Insight

Kenya Needs An All-out War On NCDs

Since independence, Kenya’s health system was primed to fight infectious diseases such as cholera. However, sickness and deaths from Non-Communicable Diseases (NCDs) are rising. This means Kenya must expand its health facilities to deal with NCDs.  

The burden of diseases in Kenya has mainly been from infectious diseases but it is now shifting to Non-Communicable Diseases (NCD)s and injury.

“This will render the services in health facilities inadequate, should the government not take action now said David Makumi, the vice chairman of the NCD Alliance-K .The civil society is calling on the government to allocate more funds to NCDs.

Makumi is a registered nurse who also sits on the board of the National Cancer Institute of Kenya. He was awarded a prestigious Distinguished Award by the U.S. Oncology Nursing Society in 2011 for his contributions to cancer care.

Data from the Institute for Health Metrics and Evaluation (IHME), a global health research center at the University of Washington show that infectious diseases remain the top four causes of deaths in Kenya.

While infectious diseases such as malaria, diarrhea, pneumonia and Tuberculosis (TB) are easier to prevent and treat, NCDs are more expensive to manage.

Government intervention needed

This means if the government doesn’t take action to prevent the growth of NCDs, its health system will be unable to cope with the burden by 2030.

This is according to a recent policy brief by Amref Health Africa, an international non-profit organisation based in Nairobi.

The Ministry of Health’s Stepwise Survey says NCDs now account for one in every three deaths in Kenya, and 55 per cent of all hospital admissions. The Kenya Stepwise survey is the first nationally representative survey to collect comprehensive information on risk factors for NCDs and Injuries.

The survey predicts the burden of NCDs such as cancer, diabetes, pulmonary and heart diseases will rise sharply, without adequate intervention, by 2030.

The NCD burden will be driven mainly by population growth. The projected demographic growth could double the number of adults needing services for NCDs in Kenya by 2035.

Results from the last national census in 2019 indicate that Kenya has a population of 52.57 million and an annual growth of 2.3 per cent.

Dialysis facilities, currently available in all 47 counties, will be inadequate if nothing is done to stop the growth of NCDs. 

Reduce risk factors

                                                                                                                                                          

   If interventions do not match the growing burden, Kenya’s ten public chemotherapy centers and three public radiotherapy centers, will be inadequate in 10 years” David Makumi

 

“The best intervention is to increase public awareness campaigns and interventions to reduce risk factors and the burden of NCDs in Kenya,” said Dr Catherine Karekezi, technical advisor at the Non-Communicable Diseases Alliance Kenya.

Dr Karekezi is also the medical director at Kenya Diabetes Management and Information Centre.

Amref Health Africa says in a do-nothing scenario, deaths caused by NCD will exceed the combined deaths from infectious and nutritional diseases ( like kwashiorkor), as well as maternal and prenatal deaths by 2030.

“The health system will be overwhelmed. The situation will be catastrophic to families and the economy, considering the huge capital expenses needed to treat NCDs, as well as the harmful effects of NCD-related illness and premature deaths. The time to act is now,” Amref says in its policy brief.

These diseases are expensive to treat, and the majority is not fully covered by the National Hospital Insurance Fund (NHIF)

For instance, a study in Plos Journal in 2018 found that NCD screening costs in Kenya ranged from $4 (Sh400) to $36 (Sh3,600). PLOS is a nonprofit, Open Access publisher empowering researchers to accelerate progress in science and medicine by leading a transformation in research communication.

Stroke admissions cost $1,874 (Sh187,400 in public facilities) versus $16,711 (Sh1.6 million in private facilities). Cervical and breast cancer treatment costs for stage III (curative approach) was about $1,500 (Sh150,000) in public facilities and more than $7,500 (Sh750,000) in private facilities.

Health insurance coverage in Kenya is generally low at 19 per cent. The National Health Insurance Fund (NHIF) covers 16 per cent of Kenyans, whereas the 32 private health insurers collectively cover a mere one per cent of the Kenyan population.

