Flying solo weakens chronic disease fight

The most significant threat to global health is the rise of non-communicable diseases (NCDs). These conditions — including cancers, cardiovascular disease, diabetes, mental illness and respiratory conditions — are responsible for two-thirds  of death and disability globally. And because they disproportionately afflict people in developing countries, they are strongly linked with development and social justice. [1,2]

Although the global health landscape is teeming with organisations trying to tackle NCDs, there are two major gaps in the current response. Firstly, a lack of alignment has led to duplicated effort in some areas and a complete vacuum in others. The second gap is the lack of a neutral forum for sharing data, lessons learned and evidence-based strategies, including the crucial area of ‘implementation science’.

The WHO Global Coordination Mechanism on NCDs, with which I am affiliated, was established by the WHO director-general in 2014 to address both these gaps and ultimately boost aid effectiveness.

The first problem

A special coordination mechanism is needed to correct what are effectively ‘market failures’ in the field of NCDs and development: competing priorities and misaligned objectives that mean the responses of health and development agencies do not always align.

Among the myriad entities working on NCD are government aid agencies such as the UK Department for International Development (DFID) and USAID (the United States Agency for International Development), charities such as Médecins Sans Frontières, civil society groups such as the NCD Alliance and, increasingly, the private sector — including big pharma and processed food companies. [3]

It is not surprising that these groups have no formal means of coordinating their activities. Duplication remains a stubborn problem in development, despite regular high-profile declarations on cooperation, most recently at the 2014 Development Cooperation Forum in Berlin, Germany.

A formal coordination mechanism boosts agencies’ aid effectiveness, aligning action in a way that focuses efforts on areas of greatest need and allows each agency to play to its strengths.

“NCD epidemics form at the confluence of epidemiological, demographic and economic transitions — the major drivers are globalisation, unplanned urbanisation, shifting cultural patterns and social change.”

Luke Allen, WHO

Such a mechanism had not previously arisen organically because every player has their own unique agenda. Bill Gates is trying to build a legacy, Novartis wants to sell insulin, DFID has to demonstrate benefit to Britons, the World Bank must uphold market liberalisation principles, USAID would be scolded for harming Coke sales and Médecins Sans Frontières wants to demonstrate speedy results. These are crude caricatures, but they illustrate the ubiquity of competing interests.

Only a truly independent third party can align these disparate organisations around a mutually agreed, evidence-based agenda.

Skewed research agenda

The second gap that a coordination mechanism is well suited to fill is the lack of implementation research in developing countries.

Volumes have been written on the physiological processes that lead to atherosclerosis (clogging of the arteries) and insulin resistance. These conditions are now relatively well understood, and can be managed competently in developed countries. What we don’t know is how or even if the same health policies and medical management approaches work in somewhere like Lesotho. A crippling paucity of policy evaluation research means the global health community is flying blind in most developing countries.

There is also a real lack of relevant research in economics, anthropology, sociology and political science, especially in developing countries. [4] This matters because NCD epidemics form at the confluence of epidemiological, demographic and economic transitions — the major drivers are globalisation, unplanned urbanisation, shifting cultural patterns and social change. These processes can’t be understood from the lab: wider engagement with researchers from non-health fields is required, building on the WHO’s 2011 priority-setting report. [5]

Enter the mechanism

The WHO Global Coordination Mechanism (GCM) was formed to plug these gaps following a watershed UN meeting on NCDs in 2011. Its small, international team is devoted to strengthening the global NCD response by promoting alignment.

The GCM invites organisations to become ‘participants’ (via an online form) and attend biannual meetings on key themes like engaging with the private sector, South-South collaboration and integrating NCDs within the sustainable development agenda. These dialogue sessions are free to attend and provide a neutral forum for aid agencies, charities, academics and civil society groups to get around the table and talk.

At the World Health Assembly  last May, for example, the GCM brought together delegates to discuss emerging challenges and build a united global communication campaign to raise awareness about NCDs.

The GCM also hosts a virtual ‘community of practice’ forum where participants can share lessons from the field, continue what were initially face-to-face discussions and upload resources. It has also convened several expert working groups to summarise the evidence in strategic areas such as financing, and integrating NCD management with existing programmes. The groups’ ensuing recommendations highlight research gaps and areas for further action for those working in the field.

Currently there are 250 diverse participants, including major government aid agencies, international associations and NGOs. The GCM is proactively seeking to engage academic departments to work on implementation science and the non-health drivers of NCDs — relevant departments can register interest online. This includes universities from resource-poor countries.

The mechanism’s success will ultimately be determined by the extent to which other agencies engage with it. Most have formally committed to the principles of aid effectiveness and have little reason to continue flying solo.

Luke Allen is an expert consultant to the WHO Global Coordination Mechanism on Non-Communicable Diseases at WHO’s headquarters in Switzerland. He can be contacted at [email protected]

Disclaimer: The views in this article are the author’s alone and do not necessarily represent those of the WHO.