My Lessons from the Frontlines


LP1As those who followed the updates know, I traveled with a congressional delegation to Rwanda and Uganda last week, to learn from stakeholders on the ground what they are doing to address the growing burden of cancer and other non-communicable diseases (NCDs) in those countries. What was clear is that everyone is doing something. Government representatives, NGO leaders, and healthcare providers alike have identified NCDs as an immediate problem requiring action sooner rather than later. Of course, people are responding differently in various settings. Some such as health ministry or local CDC staff are still in the planning stages, looking at how to use available resources to further assess the problem and the best means for tackling it. Others such as those running health centers or community projects and leading dedicated hospital clinics are a bit farther along, given people are walking through their doors with comorbid conditions like HIV and cancer. These people basically on the frontlines have set protocols by which individuals can be screened and treated for certain NCDs, based on their capacity to do so. At least this way they address a patient’s overall health status, not just target discrete ailments.

No matter where stakeholders were on the spectrum of a response to NCDs, the key word was “leverage.” Repeatedly, they proposed the PEPFAR platform could be a means of expanding services for the prevention and control of NCDs. This is particularly relevant, given recent legislation reauthorizing the program has called for country reporting of comorbidities, including AIDS-related cancers, among the treatment population. Another area of potential integration was health-worker training, with new providers and support staff being versed in NCD risk factors and symptoms as well as educated about basic interventions and referral systems. Likewise, laboratory facilities and supply chains could be more dual-purposed to assist NCD-related healthcare. However, many of these solutions were presented as theories rather than practice; the challenge now is to implement more ideas and pilot ideal strategies.


Again, seeing the local response in living color can be important for informing policy solutions that complement country-based programs, and delegates highlighted some obvious takeaways. One was the fact that, while NCDs are becoming rampant in low- and middle-income countries, they aren’t necessarily a result of behavior or lifestyles, as is so often assumed. In fact, many cancers observed in Rwanda, Uganda, and elsewhere in sub-Saharan Africa are a result of infections. A delegate made the observation that the diseases can be the same but they’re of a different source and arguably require new solutions, other than those tailored for western, couch-potato cultures. Another distinction that resonated with delegates was the fact that many NCDs seen in these countries lead to premature death. So, it’s less a matter of trying to save people at the end of their life expectancy. Rather, interventions put in place today can help people in their prime, sustaining individuals, families, and communities as well as whole economies. As another delegate observed, countries will have little chance at being successful if their people are sick. How we interpret the NCD burden in low-resource settings is critical.

It remains to be seen how what we experienced will influence the US’ thinking in this space. The ongoing UN dialogue regarding global responses to NCDs is timely and provides a key opportunity. And surely US global health investments are affected by local realities in a way that warrants policymakers understand the new context. Ideally, we help other countries bridge persistent gaps between what they know and what they do, and further build their capacity to lead on improving public health for everyone’s benefit.


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