WHO reports that NCDs account for 63 percent of all deaths worldwide, with 82 percent of these occurring in low- and middle-income countries. This translates into 38 million people dying each year from an NCD — 28 million of them in low- and middle-income countries. About 16 million of all deaths attributed to NCDs occur before the age of 70.
Cardiovascular diseases, including heart attacks and strokes, account for most NCD-related deaths, killing 17.5 million people annually. Cancer kills 8.2 million each year, respiratory diseases kill 4 million, and diabetes accounts for 1.5 million deaths. Mental and behavioral health issues also fall into the NCD category.
NCDs are not passed from person to person, rather they are conditions characterized by slow progression over a longer duration. Modifiable risk factors such as tobacco use, physical inactivity, overuse or abuse of alcohol and other harmful substances, and unhealthy diets all increase the risk of dying from an NCD.
AIHA’s NCD Programming
AIHA’s NCD programming provides technical guidance, clinical training and mentoring, and expert advice to help tackle some of the most pressing public health issues facing low- and middle-income countries. Because NCDs are long-term chronic conditions, many of our partnerships focused on primary care elected to target diseases of greatest concern to the populations they served.
Many of AIHA’s health partnerships in Eastern Europe and Central Asia worked to develop and implement some of the region’s first and most effective interventions addressing NCDs ranging from asthma and diabetes to hypertension, cardiovascular disease, and tobacco use.
Together with our partners, we helped shift the paradigm from a fragmented system that heavily relied on tertiary care to a more holistic, comprehensive model that focused on primary care and prevention.
Primary Healthcare Partnerships
Between 1998 and 2008, AIHA implemented some 30 primary healthcare partnerships. These twinning alliances established more than 70 primary healthcare centers, family medicine centers, and women’s wellness center across Eurasia. All of these centers — many of which are still active today — offer cardiovascular screening, treatment, and patient education.
Around 15 partnerships in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, and Ukraine launched “Healthy Heart” or other wellness programs to help patients manage hypertension and avoid heart attack or stroke.
Minsk Cardiovascular Wellness Center
Working with the Ministry of Health of Belarus, the Minsk City Health Administration, Minsk Polyclinic No. 36, and with technical support from the New Jersey-based Robert Wood Johnson Health Network, AIHA helped establish the Minsk Cardiovascular Wellness Center to improve cardiovascular health in the Belorussian capital of Minsk.
Polyclinic staff received specialized training on cardiovascular screening, early detection, practice management, education methodologies, case management, and program evaluation. The partners developed clinical guidelines and educational tools, as well as case management protocols.
Their efforts culminated in the opening of the Cardiovascular Wellness Center in October 2000, which offers integrated cardiovascular disease screening and early detection, education, and counseling services to more than 27,000 people. It was the first facility of its kind in Belarus.
Since 1992, AIHA has established more than 40 hospital-to-hospital twinning partnerships to provide comprehensive technical assistance across a broad range of clinical and operational disciplines. In addition to helping hospitals learn how to better operate in a more market-oriented, patient-driven administrative structure, these partnerships worked to address fundamental health-related issues that were not being effectively dealt with under existing systems.
Based on local public health priorities, more than 10 of our hospital partnerships in Bosnia, Croatia, Kazakhstan, Latvia, Russia, Slovakia, Turkmenistan, and Ukraine designated cardiology — and prevention and lifestyle changes to improve outcomes — as a priority.
Georgia Community-based Chronic Disease Management Project
Community level pilot projects focused on developing a proactive screening, prevention, and treatment strategy for cardiovascular diseases and diabetes paired with heath education interventions focused on the most common life-style risk factors. The project also focused on strengthening the capacity of primary care institutions and pharmacies in the area.
Primary Healthcare Partnerships
Educating people and introducing them to new concepts, methods, and technologies provides them with the tools they need to make better lifestyle choices and improve their overall well-being. When dealing with a chronic illness such as diabetes, this knowledge can mean the difference between an active, productive life and an existence fraught with frequent hospitalizations and constant worry about potentially life-threatening complications.
A number of AIHA’s primary healthcare partnerships in Armenia, Kazakhstan, and Russia designated diabetes care as a priority for their communities and developed strong treatment and patient education programs to help patients successfully manage their condition.
Dubna / La Crosse Partnership
AIHA’s partnerships and programs are driven by the needs of the communities they work to serve. By assessing the unique needs of the population in Dubna, partners determined that diabetes was a significant problem. They responded by creating the Dubna Diabetes Education Center to teach diabetics, their families, and local healthcare providers about a variety of lifestyle choices that can play an important part in the management of this disease.
