By Jacob Ngwenya
An estimated 15% of the Zimbabwe’s population, have a disability, and the increase in diabetes, cardiovascular diseases (heart disease and stroke), mental disorders, cancer, and chronic respiratory illnesses, will have a profound affect on this population. According to the World Report on Disability, these diseases are estimated to account for 66.5% of all years lived with a disability in low and medium resource countries.
A large number of people living with NCDs are likely to develop impairments as the disease progresses. According to studies, 13% to 65% of the persons living with diabetes will develop neuropathy, leading to chronic ulcerations and amputations in 1% to 17% of them; 10 to 47% of persons living with diabetes will develop a retinopathy leading to visual impairment. They may be considered to have a disability when social, economic, political or other barriers hinder their full and effective participation in society on an equal basis with others. Furthermore, many individuals with pre-existing impairments are at higher risk of developing NCDs.
According to the World Report on Disability, some peoples with disabilities may be more susceptible to developing chronic conditions because of the influence of behavioural risk factors such as lack of exercise and smoking, as well as higher rates of overweight, obesity and premature ageing.
For example, some publications have already suggested that psychiatric disorders may be a risk factor of developing diabetes, through the disorder itself or through the intake of specific medicines necessary to control the condition (anti-psychotic for example).
The 2006 Convention on the Rights of Persons with Disabilities commits State Parties to: “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other people, including in the area of sexual and reproductive health and population-based programmes”.
(Article 25) NCD policies and services themselves must therefore be inclusive of people with disabilities. Eliminating physical, information and communication, economic and attitudinal barriers not only increases access to NCD prevention, treatment and rehabilitation, but may assist in accessing broader health and social services and are essential to fulfilling the right of persons with disabilities to the highest attainable standard of physical and mental health.
In the run up to the Second United Nations High Level Meeting on Universal Health Coverage (UHC) penciled for the 21st of September 2023 in New York, Head of states and governments are in the process of negotiating on the ambitious Political Declarations of which if they sail through and get implemented in member states will uphold the right to health and well-being for people with disabilities (PWDs).
Heads of States and Governments meet again to undertake a comprehensive review on the implementation of the political declaration of the high-level meeting on universal health coverage, entitled “Universal health coverage: moving together to build a healthier world”, of 2019, and to identify gaps and solutions to accelerate progress towards the achievement of universal health coverage by 2030, with a view to scaling up the global effort to build a healthier world for all.
In cognizance of the resolution 17 which is still under negotiation as at 1 September 2023 states that the heads of States and Governments will recognize the importance of the prevention, treatment and control of noncommunicable diseases and the promotion of mental health and well-being in contributing to a better quality of life, and the importance of addressing risk factors through promoting healthy diets and lifestyles, including regular physical activity, to prevent and reduce overweight and obesity.
Non-communicable diseases, including cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, are collectively responsible for 74 per cent of all deaths worldwide, with 86 per cent of the 17 million people who died prematurely, or before reaching 70 years of age, occurring in low- and middle-income countries, and cancer accounting for approximately 10 million deaths globally in 2020.
World leaders are concerned about the inequalities that PWDs face in accessing healthcare services hence the proposed resolution 22 that expresses concern that lack of knowledge, negative attitudes and discriminatory practices within the health workforce, with many likely to die 20 years earlier than those without disabilities, and experience higher health costs and gaps in service availability, including for primary care, long-term care, assistive technologies and specialized services
In the spirit of moving together the world leaders intend to make sure that vulnerable groups are tagged along in resolution 48, which is of particular interest to people with disabilities, of which disabilities might be an underlying cause or a consequence of NCDs. It commits to ensure that no one is left behind, with an endeavour to reach the furthest first, and address the physical and mental health needs of all, while respecting and promoting human rights and the dignity of the person and the principles of equality and non-discrimination, as well as empowering those who are vulnerable or in vulnerable situations, including women, children, youth, persons with disabilities, people living with HIV/AIDS, older persons among many other groups,
People with disabilities and people living with NCDs hereby call for His Excellency President E.D
Mnangagwa and his colleagues dotted around the world to make a bold and ambitious political
declaration which will ensure safety nets are put in place for people facing the double burden of disability and NCDs not leaving behind other chronic health conditions.
The political declaration will not only serve to achieve the Sustainable development goal number 3.4 which aims to reduce NCDs deaths by one-third by 2030 and SDG 3.8 which aims to achieve universal health coverage by ensuring health for all is attained by 2030 but also section 76.2 of the Zimbabwe Constitution which states that everyone with a chronic disease has a right to access the highest attainable quality of healthcare.
We also call for accelerating the implementation of the Universal Health Coverage so that we can be on track to achieve UHC by 2030. We also make a call for robust investment into health of which cannot be over emphasized as it is the only way to build equitable and resilient healthcare systems which strongly rely on domestic healthcare financing as the major source of funding.
Adequate healthcare funding that will see the establishment of the national health insurance in place which will ensure health security for everyone thereby eliminating outrageous out of pocket expenses that pushes families into a vicious cycle of poverty.
Honouring the commitment made in The Abuja Declaration calling for the allocation of at least 15% of the national budget to health which will serves as a starting point towards adequate healthcare financing.
For further innovative ways of domestic resource mobilization, we call for adoption of the
World Health Organisation’s Best Buys which spells out several innovations like imposing corrective(sin) tax on health harming products like alcohol, tobacco, sugary products, ultra-processed foods, trans-fats and fossil fuels. Private, public partnerships (PPPs) can also be considered as another potentially lucrative way of bridging the investment gap on health.
We further call for regulating and legislating of NCDs whereby alignment of laws and policies to UHC Political Declaration as well as the UN high level meeting on NCDs Political Declaration that will see the turning of the tide on NCDs and all the other chronic health conditions.
Lastly, we call for meaningful engagement of the affected communities such as people living with NCDs and people with disabilities in the design, implementation as well as in the monitoring and evaluation of policies, services and programs that affect them as no amount of technical expertise that can replace lived experience.
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