In 2005, an estimated 35 million people worldwide died from chronic diseases; this is double the number of deaths from all infectious diseases (WHO 2005). The world is experiencing an epidemic of non-communicable diseases (NCDs).

NCDs are an under-estimated cause of poverty and a barrier to economic development. Kenya, like most developing countries, is faced with an impending epidemic of chronic diseases, with non-communicable diseases contributing to about 32 per cent of total mortality rates (WHO, 2002). From 2005 - 2007, non-communicable diseases contributed over half of the top twenty causes of morbidity and mortality in Kenya (MOH, 2007). NCDs also contribute to half of the top ten leading causes of morbidity in the country (MOH, 2007). In 2002 mortality from communicable diseases was 68.2 per cent, while NCDs contributed over 31.8 per cent of total mortality (WHO, 2005). In 2007 non-communicable diseases contributed over 33 per cent of total mortality. Some of the causes of the rise in NCD fatalities are thought to be the following: a change in lifestyle – as the population surges towards urbanization, and away from rural areas; unhealthy eating habits; reduced physical activity as more motorized transport is used; and an increase in smoking and alcohol consumption. (see table below)

NATIONAL HEALTH SECTOR STRATEGIC PLAN
Preventive and promotive health services are the core business of the Ministry of Health
NCDs are not being addressed
Chronic diseases have not received the priority attention in public health policies and programmes, commensurate with their disease burden
Over emphasis on communicable disease
Donor driven agenda – prioritising infectious diseases

The Ministry of Health Division of Non-Communicable Diseases is attempting to reverse this trend by creating awareness of NCDs among policy makers, and entrenching NCDs in the Annual Operating Plans (AOP) of the sector. The AOP National Strategic Approach is to advocate policy changes aimed at placing NCDs high on the health and development agenda; build capacity for community-based actions; and strengthen health services for the Integrated Prevention and Management of Chronic Diseases. Furthermore, the National Strategic Approach aims to create multi-sector partnerships and networks for chronic disease and to carry out operational research on NCDs. In the battle against NCDs, the Ministry of Health has already achieved much, including: setting up legislative and legal frameworks; developing policy guidelines; and developing clinical and training guidelines.

In order to strengthen and re-orientate the health care system, it is further advocated to prioritise NCD programmes at all levels. The integration of NCDs into the National Health plans and into the primary health care system is also paramount.

To further strengthen capacity and improve NCD control, the following aims are to be achieved: retraining and redeployment of health workers; provision of medical equipment and other supplies specifically for NCDs; provision of job aids and guidelines for care providers; and infrastructure improvement for service delivery. It is also imperative to raise awareness of NCDs among policy makers and partners, as well as with health workers and the general public. Early detection and treatment is also an area that needs to be improved. This can be achieved by carrying out surveys to ascertain the prevalence of smoking and alcohol use; screening for risk factors during routine hospital visits and in medical camps; and data collection and reporting at the health facility.

For an effective strategy to be enforced, and results to be seen, the Ministry recognises, and asserts, that a creation of networks and partnerships for disease control across various sectors must be implemented. Joint planning with stakeholders is necessary to this end, in order to help mobilise resources for NCDs, and to map coverage.

THE FUTURE
The Ministry intends to develop and implement a national policy for the prevention and control of NCDs, as well as to finalise and implement an NCD national strategy. It also plans to increase awareness of the magnitude of the burden of chronic NCDs, and increase political, financial and technical commitments to prevent and control NCDs across Kenya. It further intends to respond to the double burden of infectious and chronic non-communicable diseases and to contribute to the strengthening of health systems, especially primary health care systems.

Supported by a national coordinating mechanism, the Ministry will facilitate the strengthening of appropriate multi-sector collaboration, and will generate more information about the socioeconomic consequences of chronic diseases in the country to help in the advocacy for resource mobilisation. It also needs to identify the core interventions needed for chronic disease prevention and control, encourage dialogue with the private sector to build strong public private partnerships, raise media interest in functioning as advocates for healthy behaviours, and explore and capitalise on new financial measures and funding mechanisms. All of these are not without their challenges, principally: low levels of awareness, low funding, and competing priorities that threaten to lower the prioritisation level of NCDs on the national scale. |