160 Chapter 7 beneficiaries of an intervention during planning and implementation to ensure the intervention continuously meets the needs of the beneficiaries [43,44]. A significant limitation encountered by NCD programs globally and more in Sub-Saharan Africa is limited commitment to funding, implementation of the NCD strategy and health system support as they are not an immediate risk and require a multisectoral approach for its control [45,46]. For instance, low-income countries spent 51% of their health budget on infectious and parasitic diseases compared to only 13% for NCDs [47]. In addition, only 37% of all spending on NCDs in low-income countries is from public funds, while domestic private sources and foreign aid account for 48% and 15%, respectively [47]. Globally, despite being the largest funding country, only 0.48% of the US and 1.66% of the UK government funding was for bilateral portfolios targeting NCD interventions [48]. NCD programs in most Sub-Saharan African countries depend on limited government grants to implement their activities. Public-private partnerships can close the NCD funding gap in healthcare. At the same time, collaborations with academic institutions, public health funders and non-governmental organizations can enhance research [49] and build the capacity of healthcare workers to provide improved NCD-related healthcare services. Future Studies Although DM and TB are well-known diseases with standardized treatment guidelines, some gaps still exist. Estimates of DM burden in Eswatini with associated risk factors are not reliable. Currently, prevalence is based on estimates provided by the International Diabetes Federation. The WHO STEPwise approach to NCD risk factor surveillance, last conducted in Eswatini almost a decade ago (2014), may provide unreliable estimates to guide future interventions. Therefore, addressing the challenges of diabetes care will require a survey to determine the correct estimates of the burden of diabetes mellitus and diabetes risk factors in Eswatini. As >90% of the people living with HIV in Eswatini are on antiretroviral therapy (ART), a study to determine the effect of commonly used ART drugs, particularly Dolutegravir, on blood glucose is required. This will clarify a concern for clinicians and patients if it is associated with diabetes and guide patient care. Patients’ socioeconomic status affected how they accessed TB and DM care. So, a study to determine the catastrophic cost of TB treatment for patients and those with TB and DM or another non-communicable disease in Eswatini can evaluate the treatment burden on patients and guide interventions to support patients.
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