Key Insights from the First Three Years of the Boston Declaration

Last October, Helmsley co-hosted the third annual symposium on diabetes and humanitarian crises with the International Alliance for Diabetes Action (IADA) and the London School of Hygiene and Tropical Medicine. The symposium built on the Boston Declaration, published in The Lancet Diabetes & Endocrinology in 2019, which set four major targets to address the challenges faced by people living with diabetes and other non-communicable diseases (NCDs) in conflict-affected settings.

During the meeting in Kraków, a location haunted by humanitarian crises old and new, I moderated a session on sustainable financing, which I’ve shared below. It was a time to dig into the nuances of funding NCD care in the context of disrupted health services, violence, unpredictable food supplies, and various other vulnerabilities created by humanitarian turmoil.

While Helmsley is a relative newcomer to this field, meeting needs in crisis settings is squarely part of our mission to ensure people living with type 1 diabetes (T1D) and other NCDs can lead fulfilling lives, no matter where they call home. The symposium offered an opportunity to further reflect on our role as a funder in this context.

Thanks to a roster of thoughtful, pragmatic panelists – including Dr. Vinod Varma, Advisor for Health Financing and Risk Management at The Global Fund, Dr. Olena Doroshenko, Sr. Health Economist at The World Bank, and Dr. Rachel Nugent, VP for Global NCDs at RTI International – I emerged with a renewed respect for the work and a handful of salient insights for our T1D portfolio and fellow donors.

A Solution to ‘Donor Fatigue’

People living with diabetes and other NCDs are often an afterthought in the early phases of humanitarian response. Donors are in a unique position to encourage the World Health Organization, the United Nations Refugee Agency, the World Bank, and other far-reaching global conveners to prioritize care for these communities throughout the phases of emergency preparedness, acute response, and recovery. By contextualizing clinical guidance and clarifying operational guidance, we can ensure continuous care for people living with diabetes in humanitarian emergencies.

Yet as my colleague Dr. Varma noted, we must also acknowledge that donor resources – and attention spans – are finite. Indeed, this is why health investors may be wary of wading into crises with no end in sight.

One solution to donor fatigue? We must listen and learn from partners on the ground to create more compelling, timebound, evidence-based investment cases. Agencies like RTI International have worked to monetize the immediate costs of inaction on NCDs in typical global development settings. By applying this lens to the various phases of humanitarian crises, we can start to mobilize sustainable co-funding mechanisms for targeted, crisis-tested NCD interventions.

In time, the donor community will see returns on those stabilization investments and begin building more trusted, reciprocal relationships with partners across the humanitarian-development divide.

Integrated Models Can Maximize Impact

Relative to the global burden of disease, NCDs are the most underfunded issue in global health. It’s against this backdrop that humanitarian crises stretch health systems beyond capacity, exacerbating existing gaps in access to NCD care for forced migrants and others living in conflict settings.

As with infectious disease strategies, NCD experts must continually evaluate and elevate the most cost-effective approaches to delivering care during crises. Integrated models – those that weave NCD supplies and expertise into other acute health response mechanisms – are among the safest bets.

Using existing global delivery frameworks as a starting point, NCD experts can work across silos to synthesize care for common comorbidities, like diabetes and tuberculosis. Regional WHO offices can then scale the most effective strategies – like the Package of Essential Non-Communicable Diseases Interventions for Humanitarian Settings (PEN-H) – and develop holistic guidance and technical support streams for clinicians working in evolving humanitarian settings.

This approach extends to sourcing supplies and medicines for NCD care. During the panel, Dr. Doroshenko discussed the World Bank’s Affordable Medicines Programme, which folded non-insulin diabetes medications into procurement processes for hypertension and asthma supplies, improving access to lifesaving NCD therapies while delivering real cost savings.

Building Alliances, Sharing Missions and Milestones

This ethos of integration must also apply to NCD financing mechanisms – but this will require a paradigm shift in the way development donors typically approach investment. The global health community must learn to relinquish some control of decision-making in favor of collective, cross-sector missions. In effect, we must learn humility.

At Helmsley, we care deeply about the T1D community. We also know that to make significant progress toward ensuring access to T1D care in low- and middle-income countries we need to collaborate with allies in the broader NCD and health system strengthening spaces. Still, there is more room to articulate our shared health mission with our humanitarian health counterparts, to finance that mission by pooling resources, and to celebrate hard-won progress around mutual milestones.

In Kraków, Dr. Nugent noted how crises can catalyze collaboration because shared stakes are so clear. We saw this kind of cross-sector, cross-disease allyship crop up in the early days of the Covid-19 pandemic.

In this new year, my hope is that humanitarian and development donors can fully acknowledge our common interest in crisis-ready health systems and commit to reimagining funding mechanisms accordingly.

I invite you to learn more about NCDs, humanitarian crises, and how you can help by reading the symposium output report.