Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review.
BACKGROUND
Most low- and middle- income countries are facing a rise of the burden of non-communicable diseases (NCDs) alongside the persistent burden of infectious diseases. This narrative review aims to provide an inventory of how the existing policy environment, health system, and communities are addressing the NCDs situation in Tanzania and identify gaps for advancing the NCD research and policy agenda.


METHODS
A literature search was performed on PubMed and Google scholar with full text retrieval from HINARI of English language articles published between 2000 and 2012. Documents were read to extract information on what Tanzanian actors were doing that contributed to NCDs prevention, treatment, and control, and a narration was written out of these. Reference lists of all retrieved articles were searched for additional relevant articles. Websites of organizations active in the field of NCDs including the Government of Tanzania and WHO were searched for reports and grey literature.


RESULTS
Lack of a specific and overarching NCD policy has slowed and fragmented the implementation of existing strategies to prevent and control NCDs and their determinants. The health system is not prepared to deal with the rising NCD burden although there are random initiatives to improve this situation. How the community is responding to these emerging conditions is still unknown, and the current health-seeking behavior and perceptions on the risk factors may not favor control of NCDs and their risk factors.


CONCLUSIONS
There is limited information on the burden and determinants of NCDs to inform the design of an integrative and multisectorial policy. Evidence on effective interventions for NCD services in primary care levels and on community perceptions on NCDs and their care seeking is virtually absent. Research and public health interventions must be anchored in the policy, health system, and community platforms for a holistic response.
Ifakara Health Institute, Dar es Salaam, Tanzania; emetta@ihi.or.tz; emetta2000@yahoo.com.
Emmy
E
Metta
Ifakara Health Institute, Dar es Salaam, Tanzania.
Beverly
B
Msambichaka
Ifakara Health Institute, Dar es Salaam, Tanzania.
Mary
M
Mwangome
Ifakara Health Institute, Dar es Salaam, Tanzania.
Daniel J
DJ
Nyato
Royal Tropical Institute, Amsterdam, The Netherlands.
Marjolein
M
Dieleman
Faculty of Spatial Sciences, Population Research Centre, University of Groningen, Groningen, The Netherlands.
Hinke
H
Haisma
Royal Tropical Institute, Amsterdam, The Netherlands.
Paul
P
Klatser
Ifakara Health Institute, Dar es Salaam, Tanzania.
Eveline
E
Geubbels
D002908:Chronic Disease / Q000517:prevention & control*; D003256:Community Participation / Q000379:methods; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D011315:Preventive Medicine / Q000458:organization & administration; D011640:Public Policy; D013636:Tanzania / Q000453:epidemiology
NCD; community response; health system; policy