The Political Economy of NCDs in Low- and Middle-Income Countries

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Helpdesk Query:

Produce a report looking at the political economy of non-communicable diseases (NCDs) in low- and middle-income countries. Specifically, focus on how rising rates of NCDs, which tend to be highly prevalent in wealthier socio-economic groups, may influence:

  1. The discourse on health priorities in low/lower-middle income countries where the wealthy tend to capture more than their fair share of services.
  2. The allocation of expertise and resources in countries. Is there a danger that communicable diseases and reproductive maternal and child health will receive lower priority for resource allocation as a result?
Summary:

There is a growing movement advocating for an increased focus on resourcing the control and treatment of non-communicable diseases (NCDs), ie The Lancet NCD Action Group and the NCD Alliance. The proponents of tackling NCDs often quote figures for NCD impact in LMICs without discussing disparities between socio-economic groups. The rapid search for this report identified some literature that questions the notion that NCD rates are more prevalent in wealthier socio-economic groups.

National NCD policies should be geared to addressing primary prevention and equity of health systems. Health systems need reconfiguration to ensure equitable access to essential NCD interventions. Context-specific research is identified as a requirement to address implementation gaps in NCD policy, as policy development and implementation are driven by political realities and cultural specificities.

Maher and Sridhar (2012) use a political policy priority framework to look at why funding for NCDs is inadequate and why plans to stop the spread of NCDs has been so difficult. They find that struggles for influence and determining which issues to champion is “informed by subjectively held notions of the right, the good, and the just”.

Negin and Robinson (2010) compare funding for HIV and NCDs to disease burdens in the Pacific Region. They find higher rates of mortality for NCDs but higher external funding for HIV. The authors do not investigate socio-economic groupings within this.

On a more practical level, Stenberg and Chisholm (2012) review various investment strategies related to prevention and control of NCDs. They suggest integrating NCDs into the process for national strategic health planning. Miranda et al (2008) propose reintegration of current vertical programmes (e.g. for malaria, polio, tuberculosis, HIV) into novel forms of family-orientated primary care to include NCDs. HIV advocates reject attempts to create divisions and competition between health agendas. They aim to communicate and reinforce coalitions with allied agendas, including coalitions focused on other diseases.

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