Why rising fatal chronic diseases require ‘paradigm shift’ in healthcare provision

By The Inspirer staff writer

Chronic diseases or noncommunicable diseases have proven to be deadly and costly, making prevention a better way out to tackle them. And, as such diseases threaten lives, senators and health professionals have senators want government to invest in prevention.

Noncommunicable (NCDs) – or chronic – diseases are diseases of long duration and generally slow progression. The four main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes, according to the World Health organization (WHO).

NCDs, are by far the leading cause of death in the world as they kill 41 million people each year, equivalent to 71% of all deaths globally.

Deaths from such diseases are projected to rise to 52 million in 2030.

In low- and middle-income countries, noncommunicable diseases will be responsible for three times as many disability adjusted life years (DALYs) (a measure of the potential life lost due to premature mortality and the years of productive life lost due to disability) and nearly five times as many deaths as communicable diseases by 2030.

Cancer, heart disease and kidney failure are some of the diseases that Senator Jean Damascene Ntawukuriryayo said are a cause of alarm.

For instance kidney disease or kidney failure requires dialysis with a single treatment costing between Rwf100,000 and Rwf120,000, which adds up to between Rwf1.2 million and 1.5 million per month as a patient should receive it three times a week, according to medical estimates.

Dialysis is a treatment that does some of the functions normally done by healthy kidneys and it is needed when one’s own kidneys can no longer function.

“How much do we invest in prevention so that we understand the importance we are attaching to this activity instead of resorting to treatment because the latter is expensive?” Ntawukuriryayo asked.

Senator Perrine Mukankusi asked the Minister of Health what measures are in place to control and prevent non-communicable diseases “that we have realised are increasing.”

“We understand that this rate is too high, so which strategies for exceptional mobilisation that do we have so that such diseases decline because that constitute worrying problems given the projected trend,” she wondered.

President Kagame (C), Minister of Health, Diane Gashumba (on his left) and Minister of Sports, Esperance Nyirasafari (on his right) join Kigali residents during the Car Free Day sports for all on October 21, 2018. During this initiative, cars are parked and people do physical exercises as well as get free screening for blood pressure, and other medical check-ups to help them tackle chronic diseases when they are still in the latent stage. (courtesy)

Medical expert is rooting for therapeutic ‘paradigm shift’

Dr. Emmanuel rudakemwa, Chairman of Rwanda Medical and Dental Council, and Senior Consultant Radiologist at King Faisal Hospital says Rwanda’s medical curriculum as designed through the support of the Canadians and later by Belgians back in the 1960s, was training medical doctors or medics to treat patients, but lacked focus on reaching out to people in a bid to prevent diseases.

“It means doctor whose mission is to treat waits for the patient to come up to them, if they do not come, of course they die,” he lamented.

There should be promotional health, he said, but argued that some don’t know about it, and medics who should do that are not motivated because in the philosophy to make them medics, they did not have much emphasis in promotional health concept.

Indeed, he said, prevent diseases should constitute a large part of healthcare because prevention is better than cure, and it is even cheaper.

During Car Free Day, various sports activities (workouts) such as press-ups are performed in a bid to tackle chronic diseases (courtesy)

“The medic will say that he/she treated 100 patients in a given district instead of going into the community and sensitise 1,000 people how they can prevent diseases. So, that stems from the philosophy and curriculum we teach out medics,” he indicated.

But, there is a belief that when a medic performed surgery on 1,000 people, or helped 2,000 people (women) deliver, it is a miracle. Yet, preventing collateral damage that is caused by giving birth to between 10 and 15 children, which can even result in death of both mother and baby during delivery, some think that is not an important achievement because they don’t understand it,” he said.

As the council, he said “we looked at ways to set up a curriculum having fundamental requirements such that everyone who is going to establish a medical school should take that into consideration”.

“It is necessary that policymakers and representatives of the people should know that, and the universities, as well as ministry of education should explain well how there should be a paradigm shift, which is more of mindset issue,” he said.

A section of residents perform backups in one of Car Free Day events in Kigali (courtesy)

Dr. Diane Gashumba, Minister of Health said that she cannot specify the budget that the government puts in prevention programmes from diseases, but explained that there are talks on radio, salaries to health workers who administer vaccines, and buildings and cooling equipment for storage of vaccines, are all government resources.

She said car free day is a programme that the Government is putting forward which includes sports for all is an important activity which we always encourage Rwandans to participate in, adding that it is pleasing that it is even being implemented in all districts.

Under the auspices of this initiative, she said, people get free screening for blood pressure, and other medical check-ups to help them tackle chronic diseases when they are still in the latent stage.

Participants in Car free day, including President Kagame, get free blood pressure monitoring (courtesy)

“I can say that we put more efforts in prevention, but we have to quantify that to know how much is allocated to it,” Gashumba observed.

In the current financial year, health sector got over Rwf204.8 billion, representing 8.4 percent of the total national budget.

Failure to implement proven interventions, WHO states, is rapidly increasing health care costs, and continued lack of investment in action against NCDs will have enormous health, economic, and societal consequences in all countries.

WHO’s global business case for NCDs showed that low- and lower-middle-income countries put in place the most cost-effective interventions for NCDs, by 2030, they will see a return of $ 7 per person for every one dollar invested.


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Elias Hakizimana

Elias Hakizimana, CEO&Founder of The Inspirer Ltd,(www.rwandainspirer.com) is a professional Rwandan Journalist with Bachelor’s Degree in Journalism and Communication, received from University of Rwanda’s College of Arts and Social Sciences (CASS) in 2014. He served various media houses in Rwanda including Rwanda Broadcasting Agency (RBA) in 2013 and became passionate with English Online and Print Media Publications where he exercised his talent as a Freelance News Reporter for The New Times, The Independent, The Rwanda Focus, Panorama and more before he became a Self-Entrepreneur as the CEO and Founder of The Inspirer Limited in early 2017.

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