NCDs and overseas development assistance: a view from a lived perspective

On 12 January 2022, the UK Working Group on Non-communicable Diseases launched a report on Non-communicable Diseases and UK Aid in the Era of COVID-19, commissioned from two consultants with lived experience of NCDs – Dr Zipporah Ali and Dr Helena Davies – who present their thoughts on the project in this guest blog.

It will come as no surprise to those working in NCDs in lower-income countries to hear that there is a major imbalance between the huge proportion of the disease burden accounted for by NCDs, and the tiny proportion of aid allocated to NCDs: not even 2% of development assistance for health globally is dedicated to NCDs. We were commissioned as consultants to look at this discrepancy, with a focus on UK development aid funding. It is a particularly salient time to do so, given both recent cuts to the UK aid budget (from 0.7% of gross national income to 0.5%) and the ongoing COVID-19 crisis, which has had such an impact on NCD provision globally. It is also something that we are both passionate about as people living with NCDs as well as being health professionals advocating for quality health care for NCDs.

Our research for the report was desk-based, drawing on existing research as well as a survey of NCD organisations and interviews with NCD professionals and people living with NCDs – and we were pleased to receive responses from 33 organisations from 18 countries, including in Africa, Asia and Latin America. The results of the survey were striking but unsurprising, clearly showing the deleterious effect both of NCDs on individuals and communities: out-of-pocket spending on NCD care is plunging families into poverty and COVID-19 has led to serious erosion of NCD services (including mental health services) as funding has been diverted. This impact was reiterated in the in-depth interviews that we conducted with people living with NCDs in Kenya.

It has been more challenging to unpick the role of UK ODA and NCD care. Spending on NCDs is often hidden within other programming: nutrition, infectious disease, climate change, primary health care, infectious disease (not least COVID-19) and many other areas all have important co-benefits for NCDs, but these links are often not evident or tracked. The research for our report has coincided with the release (in December) by the Foreign, Commonwealth and Development Office (FCDO) of a position paper on health systems strengthening, which is placed at the heart of its approach to health in the future. Strong health systems are fundamental to NCD prevention and treatment – and we trust that this will be recognised and actioned across the whole life course from birth to death and the whole trajectory of illness. It is also to be hoped that there will be a clear focus on NCDs in the UK government’s forthcoming international development strategy

The ODA cuts have – inevitably – seriously damaged investment in research and in on-the-ground programmes that impact on NCDs, and undermined trust in the UK. We sincerely hope that the cut in ODA can be reversed as soon as possible – and that NCDs (in the context of health systems strengthening and universal health coverage) can be at the heart of subsequent rebuilding, with the knowledge and expertise of people living with NCDs being fully taken into account, including their meaningful engagement in all aspects of NCD policy.

Dr Zipporah Ali – chair, NCD Alliance Kenya and person living with NCDs
Dr Helena Davies – trustee, World Hospice Palliative Care Alliance and person living with NCDs

Our report’s recommendations

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