Burden of NCDs and the adverse impact on health and economy
- Investing more in prevention is a useful method than anything for now. In 1989, patients with diabetes were only 1 percent of the population
Dar es Salaam. The World poorest countries are most likely to gain Sh8.12 trillion by 2030 if they will invest in prevention against chronic diseases and Non- Communicable Diseases (NCDs) that cost Sh2.94 billion for treatment per person in a year.
NCDs include cardiovascular diseases, cancer, diabetes, chronic respiratory diseases and mental disorders. Tobacco use, physical inactivity, the excessive use of alcohol and unhealthy diets all increase the risk of dying from the diseases.
According to the World Health Organization report titled ‘saving lives, spending less: a strategic response to NCDs,’ shows that prevention will also save more than 8 million lives globally by 2030.
This is good news for Tanzania being among those countries struggling to adopt the Universal Health Coverage over the years without a clear answer on when the country will be able to achieve this.
According to Health minister Ummy Mwalimu, in Tanzania a total of Sh99.09 billion is used for treating NCDs,which is an increase from Sh35.65 billion in 2016/17.
Treating patients with cancer for chemotherapy services, she said, has increased from Sh9 billion in 2015/16 to Sh22.5 billion this year.
Commenting on the hemodialysis service, the minister said the costs had increased from Sh9.5 billion in 2015/16 to Sh35.44 billion this year while the number of kidney patients has increased from 280 in 2014/15 to 2,099 this year.
She said treatment for minimal and invasive cardiac procedures had increased from Sh0.5 billion in 2015/16 to Sh4.33 billion in 2021/22 and the cost for CT scan and MRI had increased from Sh5.43 billion in 2015/16 to Sh10.87 in 2021/22.
“In recent days we have witnessed a number of claims by different people being treated under the National Health Insurance Fund (NHIF). The claims are due to the poor services the patients receive whenever they go to hospitals for treatment,” said the minister. In recent days, it has been reported that NHI is overwhelmed by ever-increasing operational costs and might collapse if serious measures will not be taken by the concerned stakeholders to rescue it. This brings about the question on how NCDs are costing the nation and what are the proposed solutions that can help Tanzania reduce the burden in treating NCDs.
Prof Andrew Swai, who is the Chairman of the Tanzania Diabetes Association (TDA), says the country cannot afford to treat NCDs due to the fact that the health budget is very limited and there is no way in near future the country can afford this.
He says Tanzania spends not less than $40 (Sh93,240) in a year on treating a patient while some other countries like Sweden and Norway spend $4,000 (Sh9,324,000) per year on treating one person while the US spends $11,000 (Sh25, 641,000) per person in a year.
Further, Prof Swai says the Government of Tanzania only spends $1,000 (Sh2,331,000) of Gross Domestic Product to treat the entire country, explaining that such an amount is almost a quarter of the budget among the developed countries.
On the challenges facing health stakeholders, who take part in fighting NCDs, he comments that there is lack of political will in making the NCDs fight become a success.
He explained that TDA came up with an idea about community pharmacies to help diabetic patients with high costs, but, he added, it was discouraged by the government that said diabetes medications should be for free.
“We all know that the policy does not allow the sale of diabetes and pressure medications that do not go beyond complications. In reality, those medications are not available in hospitals.
“Community pharmacies were meant to support them by buying those medications at a cheaper cost as TDA was buying medications from the Medical Stores Department. But the government banned the practice. This has caused more costs to the patients,” said Prof. Swai.
“There is no way we can expect the budget we have to afford the NCDs costs. Working with the Health ministry, we insist on prevention and early diagnosis as a way of helping people from being sick as well as helping the country in saving money for other health purposes,” he added.
According to him, TDA is currently working with the Health ministry by training two health experts, meaning two doctors and two nurses from each health centre, on the importance of early diagnosis and how people can protect themselves from NCDs with the aim of reducing the number of patients and cutting costs.
So far, he said they have trained health experts in five regions including Pwani, Singida, Arusha, Manyara and some parts of Dar es Salaam. He says he expects by December this year the entire of Tanzania will be covered with this training.
Investing more in prevention is a very useful method than anything for now. In 1989, patients with diabetes were only 1 percent of the population while patients with pressure stood at 5 percent.
As of now diabetes has 9 percent of the population and pressure has 26 percent. If serious measures on doing exercises and change of eating habits are not taken, Tanzania will continue to record an increase in the number of such cases year after year.
Commenting on how exercises can reduce the NCDs cases, Kelvin Mlawa, who is the Kevoo Gym instructor at Tabata Kimanga in the city, says over the years there is an increase in the number of people joining his gym with the purpose of losing weight.
He said they charge Sh250, 000 per person in a month and that people with serious weight problems tend to respect everything they are taught with the aim of reducing health dangers but soon as they get to the wanted kilograms majority do quit gym and get back to business as usual.
“There is no need of starting a gym as once the goal of losing weight is achieved one just quits and gets back to the life one is used to. This contributes to an increase in the number of NCD cases in the country. The government should seriously educate people on the dangers of not observing their health habits,” he added.
He explained that the mushrooming of gyms and jogging clubs will never be successful in controlling NCD cases in the country if people do not receive education on avoiding such cases on a daily basis.
On July 31, this year, at the NBC Marathon, Prime Minister Kassim Majaliwa was quoted as calling upon health stakeholders to join hands in fighting cervical cancer and saving the lives of women on the issue.
He said cervical cancer costs women lives, explaining that last year a total of 9,219 women were tested with breast cancer and cervical cancer and 364 of whom were diagnosed with the early symptoms of cancer and 26 were confirmed to be sufferers.
“Health stakeholders advise that cervical cancer is treatable and can be prevented. However, this is only if there is enough awareness of it and more women are encouraged to go for testing more often,” said the Prime Minister.
Dr Crispin Kahesa, who is the Director for Cancer Prevention Services at the Ocean Road Cancer Institute, says that the country needs long term plans and policies to be put in place in order to help raise the awareness of the NCDS. Putting NCDs on the priority list will help Tanzania reduce the NCD cases. He said it is time for the government to make sure that there were plans to involve health workers at all levels to talk more on NCDs to society and that this should be a long term plan of at least 15 years continuously, explaining that failing to do so, the challenges will always remain.
Dr Paschal Ruggajo, a nephrologist and NCD Specialist at Muhimbili Health Allied Sciences (MUHAS), said the treatment of NCDs is costly and often puts health budgets in a difficult situation, especially in the countries of the Sub-Saharan Africa including Tanzania.
“Tanzania is currently observing between 30 to 40 percent of in-hospital admissions. Morbidity and mortality and numbers are likely to increase as per WHO projections,” he said.
As part of the effort to raise awareness of NCDs each year there is a national conference on NCDs. Through the conference, health experts get the opportunity of sharing research, information and exchanging experiences on the better ways of dealing with NCDs.
About 70 percent of people with NCDs are still not aware of their various conditions until they go to hospital for treatment.
“As a way of fighting NCDs, health stakeholders are working hard to promote multi-sector engagement in health promotion, screening and early detection and intervention at the community and primary health care levels so that we can prevent and control NCDs,” he said.