Abstract
Background:Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya.Methods:Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence.Findings:There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030.Conclusions and Recommendations:An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs.
Highlights
The focus of the prevention and control of non-communicable diseases (NCDs) has been on four major diseases and four risk factors, as framed by the World Health Organization (WHO) in the Global Action Plan (GAP) for the Prevention and Control of Non-communicable Diseases in 2013 [1]
There is a large and diverse burden of non-communicable diseases and injuries (NCDIs) in Kenya, with the majority of disability-adjusted life-years occurring before age of 40
An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve Universal Health Coverage (UHC), for disadvantaged socioeconomic groups
Summary
The focus of the prevention and control of non-communicable diseases (NCDs) has been on four major diseases and four risk factors, as framed by the World Health Organization (WHO) in the Global Action Plan (GAP) for the Prevention and Control of Non-communicable Diseases in 2013 [1]. The emphasis on tobacco control, alcohol control, physical activity, and healthy diet as well as cardiovascular diseases, cancer, chronic obstructive pulmonary disease, and cancers was put forward as a global agenda to consolidate focus on the complex interplay between the socioeconomic, environmental and modifiable behavioral factors that underlie the causation and distribution of these chronic conditions While this four by four framework has provided valuable guidance to strategic planning and activities for the prevention of control of non-communicable diseases and injuries (NCDIs) in countries such as Kenya, where these conditions form a considerable share of national morbidity and mortality [2], it was recently expanded during the 2018 UN high level meeting to a five by five that includes air pollution and mental health. The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya
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