In This Article Expand or collapse the "in this article" section Capacity Building for NCDs in LMICs

  • Introduction
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Limitations and Future Directions

Public Health Capacity Building for NCDs in LMICs
Mohammed K. Ali, Swathi Sekar
  • LAST REVIEWED: 26 January 2022
  • LAST MODIFIED: 25 February 2014
  • DOI: 10.1093/obo/9780199756797-0087


Non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), diabetes, cancers, and chronic respiratory diseases are chronic, silent, and progressive conditions that lead to disabling and often fatal complications (e.g., heart attacks, amputations, etc.). Major societal advances, increases in life expectancies, and changes in environments and individual lifestyles during the 20th century have led to these diseases now accounting for two-thirds of worldwide deaths, and 80 percent of these occur in low- and middle-income countries (LMICs). NCDs are multifactorial—in other words, genetic, lifestyle-related, economic, and psychosocial factors all contribute to development of these diseases. As such, NCDs must be addressed at multiple levels (individual behaviors, programs, health-care delivery, and policies). There are several proven cost-effective policies (e.g., tobacco taxation), preventive services (e.g., cancer screening), and individual behavioural interventions (e.g., lifestyle modification, medication adherence) that have been shown to reduce morbidity and mortality associated with NCDs. However, NCDs are also chronic—meaning that they require long-term prevention efforts (sustained initiatives to address tobacco, physical inactivity, unhealthy diet choices) and care delivery (sustained adherence to therapies and regular preventive screenings for early signs of diseases when they are still treatable, e.g., cervical cancer screening) and cannot be resolved with single, one-time therapies. So, addressing NCDs requires appropriate capacity (the human, financial, and infrastructural resources) that is organized within sustainable systems. For example, delivering NCD preventive and care services requires extensive human resources (e.g., physicians, nurses, allied health staff, community health workers, and administrative staff) and clinics or community facilities. LMICs face particular challenges (e.g., competition for government resources by other sectors, weak health systems, few data to guide health policies), all of which reflect low capacity to address NCDs. Since capacity is broadly defined as human, financial, and infrastructural resources, capacity building or capacity development refers to a broad range of activities (e.g., training, fundraising, institutional development) that can be aimed at individuals, institutions, or society to improve health, wellbeing, and economic opportunities/development. Scholars in this field note that capacity building is most effective when based on a conceptual framework (e.g., the World Health Organization’s “building blocks of health systems”) and incorporates organizational development. In this article, we share and summarize published resources regarding human and infrastructural capacity-building initiatives to address NCDs in LMICs. Although we do not focus on growing financial capacity or advocacy for this, there are several nongovernmental organizations (NGOs) involved in capacity building to address NCDs (e.g., the NCD Alliance). Since there are few texts on this topic, we systematically searched a health journal database (the National Library of Medicine or PubMed) to identify, categorize, and share useful sources of information describing human and infrastructure development programs or policies that support delivery of preventive or care services and health systems enhancement in LMICs. As this is a nascent literature and doesn’t cover the range of topics described in traditional health systems conceptual frameworks, this article is categorized and presents the resources focused on NCD capacity by disease type (overview, CVD, risk factors, cancers, or chronic respiratory diseases). The studies are further sub-classified into sources that identify the capacity challenges or sources that propose or evaluate capacity-building solutions for NCD prevention and control. The article concludes with a short section describing limitations in the research to date and future development.

General Overviews

Defining and addressing capacity needs for NCDs has become an area of major interest following the 2011 United Nations High-Level Meeting on NCDs, as governments and agencies seek efficient approaches to deliver effective NCD care and prevention policies and services. Some of the literature regarding NCDs globally is broad, and tends to have both global and regional foci, but deals with the whole category of NCDs, as opposed to each disease individually. Most of these studies refer to cardiovascular disease (CVD), diabetes, cancers, and chronic respiratory diseases, while injuries and mental health conditions, which are also chronic NCDs, don’t have as much literature devoted to them. This chapter, similarly, does not include mental health and injuries.

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