We weren’t sure what to expect when the Rwanda Biomedical Center requested a training for their noncommunicable disease (NCD) program managers. We had never delivered this particular curriculum before, but after three months of preparation, our journey from Atlanta began. After landing in the capital Kigali, we faced a bumpy three-hour drive into the mountains to the remote northern district of Musanze. We finally arrived, exhausted but excited. What followed was four days of learning and a wealth of opportunities to address the growing crisis of NCDs in Rwanda.

A creeping global crisis

NCDs cause about two out of three deaths globally, and are a creeping crisis in low- and middle-income countries (LMICs). In Africa, NCDs are estimated to become the most common cause of death by 2030. NCDs are particularly challenging because unlike infectious diseases, patients often need long-term health care. While many NCDs are preventable by reducing four main behavioral risk factors (tobacco use, physical inactivity, excessive use of alcohol, and unhealthy diet), these very same risk factors become more common as countries like Rwanda urbanize. The soaring burden and costs of NCDs in LMICS resonate globally by weakening economies and health systems, leaving countries unprepared to deal with pandemic threats that can easily spread across borders.

Preparing for the future

Despite these looming threats, “the NCD movement is too quiet, too pedestrian, and too polite to make the impact it deserves,” according to Richard Horton, Editor-in-Chief of The Lancet. Yet the Rwandan Ministry of Health (MOH) is not staying silent: they set an ambitious national goal to reduce 80% of premature deaths caused by NCDs or by injuries in people under 40 years old by the year 2020, known as “80x40x20”. To achieve this goal, Rwanda is making moves to expand access to medical care, focus on the most prevalent diseases, and deliver medical services more efficiently.

The Rwanda Biomedical Center (RBC) partners with the MOH to promote quality, affordable, and sustainable population health care services through innovative, evidence-based interventions and practices. The RBC requested NCD training for their 12 public health professionals responsible for the day-to-day implementation, management, and monitoring and evaluation of NCD prevention and control programs. While this staff is devoted to working on NCDs, few had prior NCD experience. In December 2016, the CDC Global Noncommunicable Diseases Branch piloted a four-day course to meet their needs.

The training focused on public health core competencies, including leadership, interdisciplinary partnerships, data analysis, program planning, and creating evidence-based interventions. Mastering these areas is especially important to tackle the complexities of NCD management and risk factors.

The right stuff

A compelling training helps equip public health workers with the right tools and knowledge so they can make data-based decisions and communicate to target populations. The best trainings illustrate key points using real-world examples that participants can relate to. While driving in Rwanda, we noticed bicyclists hanging on to the back of moving trucks. We shared with the RBC staff this observation of risky road behavior to justify the need for coalition building and data to support road safety initiatives. We saw their eyes light up with ideas as we explained CDC’s Health Impact Pyramid (pictured to the right) and emphasized the importance of population-level interventions. We hoped to motivate them to act and inspire them to advocate for the resources and support they need to be successful.

What next?

As a result of the training, we are identifying more activities that foster NCD prevention in Rwanda. The RBC has already begun implementing some ideas from the course, such as creating disease-specific fact sheets. In addition to expanding our collaboration with Rwanda, our branch plans to hit the road with this course and train public health staff in additional countries in 2017. The only way to address the NCD epidemic is to keep making noise!

The Global NCD Branch would like to acknowledge these individuals for their contributions to the NCD Program Managers Training course. From the Global NCD Branch: Brian Robie (retired), Lauren Billick, Sheryl Pouech, and Jami Husain. We would also like to thank Dileep Bal (independent contractor), Denise Duran (Division of Cancer Prevention and Control), Sheryl Pouech (Office of Public Health Preparedness and Response), and the National Public Health Institute team (Workforce Institute and Development Branch, Division of Global Health Protection).