Non-communicable diseases (diabetes & cardiometabolic care)
Non-communicable diseases (NCDs) are the world’s leading cause of death. Every year, NCDs are responsible for the loss of 41 million lives, with >80% of deaths linked to four major groups: cardiovascular (CVD), cancer, respiratory diseases and diabetes. While the burden is universal, it is disproportionately high in low-and middle-income countries (LMICs). Over three-quarters of all NCD deaths, including 85% of those classified as ‘premature’, happen in LMICs – with the world’s poorest billion facing tens of millions of disability adjusted life years (DALYs) due to ill-health, early death and disability. In line with the Sustainable Development Goals, the WHO Global Action Plan for the prevention and control of NCDs aims to cut the relative risk of premature mortality in the top four disease groups by 25%. Objectives also include ambition to reach 80% availability of the affordable basic technologies and essential medicine required to treat these major NCDs. Diagnostics are an integral part of this plan and are essential – not just to the identification and treatment of cases, but also to the management and control of life-long and chronic conditions like diabetes and CVD.
Early detection and the management of chronic conditions is key to avoiding long-term complications and reducing the health and economic burden of NCDs. Yet diagnostics remain the weakest link in the care cascade. In the case of cardiometabolic conditions like diabetes and CVD, high costs and supply barriers mean that essential diagnostic tools are inaccessible to many LMICs. This sees primary healthcare (PHC) facilities ill-equipped to address basic testing needs for cardiometabolic conditions, with studies estimating that over 50% of people living with diabetes and hypertension are undiagnosed.
Looking beyond the initial diagnosis, whilst facility and home-based monitoring technologies – including for the self-monitoring of blood glucose – have enabled millions worldwide to adequately manage their condition, equality of access remains an issue. For example, despite the high global availability of blood glucose measurement tools, only 48% of LMICs report this technology as being ‘generally available’, with other studies showing one in three people with diabetes in LMICs to have never had their blood glucose measured. With the first global targets for diabetes setting a threshold of 80% diagnostic coverage and ‘good’ glycemic and blood pressure control, the need to improve access to affordable, fit-for-purpose diagnostics for diabetes, and other cardiometabolic conditions, is clear.
GOAL: Increase the availability, affordability and uptake of essential diagnostics – reducing premature mortality and improving the quality of life for people living with diabetes and other cardiometabolic conditions
Our strategy recognizes that the diagnosis and management of such conditions requires a long-term, holistic approach that brings diagnostic solutions closer to the people that need them. Focusing on primary healthcare and self-monitoring in LMICs, we work with communities, healthcare professionals, developers and manufacturers to identify and address key barriers to access. This includes market-shaping activity to improve the affordability of existing tools, as well as research, technical guidance and support to inspire innovation in product design and delivery. In line with this, our strategy is designed to:
- Deliver a portfolio of affordable, fit-for-purpose tools that leverage the potential of existing and new technologies to transform diabetes diagnosis and management
- Improve access to multiparameter point-of-care (POC) testing for the screening and diagnosis of cardiometabolic conditions in primary health facilities
- Increase the uptake of essential diagnostics for diabetes and other cardiometabolic conditions by integrating testing into existing health and community programmes
We also recognize the need to bring transparency to the diagnostic landscape and are working with our partners to evaluate products and models – generating the evidence needed to inform national decision-making and shape procurement and policy developments that help close the diagnostic and care cascade gap.
Workstream #1 | Improving access to new and existing tools for the diagnosis and management of diabetes in LMICs.
Rationale: The diagnosis and (self-)monitoring of blood glucose levels is key to bringing diabetes under control and reducing the risk of long-term complications, but existing products are often not optimized for use, or financially accessible to, people living in LMICs.
Approach: FIND is working to improve access to existing tools and support the development of novel, fit-for-purpose solutions. As part of this, we evaluate and generate key data to evidence the performance of existing blood glucose self-monitoring and HbA1c point-of-care products in LMICs. We are also working to improve financial access to these tools through active market-shaping, including price negotiations and innovative supply/financing models. In addition, FIND supports the evaluation of new and existing minimally-invasive technologies for continuous glucose self-monitoring – combining this with user-centred research to inform, support and guide the development of target product profiles (TPP) and broader R&D priorities.
- Evidence of performance of diabetes diagnostic and self-monitoring tools in LMICs
- At least five existing diagnostic and monitoring tools available at a reduced price
- 1–2 new glucose self-monitoring technologies selected for development, registration and implementation in LMICs
Workstream #2 | Supporting the diagnosis and monitoring of cardiometabolic conditions through primary care facilities.
Rationale: Diagnosis and care at primary level is key to preventing long-term complications from cardiometabolic conditions, yet many primary care facilities in LMICs are unequipped to meet these basic testing needs.
Approach: FIND is working to increase availability and access to multiparameter point-of-care devices for the screening and diagnosis of cardiometabolic conditions. This includes a landscape analysis of key tools, together with the evaluation and testing of point-of-care devices and implementation models to evidence usability in intended settings, and define potential for optimization. This work is supported by active market-shaping interventions that remove financial barriers to access and improve the overall uptake of multiparameter point-of-care devices at primary level.
- Multiparameter cardiometabolic point-of-care devices evaluated
- Optimization potential for product and implementation models defined
- Up to two cardiometabolic point-of-care tools available to countries at reduced prices
Workstream #3 | Promoting the integration and uptake of point-of-care diagnostics for diabetes and other cardiometabolic conditions.
Rationale: COVID-19 has created opportunity to transfer learning and promote the development and integration of community-based testing as a means to improve access to diagnostic screening, management and care.
Approach: FIND is supporting the uptake of diagnostic testing through the implementation and evaluation of new delivery models for screening and chronic disease management. This includes the development of integrated, community-based testing that utilises existing infrastructures for infectious diseases (e.g. vaccination) for cardiometabolic screening. Critically, we also work to verify the value and potential of such models – building a robust evidence base to inform policy developments and promoting the integration and use of digital surveillance data at a national level.
- Integrated screening and care piloted and evaluated in at least two countries
- Evidence of successful implementation of NCD screening and surveillance activity with digital integration into national health systems in at least one country