This makes NCD services unaffordable for most people given the overall high cost of services.

Current outlook

The Stepwise survey offers a clearer picture of the top NCDs in Kenya. The country faces the three main cancer, diabetes, cardiovascular diseases (CVDs), and chronic respiratory diseases.

Cardiovascular diseases account for 6 to 8 per cent of all deaths every year. “Autopsy studies suggest that more than 13 per cent of cause-specific deaths among adults could be due to CVDs,” the survey says.

Kenya’s annual fatality rate in 2020 was 5.3 per one thousand people. This amounts to about 500,000 deaths from all causes annually.

The Stepwise survey also says diabetes causes 20,000 annual deaths while approximately 33,000 people die of cancer every year.

There is limited data on Chronic Obstructive Pulmonary Disease (COPD), a group of chronic lung diseases that limits the flow of air in the lungs.

“In Kenya COPD is estimated to cause approximately the same amount of Disability-Adjusted Life (DALY) Year as ischemic heart disease, stroke and epilepsy,” says the Stepwise survey. The DALY is the number of years lost due to ill-health, disability or early death.

For Kenya, a new class of NCDs is also coming up – injuries and violence. The leading causes of injuries in Kenya include assault (42%), road traffic crashes (28%), unspecified soft tissue injury (11%), cut-wounds and dog-bites, falls, burns and poisoning (each less than 10%).

The strategy

Kenya’s  National Strategy  for The Prevention and Control of Non-communicable Diseases 2015-2020expired last year.

The strategy aims at reducing premature deaths from NCDs by 25 per cent by 2025. This is to be achieved by controlling the risk factors.

To achieve this target, the strategy recommends that Kenyans should embrace a more active life, by adopting a more robust lifestyle such as walking instead of taking a bus where possible.

Kenyans also need to drink less alcohol and consume less salt. The policy is adapted from the WHO Action Plan 2013-2020, which gives these global targets.

Hurdles ahead

According to the targets, Kenya would also need to reduce tobacco use by 30 per cent by 2025. These interventions face various hurdles. First, there is inadequate political support and resources, to enforce and implement legislation and action plans on NCD prevention and control.

There is also limited capacity and data to implement preventive and curative interventions on NCDs.

The government is currently working on the strategy, for next decade ending in 2030. “We expect to launch it soon,” said Dr Erjesa Waqo, the head of NCDs at the Ministry of Health.

Experts are convinced that action needs to be taken to slow down the increase of NCDs cases. “This means on top of prevention, the country must also increase capacity by training more health workers and equipping health facilities,” says David Makumi.

A study published in October 2020 explains that HIV is an important factor in the growing numbers because people living with HIV are more prone to developing NCDs.

The number of People Living With HIV (PLWH) will increase through new infections, and better treatment means they will live longer.

The study was published in the Clinical Infectious Diseases journal, titled: Mapping the Current and Future Non-Communicable Disease Burden in Kenya by Human Immunodeficiency Virus Status.

“Population growth will result in a sharp increase in the absolute number of adults needing services for NCDs,” says the study.

However, the benefits of action are clear. The study projections suggest that if policy directions and interventions that give more emphasis on NCDs are sustained, overall morbidity and mortality will be reduce.

What journalists should do: 

  1. Check out the national budget to find out how much is allocated toward each specific NCD. Further, check if the allocated money is used for fighting NCDs.
  1. Find out the NHIF coverage for each specific NCD. For instance, does it cover diabetes and hypertension medications? If yes, is it full coverage or to what extent?
  1. Talk to Kenyans living with NCDs and highlight the challenges they face.
  1. Investigate specific actions taken to stop the spread of NCDs. For instance, tobacco control and pollution control. Does government conduct proper regulation of chemicals in food?
  1. Find out how developed countries are dealing with the challenge of rising NCD cases. Especially when it comes to unhealthy diet and lack of mobility.
  1. Check our LIST OF EXPERTS for this and other topics.

 

 

 

 

 

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