cell disease. Any disruptions in the supply chain could jeopardize patient care. Therefore, investing in robust supply chains is imperative but resource-intensive. This remains a major challenge for us to navigate.

Capital: How do you ensure the functionality of the supply chain?

Emily: Addressing supply chain challenges requires a multifaceted approach. Initially, when a clinic opens, we ensure a buffer stock of supplies is available, both through government channels and additional purchases made by our partners. This buffer stock mitigates the risk of supply disruptions in the early years of clinic operation. Concurrently, we work at the national level to establish policies, approvals, and quantifications necessary for supplementing the supply chain as needed. Globally, we collaborate with partners on initiatives such as price negotiation and procurement strategies to address long-term supply chain sustainability.

Capital: Pen Plus aims to decentralize health facilities, but logistics can be a challenge in Africa. How do you tackle this?

Emily: The clinics we support are integrated into existing healthcare infrastructure, typically within district hospitals like Amin Hospital in Addis Ababa, Ethiopia. These hospitals already have established supply chains, including pharmacies and warehouses. Therefore, our clinics leverage the existing infrastructure, ensuring seamless integration into the government’s healthcare services.

Capital: Foreign currency shortages in Ethiopia often affect industries like pharmaceuticals, impacting access to essential medications like insulin. How do you address this issue?

Emily: Our initiatives operate within government facilities, and we collaborate closely with partners and governments to ensure cost is not a barrier to care. In many cases, insulin is provided free of charge at hospital levels, and in other instances, it’s covered by insurance. Long-term solutions involve strengthening the supply chain as part of our program. However, while I’m not an expert on foreign currency issues in Ethiopia, I’m unable to provide specific strategies in that regard.

Capital: How do you engage with local communities in your initiatives?

Emily: Our approach involves integrating staff from local communities into hospital teams, fostering long-term retention and community connections. Additionally, we conduct training for community health workers who help disseminate information about our clinics and the conditions we address. We utilize various methods such as radio messaging and community awareness campaigns. Moreover, our partners facilitate peer support groups, led by patients, which empower community members and promote mutual learning and support.

Capital: What are the most pressing NCDI issues globally and in Africa?

Emily: NCDI encompasses a wide range of conditions, but our focus is on those causing significant mortality among children and young people. Rheumatic heart disease, congenital heart disease, sickle cell disease, and type 1 diabetes consistently emerge as top priorities globally. National commissions in many countries have identified these conditions based on data highlighting their impact on child mortality, workforce health, and disability. While these conditions serve as our entry point, the Pen Plus model also addresses additional NCDI issues.

Capital: How does innovation and technology contribute to achieving your goals?

Emily: Point-of-care diagnostics play a pivotal role in our efforts. These technologies enable hospitals to diagnose conditions more effectively and efficiently. For example, rapid tests for sickle cell disease provide immediate diagnosis, eliminating the need for costly and time-consuming procedures. Similarly, point-of-care A1C machines for diabetes and handheld ultrasound devices in cardiology enhance diagnostic capabilities, significantly impacting patient care and outcomes. Thus, technology, particularly in diagnostics, is instrumental in advancing our objectives.

Capital: How reliable are these technologies? Are they a cornerstone of your approach? And how do you assess the impact of your interventions?

Emily: Our reliance on technology varies, but we ensure its reliability through rigorous evaluation methods. One approach involves establishing a standardized set of data collection parameters across all partner countries. This data provides insights into clinical outcomes, symptom management, and the overall well-being of patients. Additionally, we conduct facility assessments to track changes over time, including staffing, equipment availability, and medication supply. Cost analysis is also underway to understand the financial implications of our programs. Furthermore, we prioritize understanding patient and community perspectives through ongoing research efforts. These multifaceted assessment strategies allow us to comprehensively measure the effectiveness of our interventions.

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