July 13, 2024

The delivery system design and clinical information are categorized under the key construct ‘health systems’. The health system forms the backbone of the management of CNCDs in SSA. Wagner (2001) [8] argued that to ensure effective management which improves the health outcomes of people living with CNCDs, there is a need for a strong health system that provides safe and high-quality care. The health system should have a dedicated and motivated team of health professionals who are well-positioned to support improvement strategies and encourage open and systematic handling of errors through the provision of quality care. The management of CNCDs under the health systems tenet of the CCM includes general services provided by health professionals irrespective of the CNCDs presented by patients. This includes checking vital signs (such as blood pressure, blood sugar, oxygen levels, temperature, pulse and respiration, laboratory tests, history taking, general education, and counseling on the conditions) to determine the health status of clients.

There are also specific services provided to patients based on the CNCDs presented and the stage of the conditions upon presentation. These include medical and surgical procedures including chemotherapy, physiotherapy, dialysis, surgeries, and prescription of medications specific to the CNCDs. The increasing prevalence of CNCDs with its rapidly increasing demand on health systems makes it nearly impossible for the health systems of SSA countries to keep up with the provision and care for the management of CNCDs management and services as expected [8]. This comes against the backdrop that even before the upsurge of CNCDs, the health systems in SSA were constrained by the non-availability or inadequacy of health-related human resources, logistics (equipment, medicines, and laboratory supplies), and funding, which hindered the provision of optimum patient care. The countries, therefore, depended largely on international donor support.

To address the challenges with the health systems, we propose various multi-sectoral investments needed to accelerate progress towards the achievement of SDG 3.4. In April 2001, all 53 heads of state of the African Union met in Abuja, Nigeria, and ratified a declaration to allocate at least 15% of their annual budgets to their respective health sectors [9]. Since the Abuja Declaration, the various countries have not lived up to the treaty signed. In 2021 for instance, countries like Ghana, Nigeria, South Africa, Kenya, and Tanzania allocated 9.1% (up from 7.7% to 2020), 4.6% (up from 4.4% to 2020), 9.3% (up from 8.5% to 2020), 5.5% (down from 6.0% to 2020), and 7.1% (up from 5.8% to 2020) respectively of their annual budgets to the health sector. In SSA countries, domestic health financing sources come from the general government (not necessarily limited only to ministries of health) and many exclude grants and other forms of official development aid (ODA). Increasing the priority given to health in the annual budget is crucial for the achievement of SDG 3.4 [9]. Thus, an increase in the proportion of the total government budget allocated to health in line with the Abuja Declaration would help the health systems of SSA countries to adequately provide care to patients with CNCDs. This is because access to healthcare in many SSA countries is still a challenge, especially in last-mile communities. With increased funding for the health sectors, infrastructure, logistics, and human resources needed to ensure optimal healthcare delivery could be realized towards achieving SDG target 3.4. In addition, an improvement in geographical and financial access by the various health authorities in SSA will go a long way to making healthcare delivery very effective and efficient as people will not travel long distances to access healthcare, and out-of-pocket and copayment will also stop, thereby reducing high morbidity and mortalities with its associated complications among populations in SSA.

While some SSA countries like Ghana, South Africa, and Kenya have implemented national policies for the control and prevention of CNCDs, most of the countries in the sub-region including Sierra Leone, Chad, and Somalia have not yet developed such policies. We recommend that the countries which currently do not have such policies should implement them to ensure holistic prevention and management CNCDs. The policies should generally seek to reduce the incidence, prevalence, and exposure of people to CNCD risk, reduce morbidity associated with the disease, and improve the overall quality of life of persons living with CNCDs. They should also focus on investments such as primary prevention and clinical care including early detection, provision of treatment services, health system strengthening involving the training of health professionals, and the development of human resource capacity.

Social health insurance has been shown as a crucial investment in improving the treatment of CNCDs [10]. In SSA, while countries like Ghana, Kenya, Nigeria, and Tanzania have successfully implemented National Health Insurance (NHI) policies to improve the health status of their residents [11], countries like Central Africa Republic, Chad, Somalia, and South Sudan have not yet implemented them. Access to basic healthcare in Chad, for instance, is limited while the country has a high prevalence of CNDs and other diseases [12]. Azetsop and Ochieng [12], have, however, shown that access to national health insurance schemes can help to mitigate such disease risks. To accelerate progress towards the achievement of SDG 3.4 through the elimination of out-of-pocket payments, we recommend that the countries yet to implement national health insurance schemes should do so to ease the financial burden of accessing and utilizing healthcare. For countries currently implementing health insurance but have separate schemes for various groups, we recommend that the schemes should be harmonized to help maximize the size of their risk pools and increase the confidence of potential subscribers in the system [2].


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