We believe that health is a basic human right. Everything we do contributes to ensuring lasting health change for all.
Non-communicable diseases (NCDs) are the world’s biggest killers – causing 7 in 10 deaths, translating to 41 million people annually. This includes 15 million people who die prematurely from NCDs in the prime of their lives – aged between 30 and 69 years. The greatest burden of NCDs is from five diseases: cardiovascular diseases such as heart attacks, cancers, chronic lung illnesses such as asthma, diabetes, and mental health conditions. These NCDs share four risk factors that can be addressed through behaviour change which are often established during adolescence and carried to adulthood – unhealthy diets, physical inactivity, harmful use of alcohol, and tobacco use.
Lower and middle-income countries (LMICs) bear 85% of premature NCDs attributable deaths. The diseases have a substantial negative impact on productivity and economies of LMICs – projected to result in losses of US$ 7 trillion over the next 15 years. The rising burden of NCDs in sub-Saharan Africa further weighs down the weak health systems.
In Kenya, the health system is struggling with a double burden of disease – the high burden of infectious diseases and the increasing burden of NCDs. NCDs are estimated to be responsible for more than half of hospital admissions and deaths. If we do nothing, NCDs deaths will exceed the combined deaths from communicable and nutritional diseases, as well as maternal and perinatal deaths by 2030. The health system will be overwhelmed. The situation will be catastrophic to families and the economy considering the huge per capital expenses needed to treat NCDs, as well as the harmful effects of NCD-related illness and premature deaths to economic productivity at both household and national levels. The time to act is now.
According to the World Health Organisation (WHO), if current global trends remain unabated, the number of NCD-attributable deaths will increase to 55 million by 2030. Implementation of cost-effective preventive and curative interventions can significantly reduce the burden of NCDs. Most NCDs are preventable. Up to 80% of heart disease, stroke, and type 2 diabetes and over a third of cancers can be prevented by eliminating shared risk factors – tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol.
In 2018 during the UN high-level meeting on NCDs, heads of state committed to implement a series of WHO-recommended actions to prevent and control NCDs aimed at achieving SDG target 3.4. To operationalise the commitments, a Global Action Plan has been developed, emphasising the need for countries to create national NCD prevention policies and embrace multi-sector action in implementing evidence-based preventive measures known as “best buy” interventions. The “best buy” interventions exist to reduce the burden of NCDs at the population level by targeting the common risk factors; they include raising the tax on tobacco and alcohol products; reducing access to and enforcing bans on tobacco and alcohol advertising; reducing salt consumption; eliminating trans-fat (and reducing sugar!) in the food supply chain; promoting physical activity, and detecting and treating NCDs at an early stage.
In line with the WHO Global NCD Action Plan, Kenya’s Ministry of Health launched the National Strategy for the Prevention and Control of NCDs 2015-2020. The strategy proposes an integrated approach to combat NCDs and their risk factors including integrating NCD interventions into existing PHC initiatives such as community health services, maternal and child health, school health, disease surveillance, HIV, TB and Malaria. In addition to the NCD strategy, Kenya has a tobacco control act and action plan, alcoholic drinks control act, and food and nutrition strategy and action plan. The challenges facing Kenya in NCDs include: (i) inadequate political support and resources, to enforce and implement legislation and action plans on NCD prevention and control; (ii) limited capacity at national, county, facility and community levels to implement preventive and curative interventions on NCDs; (iii) inadequate local NCD data to inform prioritisation, resource allocation, and track the impact of interventions; and (iv) shortages of commodities for management of NCDs at PHC level.
Our Theory of Change
Amref Health Africa is deeply aware of the projected consequences of doing nothing to address the high and rising burden of NCDs. Building on our extensive experience in designing and delivering PHC services, we are deploying three scalable models to reverse the tide of NCDs.
Empowered People and Communities: we are catalysing a movement of people committed to changing the projected narrative on NCDs. With the belief that health is created at home, we put together the first of its kind wellness festival in February 2020. The festival propagated a family approach to wellness, bringing together wellness service providers, vendors and influencers to share wellness information and promote household behaviour change targeting the four NDC modifiable risk factors as well as regular wellness screening. A post-event survey showed that 84% of the participants felt that the wellness festival increased their knowledge of wellness, with 79% learning something new about the state of their health/wellness. A full report on this inaugural event is available for further reference. The health education interventions described below further demonstrate the value we place on empowering people and communities to take charge of their health.
- Integrated Health Services: Working with partners, Amref has developed and deployed the Facility-Community Chronic Care (F3C) model for NCDs in six counties. The tenets of this model are a continuum of care for patients from screening, early diagnosis, treatment, and chronic care; integration of quality and evidence-based NCD interventions into existing PHC services; public health education through community health workers; sustainable supply of NCD treatment commodities; and deployment of technology for data collection, training and awareness. Through the application of F3C, we have screened over 1.2 million clients for hypertension, diagnosed more than 60,000 and put them on treatment. We have also supported NCD patient support groups to develop five revolving community pharmacies for sustainable NCD commodity supply; and deployed the m-Jali digital solution for data collection at the community level, and Leap for adherence messaging.
- Multi-sector Policy and Action: Amref has developed an end-to-end wellness solution run as a social enterprise targeting businesses across sectors towards sustainable control of the NCDs. Recognising that there are significant business benefits for corporates from taking action for prevention and control of NCDs, we are engaging businesses in enhancing employees’ health through wellness programmes focusing on psychosocial, physical, mental, and financial wellbeing. At the same time, working with organisations who believe that NCDs are reversible, we are catalysing action aimed at multi-sectoral NCD prevention policies especially relating to NCD risk factors – tobacco use, unhealthy diets, harmful alcohol consumption and physical inactivity.
Through these, Africa will be able to address NCD risk factors at all levels while availing care for people with NCDs through strong integrated PHC services. We will work with national and county governments, private sector and other stakeholders, through shared value platforms, to deploy these interventions.
We cannot fight NCDs alone. We, therefore, seek shared value partnerships with those who share our vision of transforming the health of Kenyans for good. Specifically, we invite the following: (i) philanthropic organisations to partner with us to deploy wellness and F3C interventions in communities, health facilities, and corporates; (ii) social impact investors to partner with us to take the wellness social enterprise to scale in Kenya and later the rest of Africa; (iii) the people of Kenya – individuals and families, to join the wellness movement, and help us shape it – as we believe that we can work together to secure a healthy, prosperous future for all; and (iv) wellness service provides and corporates who believe that Kenyans deserve better lives, to support the wellness movement in kind and cash. Together let’s beat NCDs!