Why governments need to collaborate with NGOs

This article is written by Arzu Yorgancıoğlu, Professor in Pulmonology, and Chair of WHO GARD (Global Alliance against Chronic Respiratory Diseases).

• The problem: Non-communicable diseases, and especially chronic respiratory diseases, are so important that we need the effort of all actors in the respiratory field to reduce the high burden of them.
• Why it matters: If we can disseminate and implement policies to reduce the burden globally, we can significantly reduce premature mortality due to these diseases.
• The solution: Getting together, raising global awareness and changing policies, and most importantly joining the efforts of GOs, NGOs and other respiratory initiatives.

Non-communicable diseases (NCDs) cause 41 million deaths every year, equivalent to 71% of all global deaths. 85% of premature deaths occur in low- and middle-income countries (LMICs).

The World Health Organization (WHO) Global Action Plan for the Prevention and Control of NCDs includes the target of a 25% relative reduction in premature mortality from NCDs by 2025_._ NCDs are cardiovascular diseases, cancers, chronic respiratory diseases (CRDs) and diabetes. Asthma and COPD (Chronic Obstructive Pulmonary Disease) are the two main CRDs: effective prevention, diagnosis, treatment and monitoring of asthma and COPD are essential to reduce the global burden of deaths and suffering, particularly in LMICs. COPD is the third leading cause of death globally. In 2019, 3.2 million people died from COPD, while 0.5 million people died from asthma. The Global Burden of Disease Survey 2019 estimates that 262 million people are affected by asthma, 212 million by COPD. The prevention, diagnosis, and management of CRDs is central to the NCD agenda at the WHO.

The Global Alliance against Chronic Respiratory Diseases (GARD)

GARD is a voluntary alliance of national and international organisations, institutions committed towards the common goal to reduce the global burden of CRDs under the umbrella of the WHO**.** The GARD initiative was set up to respond to a resolution of the World Health Assembly (WHA) in May 2000 that emphasised the need to increase awareness of the growing epidemic of chronic diseases worldwide. GARD was officially launched in 2006 in Beijing. GARD member countries develop activities against CRDs, which are conducted by their governments together with related stakeholders. Having Ministries of Health (MoH) in the team is the main difference between GARD and other initiatives.

The major power of this alliance is country activities. GARD country projects vary according to country-specific needs and the level of engagement of government health departments. Where government involvement is strong, as in Turkey, Italy and Portugal, progress has been considerable. In these countries, GARD has played a significant role in the development of national CRD control programmes.

GARD Turkey is a very good example of achieving a population-wide impact and ensuring sustainability and the significant involvement of the MoH.

GARD Turkey

GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. GARD Turkey Project is the National Control Programme of the Turkish MoH on chronic airway diseases (asthma and COPD).

This was the first time that the Turkish MoH gave the governance of a national programme to an NGO: the Turkish Thoracic Society (TTS). As a major national programme, the GARD Turkey Project is the first of this nature involving bringing the Turkish Ministry of Health (MoH) and a group of NGOs including TTS and 64 organisations together in joint management. Today the number of parties has reached 72 . The integrated approach of WHO GARD has also been maintained by GARD Turkey. The Turkish MoH applied this national control programme in conformity with other NCD action plans (i.e. cardiovascular diseases, obesity and tobacco control programmes).

The GARD Turkey Project has been accepted by European Innovation Partnership on Active and Healthy Aging (EIP on AHA) as a reference site with 4 stars.

I was the initiator of GARD Turkey and had experienced the advantages of working with government as well as the difficulties. We as academicians review the literature and update ourselves and write guidelines accordingly and try to implement them. It does happen easily.

Sitting around the table with lawmakers and enforcers makes a real difference. Discussing the difficulties with them may create new solutions. Sometimes our attitudes and language may differ and we may have difficulties in understanding each other and the reasons behind our choices. But at the end of the day, the goal is the same: “A world where all people breathe freely.” I strongly recommend collaborating with government for the sake of human health.

With the success of GARD Turkey; I was elected as the Chair of WHO GARD and now it was the time to work with the WHO. My experience with the Turkish MoH and government guided me. You need to be patient and try to understand the rigid rules and bureaucracy.

The greatest achievement of GARD is its ability to establish collaborative partnerships and develop a common vision with a large number of parties including professional medical societies, patient organisations, NGOs, governments and, of course, the WHO in order to address CRDs and allergies worldwide as we have experienced in Turkey. Preventing and controlling CRDs, and keeping them on the global health agenda, will require the ongoing efforts of all involved in GARD. We believe GARD Turkey is a good example of GARD countries in many aspects.

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