Non-communicable diseases have been identified as a major challenge of our time. Not only by health organizations like the WHO, but also by economic ones such as the World Economic Forum. International attention is growing rapidly and consensus on policy is growing. But in humanitarian situations, clear solutions, and action plans from global health donors, and governments are still behind. In humanitarian settings, the responsibility is difficult to place, and seems to fall somewhere between the short-term funding, and long-term development projects. What is the greatest obstacle for providing NCD treatment, for example, for the around 200,000 refugees in Kenya? One of the biggest barrier is cost, I would say, because for NCDs you look at two levels of prevention. First you look at primary prevention which involves awareness creation, health promotion, healthy living promotion, and all the issues around risk factors. Then you look at secondary prevention, which is basically early detection. So the screening comes in. Screening, of course, you need all these facilities for screening. You need the basic equipment, but you also need some slightly more expensive equipment to do that. Then now you treat. After you've done the primary prevention, the secondary prevention, then now there is treatment. After treatment it doesn't stop there, you have to continue on with care and support. That whole continuum of care becomes extremely costly. You can only manage a few cases unless you have support for example, for the refugee population. Then there has to be a lot of investment from the IOM and UNHCR side to be able to see how to factor in those costs for refugees and migrant populations to be able to be sustained on care, treatment, and on prevention. For the host community, then the government has to finance that because it cannot be financed by just development partners. It is something that the government has to plan for. That is why there is now a clarion call towards looking at more prevention, because prevention then cuts down the cost. You're looking at, if you are able to keep people off getting NCDs, that would be very ideal, and very good. If you are able to have early detection happening so that you're not waiting for Stage 4 cancer, for example. That becomes extremely expensive to manage because then you have to do chemotherapy, you have to do surgery, and you have to put on palliative care, it becomes very costly. That is why the emphasis on NCDs towards prevention is going to help in cutting down the cost. But generally it is a very costly continuum of care to provide. As more people are suffering from NCDs than from infectious diseases globally, new solutions are emerging with the purpose of saving lives, eliminating suffering, and reducing the economic impact. Right now we're looking at, as we do interventions for NCDs in inuenta and setting, what is the best buy, what is the best intervention to implement that would be cost-effective, but again have high impact. The Best Buy approach was originally presented by WHO in 2011, and covers six policy areas. For example, tobacco use, harmful use of alcohol, and unhealthy diet. The strategy argues that not only can 8.2 million lives be saved in low and lower middle income countries by 2030. A return of at least seven US dollars will yield from each one US dollar invested in the best buy. Experiences from interventions related to infectious disease are used as a method too. There's also been a lot of evidence generated around the areas that focus needs to be put on an epidemiological profiles of the different conditions. Then also looking at the causative agents for the various conditions, and trying to focus the interventions in areas where there is more need, and being able to address. For example, we have done a very good profile of the country for HIV and AIDS so we know which areas to focus on for HIV and AIDS. A very good profile for Malaria, which areas to focus on that. Now we're moving into doing a profile for non-communicable diseases to know which areas have high burden of diabetes, which ones have high burden of hypertension so that the interventions can then be more focused, and also focus really on the high impact interventions. Placing the financial responsibility, and finding the funding is a big challenge. Who's going to pay, and thereby ensure a continuum of care for refugees affected by NCDs? I think in Kenya it has been a little controversial in terms of the government planning for refugees. That again contributes a lot to some of these management of chronic conditions because you need to have the continuum of care not interrupted. If the humanitarian actors cannot afford to plan for it then the host government should plan for it, but the host government isn't willing to plan for it. That also is another dynamic that plays into it. I know it's not only in Kenya, in many countries. That is the dilemma that a lot of the humanitarian actors are in. You plan for a service when your funding comes to an end as an actor, the host government should pick it up. But most host governments feel like most of these chronic conditions are too expensive to sustain on their budgets. Financing is a major problem. Who will pay? The patients? Humanitarians? The government? Can agreement be reached with manufacturers to lower prices? After all, medicine for HIV/AIDS was reduced drastically after major advocacy to do so. What we have done to try and support ensuring that the cost is not very high, we've partnered with Novartis who have got this Access Program. The Access program is basically looking at introducing low-cost NCD drugs, 15 molecules which predominantly cover hypertension, asthma, and breast cancer, and also a bit of other cardiovascular conditions. These 15 molecules are being sold at one dollar per dose. That makes it extremely affordable. But this is just one of the initiative that is coming into the developing countries, and the refugee populations to support in access to treatment. If we are able to have more efforts being put in pushing to drive down the cost of the drugs so even the partners who are supporting this refugee operations would be able to get them at a cheaper price. Because right now if you're not buying it from the Novartis program, you buy it from the normal market, you use like 50 times more than what you would have bought through the Access program. No matter what, the treatment of NCDs is costly. Treatment of one person can cost hundreds of thousands of dollars. Let's hear what approach is taken to meet that challenge in the two Kenyan refugee camps. For cancer treatment, because there are different types of cancers, we have the ones that can be treated at the refugee camp level like the cervical cancer. There are other complicated forms that need more surgeries, and need more chemotherapies. Those ones we have to refer to our main referral facilities. What we do for example, Dadaab, then we have to bring them all the way to Nairobi. For Kakuma we take them to Eldoret. Those are some of the key referral facilities for the chemos and for the other complicated kinds of operations. For simple things like providing the drugs, and being able to do the supportive care, then that is done at the refugee camp level. For the refugee population there has been an ongoing discussion between UNHCR, and and the Kenyan government for the referral cases for that costs to be at times either wavered, and taken care of by the national government or looked at, and taken care of by UNHCR. It's not yet settled who takes care of the cost. But for the few referrals we've done, then the UNHCR has had shoulder that cost of payment for those costs. In most cases then you'd find a lot of debate going on on who should really take care of that cost. It is something that is still under discussion. Action on NCDs requires a whole of government, whole of society approach, and of course more engagement, and funding from international partners who according to Sylvia Khamati, have hesitated to engage. Why is that? For the non-communicable disease area, there are not very many partners, unfortunately. It's an area that I think for a long time people have considered it a non humanitarian area of focus. It's been considered very technical, highly medicalized, it's been very hospitalized, and therefore many partners haven't been looking at this issue. But at the moment, the partners that are working, providing health and nutrition services in the refugee camps are then the ones mandated to do this role. I know like for Kakuma side, we are working with International Rescue Committee that now started introducing a bit of screening into their programs, and seeing how they can then be able to provide these services, but they haven't done it fully scale. On the Kakuma side, it's been on and off. We've had Norwegian Refugee Council coming in. We've had the Islamic teams coming in but still it's not taken shape as it should be. So there are very few actors Providing NCD in emergencies. We would have hoped to have more because it is an area that needs a lot of attention and support.
