Detection and prevention. African governments have disappointingly not done enough to address the scourge even with the available proven and affordable best-practices. For example, there is widespread lack of cheap technologies like glucometers and blood pressure machines at lower health centres where they are needed most to saves lives through early detection and prevention
Non-Communicable Diseases (NCDs) – such as hypertension, stroke, cancers and diabetes are no longer just a health issue. They are a major contributor to poverty and underdevelopment in Africa due to the vicious interaction between low incomes, chronic ill health and medical impoverishment.
And the poor are hardest hit. For example, expenditure on insulin alone for one person with diabetes can wipe out 60 per cent of the entire household income in rural sub-Saharan Africa. People living with NCDs have to make painful tradeoffs such as cutting back on education for children or sale of assets to clear staggering NCD medical bills. With 43 per cent of Africans below the poverty line (and many more struggling just above the line), and with insufficient health insurance and universal healthcare access, many households are facing catastrophic out-of-pocket expenditures on NCDs.
The World Health Organisation (WHO), has stated that “Of all the major health threats to emerge, none has challenged the very foundations of public health so profoundly as the rise of NCDs.” And one commentator has noted that NCDs have “the potential to bankrupt health systems” in poor countries. Economically, developing regions like African will lose 4 per cent of GDP due to NCDs by 2025 if nothing more is done.
Yet NCDs are rapidly increasing and are set to overtake infectious diseases as the main health problem. In East Africa, the scourge is responsible for 35.6 per cent of deaths, up from 29.8 per cent in 2015. East Africa is also among the highest prevalence regions in relation to NCDs like cervical cancer, hypertension and rheumatic heart disease. It is an urgent situation requiring urgent action.
It was thus heartbreaking that last week’s UN General Assembly, which included a High Level Meeting (HLM) on NCDs, did not offer renewed global effort on NCDs. There has been measured hope for a global response akin to that which followed the UN Declaration on HIV/Aids in 2001. Hope was high because NCDs are now recognised in – and are critical to achieving at least nine other –Sustainable Development Goals, and momentum has been growing since the 2011 UN Political Declaration on NCDs. The global NCD civil society has also been mobilising stakeholders to take the 2018 HLM as an unmissable opportunity to renew action and catch up on lost progress. We hoped for increased financing, new innovative governmental initiatives and a strong outcome document.
However, even before the HLM, it was clear that not much would be achieved. The UN Political Declaration on NCDs adopted on September 27, 2018 fell short. The global NCD Alliance described it as ‘vague and unambitious commitments’ while World Cancer Research Fund called it a missed opportunity ‘to shift the NCD landscape seismically’.
The grapevine in the UN corridors was that there is donor fatigue to begin funding another, costlier global epidemic. The unsustainable, donor-driven funding for diseases like HIV has had a chilling effect. Geopolitical undercurrents also come into play: NCDs do not pose an infectious global health security threat unlike Ebola or HIV. Emphasis is now on public-private partnerships; and corporations with disturbing conflict of interest are getting interested.
But away from the UN, African governments have disappointingly not done enough to address the scourge even with the available proven and affordable best-practices. For example, there is widespread lack of cheap technologies like glucometers and blood pressure machines at lower health centres where they are needed most to saves lives through early detection and prevention.
Therefore, while we continue to call for concerted action at local and global levels, the outcome of this HLM underscores our emphasis that African governments have the foremost responsibility and must do more to invest in the health of citizens.
As Dr Githinji Gitahi, the CEO of Amref, noted at the HLM side event organised by the East Africa NCD Alliance in collaboration with Danish and global NCD Alliances that ‘Africa does not need a UN resolution to buy blood pressure machines’. Such affordable interventions should already be in place to save people from NCDs.
Mr Mulabi is the CEO, East Afica NCD Alliance.