NCD Alliance Webinar NCDs in Humanitarian Settings Tuesday 3 December 2019
Agenda ➢ Forced to flee and living with a chronic disease: Refugees and NCDs ➢ Models of Care for NCDs in Humanitarian Settings ➢ Scaling Up NCDs Care in the Context of a Protracted Humanitarian Emergency: The Case of Yemen ➢ Improving access to insulin through humanitarian organizations ➢ Role of Civil Society in NCDs Prevention and Control in Humanitarian Context: A Local and Regional View
Speakers 1. Michael Woodman Senior Public Health Officer , UNHCR 1. Dr Éimhín Ansbro, Research Fellow, NCDs in Humanitarian Settings, LSHTM 1. Meredith Dyson (Health and Nutrition Specialist) & Dr. Abdulbaset Al Dubai ( Health and Nutrition Officer), UNICEF 1. Rikke Fabienke Senior Global Access to Care Manager, Novo Nordisk A/S 1. Hanin Odeh D irector General, Royal Health Awareness Society, Jordan
Forced to flee and living with a chronic disease NCDs and refugees 3 December 2019
• Disruption of health system in country of origin • Loss of continuity of care during flight • Physical and psychosocial stress • Barriers to access health services in hosting area: health system, physical access, legal, cost • Poor living conditions, diet, risk factors • Lack of livelihood opportunities and income • Return home: continuity of care and health system
Dadaab camp, Kenya, 2013 Unknown Cancer • Cluster of 5 camps Resp 4% 0% 9% • 403,000 population CNS 8% • Total of 906,882 OPD MSS consultations 0% Cardiovas 43% Haem Chronic 3% Gynaec 29897 21% 3% Cerebrovas Digestive Acute 2% 10% , 87698 … 5,
Za’tari camp, Jordan 2018 (pop 78,549)
UNHCR objectives and actions ‘Caring for refugees with NCDs’ project since 2014 - capacity building project with a partner NGO (PCI) Activities: • Development of evidence based clinical protocols (based on MoH) • Training of the Trainers and Cascade training ( UNHCR, partner and MoH staff) • Supervision and CPD system ( include distance mentoring and whatsapp groups) • Training done in Jordan, Kenya, Burkina, Algeria, Bangladesh, Ethiopia, Uganda, Tanzania, Rwanda, Cameroon, Chad, DRC, Burundi • over 200 staff trained in ToT and cascaded to over 800 clinical staff • Improved knowledge of clinicians, improved clinical practice, improved systems ( e.g. drug management) Other changes: • Essential medicines list changes • HIS
‘Best Buys’ (WHA 2017) • Capacity building of clinicians • Promote EBF • Subsidies to increase fruit and vegetable consumption • Drug therapy for diabetes and hypertension and asthma • Vaccination against HPV • Hep B vaccination
Informal Interagency Working Group on NCDs in Humanitarian Settings • Broad membership, meets 2x per year • Collaborative work and exchange • Guidance: operational UNHCR and partners ; clinical guidance under development by partner • Work on indicators • Advocacy
Challenges responding to NCDs in refugee situations • National systems and inclusion • Integrating NCD care in PHC • Guidance • Referral systems • Resource limitations • Data, measuring outcomes and impact • Sustainability • Return and reintegration
Q&A
Models of Care for NCDs in Humanitarian Settings Dr Éimhín Ansbro, MB BCh BAO MSc MICGP DTMH London School of Hygiene and Tropical Medicine NCDA Webinar: 3 rd December 2019
Overview of presentation 1. What is a model of care? 2. What influences current NCD model development? 3. What models are currently in use? 4. What evidence gap & research needs are there?
