International Development Fund: non-communicable disease programme

Introduction

This report presents findings of a commission from the Scottish Government (SG) to help redesign its development work on health in support of the Governments of Malawi, Rwanda and Zambia with a specific focus on non-communicable diseases (NCDs). The commission is in alignment with shifts in the SGs development priorities, with the ambition of more strategic, impactful and evidence-based programming. This includes specific focus on programming that is partner led, that considers and uses decolonised approaches to development where possible with a focus on gender mainstreaming.

The report uses three main methods; a desk based review of the literature; key informant interviews; and a workshop with SG colleagues. This document presents findings to SG in the form of a report and includes a strategic case, an appraisal case and commercial case. The strategic case outlines why support is required by the SG to support the three partner countries to tackle NCDs. This includes a summary of why NCDs are of interest with a focus on sub-Saharan Africa (SSA), how NCDs are linked to poverty, current funding allocations available for NCDs and the rational for SG investment in NCDs in Malawi, Rwanda and Zambia. The appraisal case outlines the impacts and outcomes expected through the SG international health programme and compares potential options available to SG alongside the evidence available to support the options. A Theory of Change (ToC) of the preferred option has also been developed. The third section covers the commercial case, comparing the value for money of the proposed options to global NCD standards and introduces potential delivery options.

The evidence for investing in NCDs is compelling. Globally NCDs are the leading cause of death and disability, killing around 41 million people a year and this is predicted to rise to become the main cause of death and disability in SSA by 2030.^[8] Indeed, many countries are facing a ‘double burden’ with increasing rates of NCDs coupled with ongoing high mortality from communicable disease.^[9] The preferred approach for SG investment in Malawi, Rwanda and Zambia includes programming at global, regional and national level with a focus on scaling up access to services at district level as per PEN Plus the regional strategy adopted by WHO Member States. This is either through direct support for service delivery, increasing the number of trained health workers or integration of palliative care into NCD services.