By Dr. Githinji Gitahi
Not too long ago, non-communicable diseases (NCDs) were believed to be diseases of the rich, or the very old, and mostly in developed countries. Today this is no longer the case. Non-communicable diseases, primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide nowadays. NCDs have become a global phenomenon with no boundaries in terms of age, social status or geographical location.
However, at least 80% of NCDs deaths occur in low-and middle-income countries, according to the WHO. Unfortunately Kenya has not been left behind. While Africa is still saddled with communicable diseases like malaria, water-borne illnesses, HIV and TB, the continent is now having to deal with the additional burden of a rising prevalence of NCDs. For Kenya and other African countries, this only serves to strain further their stretched health system. Early April the Ministry of Health in conjunction with World Health Organisation (WHO) and the Kenya National Bureau of Statistics released the first nationally representative survey on NCDs. Conclusion: NCDs are responsible for one third of Africa’s disease burden. And according to the Kenya stepwise survey for non-communicable diseases risk factors 2015, NCDs account for more than 50 per cent of hospital admissions and over 55 per cent of all deaths in Kenya.
For example: poor dietary habit is a key risk factor to almost all non-communicable diseases. According to the WHO early 43 million children under-5 years old were overweight in 2010. And only six per cent of Kenyans consume the recommended amounts of fruits and vegetables per day. Inadequate intake causes poor health and increases the risk of non-communicable disease, including heart diseases and cancers. Inadequate fruits and vegetable consumption is among top 10 selected risk factors of global mortality with 1.7 million people dying every year due to conditions attributed to low fruits and vegetable consumption.
As a result of increased production of processed foods, rapid urbanisation and improved lifestyles, Kenyans have changed their food preference and eating habits to accommodate unhealthy diets high in fats, sugar and salt but low in fibre. Adoption of western lifestyles has led many Kenyans, especially those in urban areas, to the consumption of fast foods seen as more convenient and at times as a much ‘classier’ option by a growing middleclass. To improve overall health we need to reduce the risk of certain non-communicable illnesses like heart diseases, some type of cancer, diabetes and obesity. But how? Amref Health Africa believes that sustainable partnerships, in combination with community health workers and digital innovation can put an end to NCDs as mentioned above.
Community Health Workers
I believe that if CHWs were able to do their work as expected, there would be tremendous improvement in prevention in communicable diseases as non-communicable diseases as well. However, for a long time they have never been a priority agenda for the public health sector and they are rarely recognized or paid for the work they do. Luckily, this is bound to change. Key players in health including WHO and IntraHealth International have teamed up to launch a global-wide campaign to have CHWs formally employed and given benefits as any other civil servants. As a result, there were mentions and discussions on CHWs in several sessions of the 70th World Health Assembly this May. The incoming WHO Director-General, Dr Tedros Adhanom Gbebreyesus, the former Minister of Health in Ethiopia, promised to strengthen primary health care which includes revamping the CHW agenda. And that’s very promising as Ethiopia has led the way in showing how best CHWs can be used by the health system. The potential of health CHWs is enormous. In fact, it is now acknowledged internationally that Ebola would not have had the toll it did in West Africa if the community health workers were available to do their work.
This leads me to my second and most important point – partnerships. We will not be able to address the issue of NCDs in Africa if we do not join hands and work together. While it is the primary responsibility of governments to respond to the challenge of non-communicable diseases, the complex nature of health, and in particular the challenges posed by NCDs, requires concerted action by all. Partnering and tapping into our unique strengths is the only way we will make meaningful, holistic and sustainable progress.
We believe that communities and community health workers are a key partner because, if programmes and initiatives are to succeed, they must have ownership at local level. We also partner with organisations that have an alignment of purpose with us – hat is, driving lasting health change in Africa. Our partnership in Kenya with Japanese pharmaceutical company Takeda is a prime example Through this partnership, Takeda leverages on our revolutionary mhealth platform, LEAP, to train community health workers in Kenya on diabetes and hypertension awareness. The LEAP platform rides on the deep mobile penetration rates in Kenya, estimated at 95 per cent of the adult population, to provide CHWs with access to information and training directly on their mobile phones.