What is a model of care? A “Model of Care” broadly defines the way health services are delivered. • best practice care and services • person, population group or patient cohort • through stages of condition, injury or event • right care, right time, right place, right person https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0009/181935/HS13-034_Framework-DevelopMoC_D7.pdf
Core components of a NCD model of care Health System Building Blocks Workforce - trained and supervised Equipment & medications - WHO PEN / EML Information - guidelines, patient files, M&E tools Facilities & services - mobile, community-based or facility-based care Financing & governance - secure financing; public / humanitarian policy. Quality Continuity, Person- Integration -> NCD centeredness referral Care pathways
What influences model development? Late recovery - chronic Early response - care delivery, health identify those at risk of system strengthening, Phase of early death e.g. DM T1 community engagement Crisis & Priorities Early recovery - continuity of medication & care for established disease Population epidemiology and location; Security and Access; Organisational Ethos; Contextual Health System Readiness and Responsiveness . Factors Assessment Response Evaluation
Examples of current models 1. Acute natural disaster – Post Earthquake in Philippines 2. Protracted conflict - UNRWA in Middle East* 3. Acute on chronic conflict – MSF in DRC
Gaps in Tools and Evidence 1. Standardised and suitable tools and equipment a) Guidelines, training tools b) Equipment, diagnostics, medications & delivery devices • Heat stable, long-life • Low literacy patient +/- non physician health worker • Affordable to patient / system 2. Standardised assessment a) Rapid assessment tools b) Health system assessment tools c) Monitoring & Evaluation – Indicators 3 . Evidence a) Epidemiology b) Cost-effective, high quality models of care
Any questions?
Q&A
NCDs in Emergencies: Experience from Yemen Presenters : Scaling Up NCDs Care in the Context of a Protracted Meredith Dyson, Health and Nutrition Specialist Humanitarian Crisis: The Case of Yemen Dr. Abdulbaset Al Dubai, Health and Nutrition Officer 3 rd December, 2019 UNICEF Yemen
Title Health Situation in Yemen Morbidity and Morality: • 29% of mortality caused by communicable diseases, maternal and poor nutrition conditions • Every two hours, a mother and 6 newborns die • Every ten minutes, a child dies from preventable causes • Ongoing outbreaks of measles, diphtheria, and cholera • GAM rate: 11.6% nationally, with 365,000 children at risk for severe acute malnutrition • 57% of mortality caused by non-communicable diseases • Over 68,000 people injured or killed in the conflict Health System Functionality • Only 51% of health facilities are fully functional • 18% of districts across Yemen have no doctors appointed within the district • 56% of the population – 19.7m people – require assistance to access health care • Inconsistent payment of salaries to health workers and other civil servants
Title NCD Patients: “The silent indirect cost of the war” * The mortality estimates for Yemen have a high degree of uncertainty because they are not based on any national NCD mortality data. Source: WHO, 2018 NCD Country Profiles.
Title Scaling Up NCDs Care in the Context of the Yemen Minimum Service Package (MSP) Minimum Service Package 1. General Services and Trauma Care 2. Child Care at all levels 3. Nutrition 4. Communicable diseases 5. Reproductive, Maternal, and New-born Health 6. Non-Communicable Diseases 7. Mental Health 8. WASH and Environmental Health in Health Facilities
Title Supporting and Scaling Up NCDs Care in Yemen Diagnostic and management services for some cancers, transplantation NCD patients are not available inside the country. Chronic Renal Failure Care: • Immunosuppresive drugs, • Dialysis Cancer Care: • Essential Anticancer drugs including palliative medications to 30000 patients under active treatment in 10 cancer centers • 2 centers for Breast and cervical early detections
Title Challenges and Way Forward • Data availability and needs • Referral pathways and mobility between levels of care • Limited awareness, attention, resources, capacity, supply and logistics systems • Ensuring all building blocks of the health system are targeted • Reducing financial barriers to accessing healthcare is essential to achieve the goals on the ‘development’ side of the nexus and to deliver non-traditionally humanitarian services like detection and management of NCDs
Thank You!
Q&A
Improving access to insulin through humanitarian organisations NCD Alliance Webinar, 3 December 2019 HASSAN ALUBEID, Hassan has type 2 diabetes, he comes from Syria but lives in Lebanon
Many people lack a regular supply of insulin 1 Novo Nordisk Approx. 100 million produces 1/2 people require insulin… …only of the world’s insulin 2 50 million have reliable access to this life- saving medicine 1 1. ACCISS. Inequities and Inefficiencies in the global insulin market. Amsterdam: Health Action International. 2015; fact sheet 1. HAIWEB2015. 2. Novo Nordisk. Annual Report 2018. Novo Nordisk Bagsværd, Denmark. 2019.
OLIVIA AKA Ivory Coast Novo Nordisk Olivia has type 1 diabetes Access to Insulin Commitment Our commitment to provide low-priced human insulin to governments in least developed, low- and middle-income countries and selected humanitarian organisations. 2019 ceiling price 4 USD/vial
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