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Universal Health Coverage : From Promise to Practice

Universal Health Coverage : From Promise to Practice ... moving to the rear end of practice : D evelop and evaluate a piece of basic secondary disease prevention , meant to contribute to UHC Routine screening for NCDs in rural and urban sub- Saharan Africa.

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Universal Health Coverage : From Promise to Practice

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  1. Universal HealthCoverage: FromPromiseto Practice ... movingtotherear end ofpractice: Developandevaluate a pieceofbasicsecondarydiseaseprevention,meanttocontributeto UHC Routine screeningfor NCDs in rural and urban sub-SaharanAfrica

  2. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Ellis Owusu-Dabo, PhD Group Leader, Non-CommunicableDiseasesBernhard Nocht Institute for Tropical Medicine, Hamburg, stationed in Kumasi, Ghana Changing Patterns of Disease Burden in sub-Saharan Africa: Building Research Capacity for Non-Communicable and Infectious Disease Control through District Health Empowerment (BRIDGE)

  3. Kumasi Centrefor Collaborative Research (KCCR) Joint venture oftheMinistryofHealth, Ghana, Kwame Nkrumah University, Kumasi, and Bernhard Nocht Institute, Hamburg, Designedas a researchplatform tosupportjointGhanaian-international projects Based on a State Agreement of 1998, whichhasrecentlybeenextendedbeyond 2018

  4. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica • Situation • Twentyyearsfromnow, NCDs will causethemajordiseaseburden in sub-SaharanAfrica • The causesoftheincreasearehypothetical • In sub-SaharanAfrica, diseasepreventionandhealthcarearedesignedfor IDs – acuteintervention(except HIV) • NCDs requirelong-term follow-upofpatients • NCDs are in high-income countries predominantlydiagnosedbyopportunistichealthvisits

  5. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Partners • Kwame Nkrumah University of Science and Technology, Kumasi, Ghana • University of Ghana, Accra, Ghana • Hospital Engineering Ltd, Tuttlingen, Germany, and Accra, Ghana • University Medical Center Hamburg-Eppendorf, Hamburg, Germany • Hamburg Institute of International Economics, Hamburg, Germany • Technical University Dresden, Dresden, Germany • Universitéd‘Antananarive, Madagascar • Institut des Recherches en Sciences de la Santé, Ouagadougou, Burkina Faso

  6. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Proposed Study Design (I) • EnsuresupportofMoHandlocalhealthadministration(DistrictHealth Management Teams) • Ensureavailabilityof 4 essential drugs(Glibenclamide, Metformin; Lisonopril, Nifedipine)

  7. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Proposed Study Design (II) RecruitoneDistrict Hospital (DH) eachandassociated Primary HealthCentres (PHCs) of ... rural, poor urban, rich urban districts PHC PrivateHospital? DH Management Team Central Lab

  8. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Proposed Study Design (III) • Introduce in PHCs- simple NCD tests, i.e. forbloodglucose, bloodpressure, heightandweight, spirometry- simple and user-friendlydocumentation, incl. securedcloud, anonymisationoption- SOPs forconsultations, treatmentsand DH referrals • Ensure/introduce in DHs- thesame diagnosticsas in PHCs andaccessto Central Lab- the same documentationas in PHCs- SOPs forconsultations, treatmentsandfollow-ups- underdiscussion: ultrasound, ECG, exerciseECG • Establish Central Lab andintroduce- improved NCD routineoffastingglucose, GPT, cholesterol- improvedID routineofbacterialcultureandantibioticresistance- antibioticstewardshipfor DHs

  9. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Proposed Study Design (IV) • EstablishManagement Team incl. officerstoco-ordinate training, technicaldevelopmentwith link toengineering, manufacturers • Establish Central Lab incl. biochemistry, bacterialculture • Continuouslytraindistricthealthstaff, introduceincentives • Monitor staffcompliance, evaluateandpossiblyadoptsuggestionsforimprovement • NegotiatewithGhanaianMoHscreening(astreatment) tobecoveredbyNational Health Insurance

  10. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Proposed Study Design (V) • Evaluateusefulnessofintroduceddevices (diagnoseswith/without) • Replicateandevaluateset-up in twomore urban centresoutside Ghana • Approach an evaluationofthecost-effectivenessofintroduceddevices • Compare NCD prevalences in the rural, poor urban andrich urban districts • Have expert teamsearchdataforneglected/disregardeddiseases • Search for potential causesforchangingdiseasepatternsbyestimating- physicalactivitiesbyinterrogation- dietaryhabitsbyinterrogation- infectionhistoriesbyserology- environmental toxinloadsby HPLC and GC-MS- social stress historiesbyhaircortisollayers • Verifyevidencebyrandomizedstudiesbased on 2010/2011 Ghana census

  11. Routine screeningfor NCDs in rural and urban sub-SaharanAfrica Potential • Addresses relevant issues, NCDs in SSA andantibioticresistance • Development ofstandardequipmentand SOPs mayfacilitatequalitymanagement • Development ofstandardequipmentmayreduceimplementationcosts • Set-upesp. documentationmayfacilitateclinicaltrials • Research componentmighthintatcausesforchangeand, thereby, atprevention • Research componentmightreveal additional targetsforprevention in the North

  12. Thankyou

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