Prioritizing Health-Sector Interventions for Noncommunicable Diseases and Injuries in Low- and Lower-Middle Income Countries: National NCDI Poverty Commissions.
Prioritizing Health-Sector Interventions for Noncommunicable Diseases and Injuries in Low- and Lower-Middle Income Countries: National NCDI Poverty Commissions.
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DOI：
10.9745/ghsp-d-21-00035
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发表时间：
2021-09-30
期刊：
影响因子：
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通讯作者：
NCDI Poverty National Commissions Authorship Group; NCDI Poverty Network Secretariat
中科院分区：
文献类型：
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作者：
Gupta N;Mocumbi A;Arwal SH;Jain Y;Haileamlak AM;Memirie ST;Larco NC;Kwan GF;Amuyunzu-Nyamongo M;Gathecha G;Amegashie F;Rakotoarison V;Masiye J;Wroe E;Koirala B;Karmacharya B;Condo J;Nyemazi JP;Sesay S;Maogenzi S;Mayige M;Mutungi G;Ssinabulya I;Akiteng AR;Mudavanhu J;Kapambwe S;Watkins D;Norheim O;Makani J;Bukhman G;NCDI Poverty National Commissions Authorship Group; NCDI Poverty Network Secretariat
16个低收入和中等收入国家的非传染性疾病和伤害扶贫委员会就实现全民健康覆盖的国家举措所需的一套扩大的地方非传染性疾病和伤害优先事项以及卫生部门干预措施提出了循证建议。这些委员会为政策、研究和宣传工作提供了一个集体平台，以扩大对赤贫人口采取的具有成本效益和公平的卫生部门干预措施的覆盖面。在16个低收入和中低收入国家设立了国家非传染性疾病和伤害扶贫委员会，以界定当地非传染性疾病和伤害流行病学，确定一套扩大的非传染性疾病和伤害优先条件，并建议具有成本效益的公平卫生部门干预措施。各委员会平均优先考虑35项卫生部门干预措施，估计这些措施的人均额外费用为4.70 - 13.70美元，约占目前卫生总支出的9.7%-35.6%（占目前国内生产总值的0.6%-4.0%）。各委员会在了解非传染性疾病机构的贫穷问题、为国家规划和实施非传染性疾病机构卫生部门干预措施提供信息以及改善非传染性疾病机构的治理和协调方面取得了积极成果。政策制定者应利用国家NCDI扶贫委员会的调查结果，以证据为基础，以地方为驱动，确定优先事项，以指导卫生部门的政策，计划和NCDI投资。将需要外部资金来弥补非传染性疾病感染者筹资方面的差距，以便在内陆发展中国家实现全民医保。低收入和中低收入国家预防和管理非传染性疾病和伤害的卫生部门优先事项和干预措施主要采用了世界卫生组织《2013-2020年非传染性疾病全球行动计划》的内容。然而，内陆发展中国家根据当地流行病学和与背景相关的风险因素或纳入健康成果的公平分配，在非传染性疾病的条件和卫生部门干预措施中确定优先次序的努力有限。为最贫穷的10亿人重新制定非传染性疾病和伤害的柳叶刀委员会支持国家NCDI扶贫委员会界定地方NCDI流行病学，确定一套扩大的NCDI优先条件，并建议具有成本效益的公平卫生部门干预措施。2016年至2019年，成立了15个国家委员会和1个国家级委员会。六个委员会完成了优先排序工作，平均选择了25个国家土著发展委员会的条件;所有委员会选出了15种疾病，包括哮喘、乳腺癌、宫颈癌、1型和2型糖尿病、癫痫、高血压性心脏病、脑出血、缺血性心脏病、缺血性中风、重度抑郁症、机动车道路伤害、风湿性心脏病、镰状细胞病、和蛛网膜下腔出血各委员会根据成本效益、财务风险保护和增强公平的排名，平均优先考虑35项卫生部门干预措施。据估计，优先干预措施的人均成本将增加4.70 - 13.70美元，约占当前卫生总支出的9.7%-35.6%（占当前国内生产总值的0.6%-4.0%）。对委员会代表进行的半结构化调查和定性访谈表明，在若干专题领域取得了积极成果，包括了解非传染性疾病机构的贫穷情况，为国家规划和执行非传染性疾病机构卫生部门干预措施提供信息，以及改善非传染性疾病机构的治理和协调。总的来说，国家土著民族发展委员会的扶贫委员会为在国家土著民族发展委员会内部以证据为基础、由地方驱动确定优先事项提供了一个平台。
Noncommunicable Disease and Injury (NCDI) Poverty Commissions in 16 low- and middle-income countries provided evidence-based recommendations on a local, expanded set of priority NCDIs and health-sector interventions needed in national initiatives to attain universal health coverage. These commissions provide a collective platform for policy, research, and advocacy efforts to improve coverage of cost-effective and equitable health-sector interventions for populations living in extreme poverty. National Noncommunicable Disease and Injury (NCDI) Poverty Commissions were established in 16 low- and lower-middle-income countries (LLMICs) to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions. Commissions prioritized an average of 35 health-sector interventions estimated to cost an additional US$4.70–US$13.70 per capita or approximately 9.7%–35.6% of current total health expenditure (0.6%–4.0% of current gross domestic product). Commissions demonstrated positive outcomes in understanding NCDIs of poverty, informing national planning and implementation of NCDI health-sector interventions, and improving governance and coordination for NCDIs. Policy makers should use findings from the National NCDI Poverty Commissions to provide evidence-based, locally driven determination of priorities to guide health-sector policies, programs, and investments for NCDIs. External financing will be required to bridge the gap in financing for NCDIs to achieve universal health coverage in LLMICs. Health sector priorities and interventions to prevent and manage noncommunicable diseases and injuries (NCDIs) in low- and lower-middle-income countries (LLMICs) have primarily adopted elements of the World Health Organization Global Action Plan for NCDs 2013–2020. However, there have been limited efforts in LLMICs to prioritize among conditions and health-sector interventions for NCDIs based on local epidemiology and contextually relevant risk factors or that incorporate the equitable distribution of health outcomes. The Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion supported national NCDI Poverty Commissions to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions. Fifteen national commissions and 1 state-level commission were established from 2016–2019. Six commissions completed the prioritization exercise and selected an average of 25 NCDI conditions; 15 conditions were selected by all commissions, including asthma, breast cancer, cervical cancer, diabetes mellitus type 1 and 2, epilepsy, hypertensive heart disease, intracerebral hemorrhage, ischemic heart disease, ischemic stroke, major depressive disorder, motor vehicle road injuries, rheumatic heart disease, sickle cell disorders, and subarachnoid hemorrhage. The commissions prioritized an average of 35 health-sector interventions based on cost-effectiveness, financial risk protection, and equity-enhancing rankings. The prioritized interventions were estimated to cost an additional US$4.70–US$13.70 per capita or approximately 9.7%–35.6% of current total health expenditure (0.6%–4.0% of current gross domestic product). Semistructured surveys and qualitative interviews of commission representatives demonstrated positive outcomes in several thematic areas, including understanding NCDIs of poverty, informing national planning and implementation of NCDI health-sector interventions, and improving governance and coordination for NCDIs. Overall, national NCDI Poverty Commissions provided a platform for evidence-based, locally driven determination of priorities within NCDIs.