By Watipaso Mzungu
Malawi NCD Alliance has called for urgent integration of Non-Communicable Diseases (NCDs) into HIV prevention and care to ensure there is equitable access to health services in public health facilities.
The Project Coordinator for Malawi NCD Alliance, Samuel Kumwanje, has made the call in light of the shrinking financial resources for addressing HIV and the NCD burden in Malawi.
Currently, the total cost of implementing the Health Sector Strategic Plan 3 (2022-2030) for all the eight years is estimated at US$31.2 billion (MWK32 trillion), representing the full resource need before the prioritization.
In a statement issued on Tuesday, Kumwanje said this poses a huge challenge for Malawi to raise adequate resources to train health workers, invest in sustainable health infrastructure, procure medical equipment and supplies to tackle NCDs and HIV.
“Unfortunately, funders such as Global Fund for HIV, TB and Malaria are also struggling, hence integration of HIV and NCDs is one of the viable options at hand. As the treatment options for HIV have expanded and improved, management approaches have transitioned from acute, emergency care to chronic care,” reads the statement in part.
Kumwanje further stated that chronic care management for HIV is a platform that can be leveraged to integrate NCD services that are otherwise lacking since there are similarities in prevention, detection, care and long-term management of HIV and NCDs, which can enable integration of NCDs into HIV clinics.
According to Kumwanje, at present, data shows that although mortality from HIV has decreased by greater than 50 percent since 2010 with a stable TB death rate of 14 cases per 100,000 people in 2020, NCDs and injury mortality has been on an increase over the last decade now accounting for over 40 percent of mortality in the country.
NCDs are estimated to account for 32-40 percent of total deaths in Malawi, with 10 percent attributed to cardiovascular conditions, 10 percent to cancers, two percent to chronic respiratory diseases, one percent to diabetes, and nine percent to other NCDs (WHO 2018), according to the Malawi NCD Alliance.
Furthermore, more than 60 percent of NCD Disability Adjusted Life Years (DALYs) occur before the age of 40 and 62 percent are attributed to conditions not related to common behavioural and metabolic risk factors.
Kumwanje said he is of the view that the integration of HIV and NCDs will improve the capacity building of medical personnel to respond quickly when the needs arise because both HIV and NCDs have many similarities.
“Both HIV and NCDs have a long life span, both requires frequent visit to the hospital and medication, both HIV and NCDs require more financial support. The integration of NCDs in HIV and NCDS is a tool for the development and needs to be support by the Government, Donors, CSO, religious institutions and communities, we ask all the stakeholders to support the call,” he said.
He emphasized the need for Malawi to fully invest in quality health infrastructure for integration of NCDs and HIV.
At present, most health facilities are poorly equipped for diagnostics for NCDs and with weak integration with the HIV cascade of treatment.
“The healthcare system in Malawi is under-equipped to care for patients with NCDs. The Service Provision Assessment (SPA) 2013-2014 reported that less than 20 percent of facilities had equipment and medications required to treat NCDs, and less than 35 percent of staff were trained in care,” explained Kumwanje.
Malawi NCD Alliance is a membership organization that comprises Non-Communicable Diseases Alliance (NCD Alliance) Malawi Chapter and National Association of People Living With HIV/AIDS in Malawi (NAPHAM).
NCD Alliance Malawi Chapter has been working to build advocacy for the integration of Non-Communicable diseases into the cascade of HIV prevention and care, taking into consideration that the resources for NCDs and HIV are shrinking.
In 2022, the NCD Alliance Malawi chapter produced a policy report on the integration of NCDs with HIV prevention and care drawing lessons from the International NCD Alliance’s ‘Our Views, Our Voices’ initiative to promote integration across the global NCD response.
The work, supported by a grant from “The Leona M. and Harry B. Helmsley Charitable Trust”, is critical and comes at a time when the chronic disease burden is growing in Malawi alarmingly, while HIV still remains a major public health challenge.
On the other hand, NAPHAM Executive Director Paul Manyamba disclosed that his association is planning to integrate NCDs in its operations more especially in the ART clinics and this integration will bring the issues related to HIV and NCDs together and improve in service delivery. N
Manyamba added that NAPHAM with Mininstry of Health have managed to achieve the 95: 95:95 target, which is an indication that Malawi is doing fine in the response of HIV and AIDS.
“Therefore the integration of HIV and NCDs will help to improve the service delivery and responses in terms of care, support, treatment and prevention of both NCD and HIV,” he said.
Meanwhile, the NCD Alliance has affirmed its position that NCDs need urgent attention in terms of increased budgetary allocation.
In addition, more efforts need to be done to into integrate NCDs into HIV care and prevention. Unfortunately, there is no specific budget for NCDs in particular for promotion, prevention, and research and achieving a successful health care financing system continues to be a challenge in NCDs compared to considerable investment into HIV.