This resulted not only in patients taking a more active role in their own care, but also in radical changes in the attitudes and responsibilities of healthcare providers.
The diabetes management program they created is a fully replicable model that uses a multidisciplinary, wellness-oriented team approach to educate patients in self-management of their disease. It is modeled after a community-based program used by healthcare providers in La Crosse and was adapted by the partners to meet the needs of the local population.
Between 1993 and 2005, staff at the Dubna Diabetes Education Center trained more than 2,500 diabetics; 1,100 family members; and 340 medical practitioners. Insulin use declined by 30 percent and average length of hospital stays associated with diabetes-related complications was cut in half, leading to a consequent decrease in healthcare spending and — more importantly — immeasurable improvements in the quality of life for the region’s diabetic population.
As a result, the Dubna Health Administration reported a savings of more than 188 million rubles and the program has served as a model for national replication under the auspices of the Gore-Chernomyrdin Commission.
Russia Diabetes Disease Management Initiative
In 1993, diabetes affected approximately 7 million people in Russia. Diabetes and its associated complications created enormous suffering, impaired workforce productivity, and placed significant financial burdens on Russia’s transitioning healthcare system. These factors prompted the Russian Ministry of Health to designate diabetes as an intervention priority for U.S.-Russia collaboration under the Gore-Chernomyrdin Commission Health Committee.
The resulting Russia Diabetes Disease Management Initiative (1993-1998) was modeled after the community-oriented approach successfully implemented in Dubna, Russia, by AIHA’s Dubna/La Crosse partnership.
Primary Healthcare Partnerships
Many nations throughout Central and Eastern Europe and Central Asia have experienced a marked increase in cases of asthma over the past three decades due to escalating rates of air pollution and tobacco use, among other things.
Living with a chronic disease can be a huge challenge for many people, especially if they don’t understand their ailment or know what they can do to effectively manage it. For people with asthma, the fear of what can trigger an acute attack is ever-present.
Changing the mindset of patients suffering from asthma — and many of the healthcare practitioners who treat them — was an objective of many AIHA primary care partnerships. Educating patients and their families to adopt a proactive approach to treatment and prevention by using evidence-based protocols and incorporating lifestyle changes geared to reduce attacks are the mainstays of the programs that result from the efforts of our partners.
Instruction about clinical interventions, self-administered therapies, and preventive measures can make a world of difference in quality of life for asthma patients. Several partners in Armenia, Kazakhstan, and Russia developed strong, successful asthma programs.
Almaty / Tucson Partnership
Through a partnership with the Tucson / Almaty Healthcare Coalition — a consortium representing virtually the entire Tucson area healthcare community — clinicians at the Republican Institute for Pediatrics and Children’s Surgery could access to the most up-to-date medical literature and Internet resources, as well as have an opportunity to conduct consultations with experts from the United States and all over the world.
During professional exchanges, the Almaty partners witnessed first-hand the benefits of treating asthma attacks with steroid inhalers, which — according to evidence-based protocols — is also an important component of prevention regimens and had previously not been an accepted practice in Kazakhstan.
Partners began treating asthma more proactively by teaching patients and their families to help prevent attacks by using nebulizers and making lifestyle changes such as avoiding things—cigarette smoke and pets, for example—that can trigger asthma. Eventually, this patient education program took the form of an “Asthma School” that continues to provide ample evidence of the effectiveness of the new treatment and prevention protocols.
Mental and Behavioral Health
Primary Healthcare Partnerships
When AIHA was implementing its primary care and family medicine partnerships in Eurasia during the late 1990s through 2008, mental and behavioral health were largely stigmatized and the huge toll they exact on health and productivity was vastly underestimated.
Driven by the pioneering study “Global Burden of Disease,” jointly conducted by WHO, the World Bank, and Harvard University, which indicated that four of the 10 leading causes of disability worldwide among persons aged 5 years and older fall under the category of a behavioral disorder, AIHA and our partners began working to integrate mental and behavioral health programs and services into the overall framework of their healthcare programs and facilities.
In a primary care setting, the inextricable link between a patient’s mental and physical well-being quickly becomes apparent.
Responding to the needs of the people they serve, healthcare providers at partner institutions in Eastern Europe and Central Asia initiated staff training programs on mental and behavioral health topics and added patient education and counseling to the list of services they provide.
As gatekeepers to the healthcare system, primary care practitioners were taught to recognize the importance of being able to detect mental and behavioral disorders in their patients and to provide them with appropriate services or referrals.
Targeted programs often differed based on community needs, including gender-based violence, alcohol or tobacco abuse, injecting drug use, depression, and aggression.