Non-communicable diseases in low- and middle-income countries: context, determinants and health policy

The organised efforts of societies have resulted in the most remarkable improvements in child and maternal survival, control and eradication of major infectious diseases and fertility control that have resulted in population ageing – an underlying cause of the increase in non-communicable diseases – over the last 50 years. We now need to seek ways of building on these successes by strengthening existing health-care systems in their ability to provide comprehensive, accessible, community-based, family health care – preventive, curative and rehabilitative – for both communicable and non-communicable diseases. This will involve re-integration of current vertical programmes (e.g. for malaria, polio, tuberculosis, HIV) into novel forms of family-orientated primary care. Setting up new vertical chronic disease programmes for non-communicable diseases would simply perpetuate an approach that has undermined the ability of the health system to operate effectively in many countries. The primary care agenda embodied in Alma Ata in 1978 and now revitalised by World Health Organization’s new framework for strengthening of health systems is the main priority for making a start in tackling non-communicable diseases in low- and middle-income countries.

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