We also leverage on M-Jali, a digital record-keeping tool that allows CHWs to record health information in the community. The platform then links with the District Health Information System and enables us to go full circle by helping to improve diagnosis and treatment decisions at county and national levels. Our partnership with Takeda has not only empowered community health workers with knowledge on diabetes and hypertension, but has also helped communities set up a first line of defense against diabetes and hypertension by changing lifestyles and minimising exposure to risk factors. And we continue our partnership. At this moment we are working together to explore ways of leveraging on the LEAP platform to train CHWs on awareness of cancer. Awareness is key as four in five cases of cancer in Kenya are diagnosed in the late stages of the disease, according to the Kenya Cancer Registry.
Potential digital innovation
This partnership demonstrates the potential of innovation, especially digital innovation, to drive transformation. I am glad that innovation was given special emphasis at the Blueprint for Success Summit in Geneva. I was particularly impressed by the session on how drones will revolutionise medicine distribution. This concept could be useful in Africa where transport infrastructure gaps present an obstacle to effective distribution of drugs.
Coincidentally, the Malawi government, alongside UNICEF, last year began experimenting with the use of drones to deliver HIV test kits to children in rural areas. Rwanda also begun using drones for delivering blood for transfusion last year, allowing it to reach patients in remote areas who were previously inaccessible due to poor roads. We hope to see similar interventions across Africa, especially for NCDs. It is my sincere hope that the resolutions that we made will result into action and tangible results. I am especially keen on seeing more partnerships being forged in our common endeavour to reduce the prevalence of NCDs in Africa.
Who are those heroic health workers, who work hard to heal and cure people disproportionately who are affected by communicable and non-communicable diseases in the most vulnerable communities?
Reuben Kimweli walks briskly, squeezing through a low and narrow alleyway between mud shacks in Kibera, Kenya’s biggest slum. He calls greetings to men playing a game of cards, then turns a tight corner, careful not to step on a chicken. To get to the home on his mind, he negotiates more stretches like these, jumps trenches and, yes, asks directions.
With no listed physical addresses, those who give directions here count on neighbourhood landmarks: next to the shop by the gulley, after the tree with giant branches, then walk straight past the huge street light. His sleuthing may mimic a police detective, but he is a different type of an investigator. All the same, he is pursuing potential killers like malaria or tuberculosis. Reuben is one among thousands of community health workers on the frontlines of the global effort to track down more than 4 million cases of tuberculosis that go undiagnosed, untreated or unreported every year. According to the Global Tuberculosis Report 2016, 40 percent of the 10.4 million people who get sick with TB, and 80 percent of the 580,000 people suffering from drug-resistant TB, are missed by health systems every year. And you can’t stop a disease if you can’t find it.
Despite advances in diagnostic tools and newly updated treatment regimens, the world has been unable to stay ahead of the disease. Lucica Ditiu, Executive Director of the Stop TB Partnership, says that if the world stays the current course – cutting incidence rates by 1.5 percent a year – it will take 170 years to eliminate the disease. That takes us to the year 2187.
The good news is, TB is preventable and curable. The bad news is, it is contagious and transmitted through the air; a person with active TB but who goes without treatment can infect an additional 10-15 people a year. So long as millions of people live with the disease without treatment and continue to transmit the infection to others, we will not bend the curve of TB incidence downwards, and TB – particularly multidrug-resistant TB – will remain a growing threat to global health security.
When Reuben met Agnes, she had already been diagnosed with TB and was on treatment. But as a school teacher, Agnes’ profession meant she posed a high risk to others. Reuben walked the treatment journey with her, advising her to postpone her classes until she was declared non-contagious. He also monitored the health of the children she had taught, ready with a quick referral if any became sick. Fortunately, none did. Agnes’ own children were not as lucky; three of her four sons contracted TB. But Reuben’s quick assessment and intervention meant speedy diagnosis and treatment – the whole family is now TB-free.
“I love what I do. I grew up in Kibera. I know where to go to reach people affected by TB – to trace contacts who might also be infected and to engage with people who have stopped their treatment,” says Reuben.
*Dr. Githinji Gitahi is Group CEO of Amref Health Africa in Kenya