Govt may have dropped NCDs ball

THE EDITOR: Newly minted Independent Senator Sunity Maharaj, in her wide-ranging maiden contribution to the budget deliberations in the Senate last week, struck a poignant note, that the 2024 national budget had failed to address chronic non-communicable diseases (NCDs), the country’s primary killer. The senator’s enlightenment prompted a detailed review of Finance Minister Colm Imbert’s hours-long presentation to include the supporting 2024 public sector and social sector investment plans (PSIP & SSIP).

In respect of health, the minister made reference to government achievements of global and regional benchmarks in the areas of maternal, child and neonatal care, in the preceding four years, emphasising that the accomplishments were “way ahead of schedule.” He then went on to add that “we have adopted a multidisciplinary approach for sustainable solutions towards preventing, managing and controlling the burden of morbidity, mortality and disability due to NCDs.”

My response to the foregoing is framed against the backdrop of a document titled National Strategic Plan for the Prevention and Control of Non-Communicable Diseases: TT 2017-2021.

This well crafted document, made public by the Ministry of Health in 2017, envisioned a phased implementation of the plan, ie, phases 1, 11 and 111, that would be guided by principles and approaches including multisectoral action, health promotion, prevention-focused integrated care, and universal health coverage, and be evidence-based via collaboration between policymakers, researchers and implementers.

Financing the plan was not envisioned as an issue, since completion and mobilisation of an IDB loan for US$110 million, negotiated in 2014, would be a major action plan for phase 1.

Of the remaining action plans slated to be completed by the end of phase 1 (2017-2018), most important was the establishment of a “dedicated NCD unit,” aimed at strengthening the capacity of the Health Ministry to support the multisectoral action described as a guiding principle above. The unit was projected as a multisectoral team that would report to the permanent secretary.

Its initial tasks, as expounded in the document, would be to develop phase 1 action plans – there were 18 in all – and the monitoring and evaluation framework, elaborated later in the plan document. For interested people, the action plans for phase 1 are located on pages 22-31 of the strategic plan, which can be found online.

Sadly, after intense scrutiny of not only the documents referenced at the end of paragraph 1 above, but also pre-, inter- and post-pandemic national budgetary documents, from 2018 through 2023, Senator Maharaj’s observation – that the 2024 national budget had failed to address the NCDs – could be applied to all Finance Ministry national budgets since the advent of the National Strategic Plan for NCDs 2017-2021.

Most alarming was the finding that the lead item in box 3.3 of the 2024 SSIP: Policy and Research Initiatives of the Health Ministry for Fiscal 2024 is: National Policy for the Prevention, Management and Control of NCDs. Has the 2017-2021 strategic plan for the NCDs been scrapped, thus prompting this latter initiative? This does not seem likely since the Finance Ministry, on October 2, did categorically state that the government had adopted “a multidisciplinary approach towards preventing…due to NCDs” (see para 2).

The greater likelihood is that the Health Ministry has simply dropped the ball on the NCDs; or are we the public being subjected to the not unusual mamaguy? Either possibility is unacceptable. In the preambular pages leading up to the above referenced “action plans,” much weather was made of NCDs being the main culprit for TT's much lower life expectancy when compared with six of our Caribbean neighbours.

Any doubts about the precarious nature of our very existence were put to rest by the intervening pandemic. So far 4,390 deaths (and counting) have been attributed to covid19, and as the Health Ministry's daily reports remind us, the dominant factor is “older persons with comorbidities.” Succinctly, what had and continues to kill us softly was blatantly exposed by the covid pandemic.

The NCDs constitute a public health emergency in TT which requires public health approaches, many of which were embodied in the action plans which, according to the 2017 Strategic Plan for Prevention and Control of the NCDs, should have been completed at the end of phase 1.

The Finance Ministry (or the Health Ministry) needs to clarify exactly what comprises the “multidisciplinary approach” (para 2) taken thus far by the government in confronting the NCDs emergency. John Public cannot be left in the dark in this situation that threatens our very lives.

KENWYN H NICHOLLS

international public health consultant