COVID-19 significantly impacts health services for noncommunicable diseases

9 Jun

GENEVA - Prevention and treatment services for noncommunicable diseases (NCDs) have been severely disrupted since the COVID-19 pandemic began, according to a WHO survey released today. The survey, which was completed by 155 countries during a 3-week period in May, confirmed that the impact is global, but that low-income countries are most affected.

This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death.

“The results of this survey confirm what we have been hearing from countries for a number of weeks now,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”

Service disruptions are widespread

The main finding is that health services have been partially or completely disrupted in many countries. More than half (53%) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49% for treatment for diabetes and diabetes-related complications; 42% for cancer treatment, and 31% for cardiovascular emergencies. 

Rehabilitation services have been disrupted in almost two-thirds (63%) of countries, even though rehabilitation is key to a healthy recovery following severe illness from COVID-19.

Reassignment of staff and postponing of screening

In the majority (94%) of countries responding, ministry of health staff working in the area of NCDs were partially or fully reassigned to support COVID-19.

The postponement of public screening programmes (for example for breast and cervical cancer) was also widespread, reported by more than 50% of countries. This was consistent with initial WHO recommendations to minimize non-urgent facility-based care whilst tackling the pandemic.

But the most common reasons for discontinuing or reducing services were cancellations of planned treatments, a decrease in public transport available and a lack of staff because health workers had been reassigned to support COVID19 services. In one in five countries (20%) reporting disruptions, one of the main reasons for discontinuing services was a shortage of  medicines, diagnostics and other technologies.

Unsurprisingly, there appears to be a correlation between levels of disruption to services for treating NCDs and the evolution of the COVID-19 outbreak in a country.  Services become increasingly disrupted as a country moves from sporadic cases to community transmission of the coronavirus.

Globally, two-thirds of countries reported that they had included NCD services in their national COVID-19 preparedness and response plans; 72% of high-income countries reported inclusion compared to 42% of low-income countries. Services to address cardiovascular disease, cancer, diabetes and chronic respiratory disease were the most frequently included. Dental services, rehabilitation and tobacco cessation activities were not as widely included in response plans according to country reports.

Seventeen percent of countries reporting have started to allocate additional funding from the government budget to include the provision of NCD services in their national COVID-19 plan.

Alternative strategies for continuing care being implemented

Encouraging findings of the survey were that alternative strategies have been established in most countries to support the people at highest risk to continue receiving treatment for NCDs. Among the countries reporting service disruptions, globally 58% of countries are now using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries this figure is 42%. Triaging to determine priorities has also been widely used, in two-thirds of countries reporting. 

Also encouraging is that more than 70% of countries reported collecting data on the number of COVID-19 patients who also have an NCD.

”It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with noncommunicable diseases,” said Dr Bente Mikkelsen, Director of the Department of Noncommunicable Diseases at WHO. “What we know now, however, is that not only are people with NCDs more vulnerable to becoming seriously ill with the virus, but many are unable to access the treatment they need to manage their illnesses. It is very important not only that care for people living with NCDs is included in national response and preparedness plans for COVID-19 -̶  but that innovative ways are found to implement those plans . We must be ready to “build back better”  ̶  strengthening health services so that they are better equipped to prevent, diagnose and provide care for NCDs in the future, in any circumstances.”

Editor’s note

Noncommunicable diseases kill 41 million people each year, equivalent to 71% of all deaths globally. Each year, 15 million people die from an NCD between the ages of 30 and 69 years; more than 85% of these "premature" deaths occur in low- and middle-income countries. 

 

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Statement from Dr Mike Ryan, Executive Director, WHO Health Emergencies Programme at the Yemen High-level Pledging Conference

9 Jun

(Thank you Mark, Shukran Dr. Al Rabeeah)

I am speaking today on behalf of WHO Director-General Dr Tedros, and of Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean Region 

Excellencies, distinguished delegates, ladies and gentlemen, salam aleikum, 

As we all know, Yemen is the most complex humanitarian operation in the world.  

Indeed, when Dr Al-Mandhari  - who is also participating in this event - visited Yemen last year, he saw parents who were desperate to find help for their sick children; an elderly man die before his eyes as doctors tried to save him, and he met  the son of one doctor who died of cholera while treating patients with the disease. 

The situation has since become much worse. But in spite of it all, for the past five years, WHO and our partners have stood with the people of Yemen.

When the world’s largest cholera outbreak hit, we together reversed the cycle of disease, protecting more than 10 million people. When measles threatened, we together vaccinated over 12 million children. 

When severe acute malnutrition spread, WHO and our partner MED-COM supported 80% of all therapeutic feeding centers, saving 91% of all children suffering from medical complications. And as more people face death and disease, WHO and partners are supporting 70% of all medical consultations in the country.

And we did it all thanks to your generous support.

But today, COVID-19 has pushed Yemen over the edge, with many health workers on the front line frustrated and bereft. In fact, one physician in the Kuwait Hospital in Sana’a, recently said that he is “exhausted by war and politics, exhausted by rumors and ignorance, and exhausted by greed and poverty.”

And yet, in spite of enormous constraints, this physician and other courageous and committed individuals continue to serve their people every day.

And so will WHO and our partners.  We will continue to equip, upgrade and expand the number of isolation centers to 59 across the whole country. We will continue to establish and equip EOCs, train health care workers and rapid response teams moving from over 300 to over 900 response teams in the coming weeks. We will continue to educate communities, and expand testing, all the while ensuring the continuity of other essential health services.

Last week alone, through the COVID Supply Chain Platform WHO and WFP airlifted over 34,000 kilograms of medicines and medical supplies including over 6.5 tons of COVID-19 PPE and laboratory diagnostics to support the functional labs that we have supported for COVID diagnosis. This week we are preparing another round of over 7 tons of PPE and 18 tons of medicines to support Yemen.

And we will continue to do everything we can to serve the people of Yemen, even as COVID-19 rages. But we need a massive scale-up of our COVID and non-COVID health operations to assist some of the most vulnerable population in the world.  

We recognize in a world where everyone is trying to respond to their own health crisis it is a challenge to maintain critical support to others. But in this global crisis we must recognize that there are communities and people who are even more at risk and even more vulnerable.

We will be judged by how we serve those who have the least. We will be judged by how we ease the suffering of those who suffer most and we will be judged by how we help those who are helpless.

We need peace for health and if we have that peace, we can succeed with our partners to deliver health for peace.

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