Reimagining NCD care to meet women’s needs

Women in low- and middle-income countries face rising rates of non-communicable diseases, yet health systems fail to meet their needs. Tackling this crisis requires care responsive to women’s needs, better data, and policies that prioritise women’s health across the life course.

Through the Sport and Health Cooperation Initiative, students are learning through movement, and healthcare workers are promoting grassroots sport and physical activity to patients. Photo: PATH

A perfect storm is the confluence of issues that lead to a disastrous event or situation. The current status of women in low- and-middle-income countries (LMICs)—low socioeconomic status, lower education levels, lack of transport, fewer employment opportunities, and caregiving responsibilities—when combined with an unresponsive health system, forms a perfect storm.

This confluence exposes women vulnerable to or living with non-communicable diseases (NCDs) to advanced and costly complications—a disaster for women and their dependants. We need to tailor policies and services, using a life-course approach along the continuum of care, to enable women and their dependants to achieve optimal health. Disaggregated data and research focused on women and girls are required to inform solutions and provide inclusive NCD prevention and care that is accessible, acceptable, and affordable for women.

Physical activity crucial for NCD prevention

The continuum of care begins with prevention, and physical activity is central to NCD prevention and management. However, women and girls are often excluded from physical activity and sports due to cultural norms and systemic issues.

Under the Olympism365 strategy, the International Olympic Committee and the World Health Organization (WHO) initiated the Sport and Health Cooperation Initiative and are, together with PATH, bringing together ministries of sport, health, and education, national Olympic committees, WHO country offices, and small businesses and community organisations to embed inclusive sport into regular routines at school, health facilities, and in communities.

The initiative has so far reached more than two million people across five countries, linking them to sport and health activities. This multisectoral approach, fuelled by enabling and inclusive policies and capacity building, can be replicated and scaled to advance a culture of inclusive daily physical activity for better health and wellbeing for girls and women.

Integrated people-centred primary healthcare

Global data mask national-level trends that highlight disparities in women’s access to care and NCD-related outcomes. For example, longitudinal data from Mexico indicates decreasing access to care for women over time, with women living longer with greater morbidities and higher disability-adjusted life years.

Barriers—such as distance to services, lost pay from time away from work, exclusion from insurance coverage, and fragmented delivery models requiring separate visits for each co-morbidity—lead to women choosing between their NCD care and other needs or family responsibilities, rationing care, or seeking costlier or less effective options.    

To address these challenges, PATH applies human-centred design with people living with NCDs (PLWNCDs), clinicians, policymakers, and ministries of health to understand barriers to care and co-design inclusive delivery models, built on primary healthcare (PHC) platforms, that provide integrated people-centred services, including for NCDs. PHC models include community screening, education, and linkage via referral pathways from PHC level to specialised services, based on assessed need.  

Our integrated model, such as the one implemented in Makueni County, Kenya, in partnership with Amgen, is an example of a “one stop shop” that provides convenient, comprehensive care, reducing travel and wait times and time off work.

This approach reduces individual financial burden and increases retention in care. The current shifts and reductions in global health funding underscore the urgency in accelerating the provision of integrated services via PHC platforms to maximise comprehensive care for women and girls.

Access to medicines and health products

PLWNCDs are commonly placed on lifelong treatment plans that require continuous access to safe and high-quality medicines and health products. Innovations that simplify the supply chain, increase procurement volumes with associated lower prices, dispense products at lower-level facilities and through patient groups, reduce stockouts, and stabilise the market show promise in reducing out-of-pocket costs and improving outcomes.

One example is “Diabetes CarePak,” a bundling solution for supplies required for diabetes care, which has driven significant improvement in haemoglobin A1c levels, quality of life, and self-care practices. During participant interviews, a 58-year-old woman shared, “[CarePak] saves time and transport fare. Knowing what to eat and having my own glucometer has simplified my life.”

Call to action

Across the continuum of care, disaggregated data are imperative to strengthen NCD prevention, care, and treatment responsive to women and girls’ needs. This includes data from surveillance, service delivery, and implementation research to inform services and systems design by policymakers and planners. Barriers affecting women and girls will remain hidden until investment in these data systems is prioritised. 

The long-awaited fourth United Nations High-Level Meeting on NCDs is almost here and the resulting declaration will guide actions on NCD prevention and control into the future. We call on stakeholders to operationalise the declaration through a women’s health lens and prioritise the following actions:

Financing: Design inclusive universal health coverage packages and risk protection programmes for women, including those who are home-employed, working in the informal sector, or caregivers; and reduce out-of-pocket costs related to NCD medicines and products that disproportionately affect women.

Policy: Enable women and girls to prevent NCDs and their complications by breaking down barriers to healthy lifestyles, including promoting access to safe sport and physical activity and nutritious foods across the lifecycle.

Practice: Offer integrated, people-centred NCD services supported by digital innovations within PHC as the norm, instead of the exception.

Data: Require evidence and insights on women and girls’ health disparities, sex-disaggregated data reporting, and programme evaluation based on integration frameworks.

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The opinions expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.

Helen McGuire is PATH’s global lead for non-communicable diseases (NCDs), focusing on access to affordable NCD care and treatment within primary healthcare services in Africa, Asia, and Latin America. With the input and support of founding members, she led the establishment of the Coalition for Access to NCD Medicines and Products, which launched in 2017 and continues today.