What you need to know:
Up to 40 per cent of hospital deaths in Kenya are linked to non-communicable diseases.
More than half of the Kenyan population is struggling with one or more non-communicable diseases (NCDs), with the World Health Organization’s statistics showing that up to 40 per cent of hospital deaths in the country are linked to these conditions.
However, this is not just a Kenyan issue. Africa is facing a health crisis as experts have warned that in just five years, NCDs will overtake infectious illnesses as the leading cause of death in sub-Saharan Africa. By 2030, NCDs (cancer, heart disease, diabetes, chronic respiratory diseases, among others) will surpass HIV/Aids, tuberculosis, and maternal mortality as the leading cause of death across the continent.
Against this backdrop, nearly 1,000 delegates from more than 80 countries gathered last week in Kigali, Rwanda, for the 4th NCD Global Forum. The forum focused on this growing health challenge that is not only becoming a crisis in Africa but is also a global concern.
Health Nation spoke with Katie Dain, CEO of the NCD Alliance – a global network of civil society organisations dedicated to transforming the fight against non-communicable diseases – who shared insights into the impact of NCDs on individuals and health systems as well as what the United States Agency for International Development (USAID) funding cuts mean for the fight against the rising NCD burden.
The NCD Global Forum is the first to be held in Sub-Saharan Africa. Why Africa at this particular moment, and Rwanda to be specific?
It is important that we spotlight the growing burden of NCDs in this region, where the diseases account for one-third of all deaths. In South Africa, for instance, diabetes has overtaken HIV as the leading cause of death among women, and in Ghana, nearly 45 per cent of all deaths are attributed to NCDs.
Africa faces unique challenges that exacerbate this growing crisis, including high poverty levels, malnutrition and the persistent threat of infectious diseases. This combination of factors has contributed to an epidemiological landscape that not only mirrors global trends but also includes conditions typically under-recognised, such as type 1 diabetes, sickle cell disease, rheumatic heart disease, and congenital heart disease. Holding the forum here thus presents an opportunity to address NCDs, which are becoming an urgent priority for public health in Africa. What Trump’s USAID funding cuts mean for war against noncommunicable diseases
On the other hand, Rwanda has demonstrated significant leadership in health, universal health coverage, and NCDs over many decades. Two key aspects of Rwanda’s approach stand out. First, the country’s focus on a decentralised health system, which prioritises rural populations and ensures primary health care posts are accessible across the nation. Second, Rwanda’s impressive community-based insurance scheme, which covers over 90 per cent of the population, including many NCD medications under its universal health coverage. This means that Rwanda has truly been a leader, both nationally and globally.
What is the current NCDs outlook globally?
Looking at the global NCD landscape, it’s clear that the targets set in 2012 are falling far behind. Despite global commitments, 43 million people still die from NCDs each year.
A staggering 74 per cent of these deaths occur in low- and middle-income countries, and 15 million of them happen prematurely, before the age of 70.
NCDs, once viewed as afflictions primarily of wealthy nations, are now a global issue, especially in low- and middle-income countries, where epidemiological shifts have been profound. It’s also essential to remember that the NCD challenge is not only about death but also about the immense morbidity faced by those living with the diseases.
The numbers are overwhelming: one billion people globally live with obesity, 1.3 billion with hypertension, one billion with mental health disorders, and half a billion with diabetes and chronic respiratory diseases. That aside, there are significant disparities in access to essential care, as seen with diabetes, where only one in seven people in sub-Saharan Africa consistently access insulin, compared to the global average of one in two. Similarly, childhood cancer survival rates are above 80 per cent in high-income countries but drop to just 20 per cent in sub-Saharan Africa. The scale of the crisis is further compounded by political shifts such as the US withdrawal from the World Health Organization and USAID funding cuts, which will likely exacerbate the NCD crisis.
Talking about Donald Trump’s freeze on USAID, what ripple effects are likely to result from this, particularly in the African context?
Trump’s recent announcement has a two-fold impact. For regions like Africa, where 55 per cent of development assistance has historically come from USAID, it creates a massive gap in health financing. Health programmes that have been running for decades such as the US President’s Emergency Plan for AIDS Relief (which provides life-saving medications to people living with HIV, will be disrupted. Moreover, USAID has long been a major funder of broader health systems, including support for community health workers, the health workforce, medication access, and procurement in various countries and regions. This means that to focus solely on the impact on infectious diseases and maternal and child health, where most of USAID’s funding has been going, would be lacking foresight.
The consequences of the funding cuts will be far-reaching, weakening health systems overall and leaving people with NCDs more vulnerable. There is concern that health budgets will shrink significantly, and the health system will revert to a more vertical, disease-specific approach. This would threaten the gains made in integrated care, with NCDs risking being further deprioritised, especially at the primary care level.
How can we ensure that local organisations gain the autonomy they need to thrive, even after the donors pull out?
Health systems across the continent need significant strengthening, particularly at the primary care level, to address funding challenges. The measures implemented by the Trump administration have indeed underscored the importance of local entities becoming more independent and less reliant on donor funding.
Governments must focus on mobilising domestic resources, increasing health budgets, and creating the fiscal space to fund life-saving programmes for their people instead of relying on external donors.
Dependence on a single donor is not a sustainable model for any nation, and so, there is a chance for African countries to shift toward more domestic-driven health responses. Coming to think of it, though in the short term, there will definitely be significant setbacks, including loss of lives and jobs, while health systems will experience severe disruptions, but in the long run, there are potential opportunities. This situation might create an opportunity for the global health community to move toward focusing more on domestic resources and supporting national-level responses, particularly across Africa.
How important is Universal Health Coverage (UHC) in this conversation?
UHC could be the key to ensuring that health services, including for NCDs, are accessible and affordable for everyone. For example, in Tanzania, there’s an ongoing debate about whether NCD treatments should be included in insurance coverage, but the high cost of these medications is a barrier. If we include them, other necessary services could end up being excluded, so there’s a challenge of balancing. UHC becomes even more critical in this context. It connects to the idea of integrated health systems at the primary care level, where we can use resources more efficiently to address multiple conditions simultaneously, rather than focusing on just one like HIV or TB. UHC has two key components: expanding access to essential services for the entire population and ensuring financial protection to avoid out-of-pocket costs for treatment. This is especially crucial for NCDs. While treatments for HIV are often covered and free, NCD treatments—like for type 1 diabetes—can be prohibitively expensive, even though some medications are relatively cheap to produce. As a result, patients are forced into difficult choices, sometimes sacrificing essential needs like food and education just to afford treatment.
The 4th NCD Global Forum was held in preparation for the upcoming UN high-level meeting in New York this September. What are the expectations from the UN meeting?
It will be a pivotal moment for our campaign, where we come together regionally and globally to strategise and finalise our advocacy plans. High-level meetings offer a unique opportunity to elevate issues like NCDs from being discussed only by health ministers at the World Health Assembly in Geneva to a broader conversation at the UN, where heads of state and government meet annually during the UN General Assembly. In the months leading up to the meeting, governments must negotiate a political declaration, which requires coordination between foreign affairs and health ministries to determine their positions on commitments and accountability. This process ensures that NCDs are addressed beyond the health sector, providing national advocates a crucial window to engage with their governments, highlight progress, and push for further action. The meeting also presents a chance to advocate for the inclusion of NCDs in UHC benefit packages, promote health as a fundamental right, and strengthen primary health care at the national level.
This interview was first published in Kenya Nation.