Non-communicable diseases in southeast Asia.

2004 www.thelancet.com Vol 377 June 11, 2011 According to Antonio Dans, lack of workforce and infra structure is one of the limitations to management of non-communicable diseases (NCDs) in southeast Asia. We agree that the health-care delivery system was designed mainly to manage acute infectious diseases in resourcelimited southeast Asian countries. However, many of these countries have also established a system to manage HIV as a chronic disease, and such systems can be applied for the management of NCDs too. In Burma, Cambodia, Thailand, and Vietnam, 312 566 HIV patients were on antiretroviral therapy (ART) in 2009: 68% of those in need. To promote a long-term continuum of care, these countries established pioneer chronic disease management systems. Services were integrated within public health-care facilities and linked to the communities. A key feature was the involvement of aff ected communities as co-service providers, whereby patients had a central role in promoting selfcare, treatment adherence, and peer support. Further, a longitudinal patient follow-up system has been developed with registers and individual patients’ cards and fi les, primary health care as the way to ensure care for millions aff ected with chronic conditions. This point echoes that of recent reviews on NCDs. But beyond establishment of a comprehensive service at primary level, putting people living with chronic conditions at the centre of managing themselves must be considered. Traditional service delivery platforms that put health teams at the heart of disease management might not be feasible given the nature of chronic conditions and current resources. Even with stronger prevention program mes, we can expect an ever-growing number of people to be aff ected with chronic disease in the next decades. Just between Indonesia and the Philippines, the most populous countries in the region, there will already be an estimated 29·2 million people with diabetes by 2030. Organisation of lifelong care for chronic conditions must move towards greater self-management, whereby patients gain a mastery of their disease. The role of expert patients, and peer and community support groups, must be harnessed further. In Cambodia, a communitybased diabetes support group provides not only information but also facilitates greater access to laboratory tests and essential medicines among its members. We must also seize the opportunities provided by the spread of mobile phones and smart devices to support patients in managing their own conditions and to reshape how they interact with health-care providers. We need to radically rethink our concept of health care to address the rise of non-communicable disease. This shift implies very simple diagnostic and treatment protocols, fewer barriers to essential medicines, greater access to simple monitoring devices, and a move towards true empowerment of patients.