District hospital leaders work closely with the staff of health centers, providing training, mentoring, and education, with the idea of reducing the need to transfer patients to referral centers. Each Partners In Health–supported district hospital in Rwanda has an advanced chronic care clinic for noninfectious diseases. Countries such as Rwanda that already have such integrated programs to address HIV/AIDS can more easily and less expensively integrate NCDs into their health systems, Dr. Bukhman noted.
Dr. Farmer, chair of the department of global health and social medicine at Harvard, stressed the need for "health systems strengthening" and for partnerships between governments, academia, nongovernmental organizations, private industry, and other stakeholders in order to tackle the complexity and heterogeneity of the endemic NCDs.
"It can’t be diabetes versus mental health or rheumatic heart disease versus cancer. It has to be a very collaborative effort that draws on partnerships and synergies. ... In building platforms for the delivering of care for chronic disease, we need to do many things at once."
Dr. Hotez disclosed that he has a patent on a hookworm vaccine, but no relationships with pharmaceutical companies. Dr. Mocumbi stated that she has no disclosures. Dr. Salvi disclosed that he has received fees from Merck Pharmaceuticals as an advisory board member and speaker. Partners In Health receives funding from corporate donors, including several pharmaceutical companies.