Most Low and middle incomes countries have been in the process of epidemiologic transition, witnessing the growth of Noncommunicable diseases (NCD) surpassing burden attributable from infectious diseases and maternal and child health conditions. NCD epidemic constitute a major socioeconomic development challenge in the 21st century, as it hampers health and well-being as well as economic at individual and macro levels. As leading causes of morbidity and mortality NCD poses major detrimental effects on human assets and high health care cost to any society; as well as workload and financial burden to health care system. NCD Tsunami aligns itself well with increases in elderly population and people with disabilities.
Health care systems need a face lift transformation to encounter with these demographic and epidemiological transition towards NCDs. Common health care system challenges include inadequate commitment, poor governance and a lack of coordination, shortage of competent health workforces, weak data and information systems, low access to essential and life-saving NCD medicines and technologies, weak supply chain management, and inadequate and inefficient spending of the health budgets. The need for health care system strengthening was reflected at the high level, in particular at UN General Assemblies. These include the adoption of targets of 80% of health care facilities equipped with essential NCD medicines and technologies and 50% coverage of high risk population for drug therapy and counselling by 2025; and declaring commitment to strengthen and reorient health systems to address NCD through people-centred primary health-care systems by 2016. Most important, UN General Assembly endorsed many SDG targets- relevant to the strengthening of health systems; including (i) reduce one-third of premature mortality from NCD (target 3.4) and (ii) achieve universal health coverage (target 3.8).
The high health care cost and presence of life-long chronic conditions, as well as long term comorbidities and disabilities, of NCD patients call for the reorientation of the entire health care system. Effective tackling NCDs requires robust and synchronized health system blocks. Moreover, health care system holds great, but unfortunately untapped, potential to reduce NCD risk exposure as well as empower patients through health promotion means. There is a need, and many examples of successes, in streamlining NCD care into existing health system infrastructures, rather than creating new mechanisms. A strong focus on front line service while addressing each component of health systems building blocks is a key step for NCD response.
Nursing professionals: essential forces to arrest NCDs
Nursing professionals are the backbone of health care delivery systems at all levels and in all societies, accounting for around half of total health workforces globally. While facing patient one-by-one at micro level, nursing and midwifery professionals collectively provide significant contribution for the betterment of population health, particularly through decreasing in patient morbidity and mortality, addressing health risks, and stabilizing health care cost. Nurses and midwives usually act as ‘frontline service’ responders to complex health demands; protectors and advocates for the community; and communicators and coordinators within health teams. Therefore, nursing professionals are major and inevitable determinants for the system transformation to handle NCD challenges.
Rich and poor alike, countries are facing common challenges on nursing and NCD. It is arguable that current nursing and midwifery system have not timely adapted and well prepared to effectively handle the NCD epidemiologic transition. Three major challenges include disparities in 1) competency, 2) skill-mixed management, and 3) governance system (including employment). Furthermore, Nursing professionals hold two important potentials to help tackling NCD, firstly to promote secondary prevention of NCD risk factors at health care facilities, and secondly to lead the society as a health-promoting role model.
With relatively strong institutions and health care system, Thailand has complied many good-practice cases, knowledge and exceptional expertise in NCD care. A rare phenomenon in low and middle-income countries, Thai NCD Alliance has been a platform to promote multi-sectoral and multi-disciplinary engagement on NCD. Thai Nursing and Midwifery Council has an outstanding track record been a driving force to address public health challenges, through its guidance and supportive functions-not only as regulator. Designated as a WHO Collaborating Center on nursing and midwifery, the Faculty of Nursing at Mahidol University, has demonstrated its performance as a leading nursing academic institution, with mandates to produce professional nurses with excellences to provide best care and promote health for society, edging technical knowledge on nursing, and provision of academic services. However, there are rooms for improvement for Thailand to strengthen nursing professionals to battling NCD.
Without doubt, knowledge and experience sharing can leapfrog cross-fertilization learning across individuals, institutions and countries. Furthermore; networking, partnership and knowledge management can be a cost-effective mean to boost up collective capacity and collaboration. The technical conference "N-nergizing Nursing Profession for NCD Challenges (N3 Nursing Conference)" is an opportunity to revisiting, taking stock of knowledge and experience available, and brain storming for the way forward how to strengthen nursing professionals to address NCD crisis.