NCD Alliance Webinar NCDs in Humanitarian Settings Tuesday 3 - - PowerPoint PPT Presentation

NCD Alliance Webinar NCDs in Humanitarian Settings

Tuesday 3 December 2019

➢ 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

Agenda

• 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

Director General, Royal Health Awareness Society, Jordan

Speakers

3 December 2019

Forced to flee and living with a chronic disease NCDs and refugees

• 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

• Cluster of 5 camps
• 403,000 population
• Total of 906,882 OPD

consultations

Cancer 0% Cardiovas 43% Cerebrovas 2% Digestive 10% Gynaec 21% Haem 3% MSS 0% CNS 8% Resp 9% Unknown 4% Acute , 87698 5, … Chronic 29897 3%

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

• ver 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: 3rd 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

Quality NCD Care

Person- centeredness

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.

Continuity, Integration -> referral pathways

Evaluation Response Assessment

What influences model development?

Early response - identify those at risk of early death e.g. DM T1 Early recovery - continuity of medication & care for established disease

Late recovery - chronic care delivery, health system strengthening, community engagement

Population epidemiology and location; Security and Access; Organisational Ethos; Health System Readiness and Responsiveness.

Phase of Crisis & Priorities Contextual Factors

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

Scaling Up NCDs Care in the Context of a Protracted Humanitarian Crisis: The Case of Yemen 3rd December, 2019

Presenters: Meredith Dyson, Health and Nutrition Specialist

• Dr. Abdulbaset Al Dubai, Health and Nutrition Officer

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

HASSAN ALUBEID, Hassan has type 2 diabetes, he comes from Syria but lives in Lebanon

Improving access to insulin through humanitarian

• rganisations

NCD Alliance Webinar, 3 December 2019

Many people lack a regular supply of insulin1

• Approx. 100 million

people require insulin…

…only

50 million

have reliable access to this life- saving medicine1

• 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.

Novo Nordisk produces 1/2

• f the world’s insulin2

Novo Nordisk 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

• rganisations.

OLIVIA AKA Ivory Coast Olivia has type 1 diabetes

2019 ceiling price

4 USD/vial

Adapting our ordering, manufacturing and distribution set-up

33

One-point of contact

Destination Country Known Approved packaging material Language neutral Country Specific Unknown Humanitari an Country Code 972 Language Neutral

Humanitarian country code

New Process for humanitarian sales

Humanitarian Organisations Place an order They receive confirmation within 48 hrs Production

• rder is placed

Order is produced and released Order is delivered to Shipping Hub Order ready for delivery or pick-up

34

TOTAL LEAD TIME: 6-8 WEEKS EMERGENCY STOCK – LEAD TIME: 1 WEEK

Humanitarian sales

Supply of low-cost human insulin in vials, 2018

Syria Yemen Palestine

Top countries for humanitarian sales

Estimated number of people with diabetes reached in humanitarian settings:

ICRC UNRWA WHO

Top organisations for humanitarian sales

2017 2018

* Assuming average daily dose of 40 IU, as per WHO, Drug and Therapeutic Committee - A Practical Guide, 2003, Annex 6.1.

180.000* 150.000*

Q&A

Role of Civil Society in NCDs Prevention and Control in Humanitarian Context: A Local and Regional View

3 December 2019

Jordan Context

Jordan Context

Difficulty of implementing effective national programs addressing NCDs, due to:

• NCDs are a complex matter
• Lack of human and financial

resources

• Absence of multi-sectoral

national strategy

13% and 16% respectively

Response

• Universal Health Coverage
• Primary Health Care Approach
• Community Based Approach

Civil Society Role

• 1. Direct Service Delivery
• 2. National systems strengthening through capacity building and

training of health practitioners for strengthened integrated NCDs service provision (Example: Healthy Community Clinic Model at PHC Level)

• 3. Advocating for NCDs Integration within national strategies, costed

and funded response plans and working groups

• 4. Community engagement
• CHWs
• Empowerment of PLWNCDS (People Centered Approach)

NCD Alliance Initiative: Our Views Our Voice… share views, take action, drive change

• Equipping people living with NCDs with the skills, knowledge and
• pportunities to be leaders and active players in accelerating action
• n NCDs

The Advocacy Agenda calls for action in four key areas:

1. Human rights and social justice, 2. Prevention, 3. Treatment, care, and support, and 4. Meaningful involvement.

EMR Alliance…Our Views Our Voices in Jordan and Lebanon

• Involving 15 PLWNCDs (Refugees and Nationals) in

each country

• Build capacity to become effective advocates in their

communities and build public demand for action on NCDs

• Share lived experiences publicly
• Promote the advocacy agenda
• Support collaborative and empowering dialogue

among people living with and affected by NCDs specially those affected by humanitarian crisis

Q&A

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