National Strategic Plan for the Prevention and Control of Non-Communicable Diseases

Objectives

Kenya’s National Strategic Plan for the Prevention and Control of Non-Communicable Diseases covers 2021/22 to 2025/26 and provides a national and county blueprint to halt and reverse the rising burden of non-communicable diseases (NCDs).[1][2]Its vision is a nation free from the preventable burden of NCDs, and its mission is to achieve this through multisectoral collaboration and partnerships while ensuring accessible, affordable, quality, equitable and sustainable care across the NCD continuum.[3]The overall goal is to reduce premature mortality from NCDs by one third by 2025, contributing to national commitments on Universal Health Coverage and the Sustainable Development Goals.[4][3]

• Apply a life-course, people-centred and rights-based approach, guided by equity, universal coverage, primary health care, gender responsiveness, evidence-based practice, accountability, innovation and technology.[3][5]
• Address cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, mental health conditions, violence and injuries, haemoglobinopathies, haemophilia and other bleeding disorders, autoimmune and chronic renal diseases, epilepsy and other neurological disorders, chronic skin conditions, and oral diseases.[6][5]
• Reduce exposure throughout life to tobacco use, harmful alcohol use, unhealthy diets and toxins, physical inactivity, indoor air pollution, environmental pollutants and toxins, and stress.[6][5]
• Strengthen sectoral and multisectoral coordination, leadership and governance for a harmonised NCD prevention and response at all levels.[2][7]
• Reduce modifiable risk factors through regulatory, fiscal, multisectoral, community-based and individual-level interventions.[8][9]
• Strengthen equitable, quality, accessible, affordable, responsive and sustainable NCD prevention, management and care across the life course.[2][8]
• Enhance advocacy, communication and social mobilisation, including community knowledge, empowerment and participation in prevention and management.[10][11]
• Promote research and strengthen surveillance, monitoring and evaluation to inform health planning, policy and decision-making.[2][12]

The strategic direction combines population-wide prevention with a strengthened health-system response across community, primary, secondary and tertiary care.[13][3]Priority system areas include integration of NCD care into primary health care, workforce development, health information systems, essential health products and technologies, quality improvement, infrastructure, financing and financial protection.[14][15]

Implementation

Implementation uses a multisectoral, whole-of-government and health-in-all-policies model, reflecting that many NCD determinants fall outside the Ministry of Health mandate.[6][3]The Ministry of Health leads national policy development, coordination, monitoring and evaluation, data management, research, financing, stakeholder engagement and capacity development, while county governments implement policies and guidelines through service provision, workforce management, equipped facilities, referral systems, commodities and local resource mobilisation.[16]

• Coordinate action through the National NCD Steering Committee, the NCD Interagency Coordinating Committee, national and county health management teams, county NCD coordination committees or technical working groups, and other boards and committees.[17][18][16]
• Engage county governments, line ministries, policymakers, civil society, people living with NCDs, development partners, academia, professional bodies, private-sector organisations, faith-based organisations, community-based organisations, media and communities.[19][6][20]
• Update stakeholder databases, convene biannual steering forums and quarterly technical working group meetings, build coordination capacity, support county structures and establish a multisectoral information-management web portal.[7][21]
• Strengthen private-sector engagement through an engagement framework covering policy sensitisation, responsible business practices, coordinated resource mobilisation, conflict-of-interest controls, reporting and regular consultations.[8][22]
• Integrate NCD prevention and control into health policies, sector plans, clinical guidelines, Universal Health Coverage governance, primary health care and county development plans.[8][23][24]
• Implement risk-factor reduction through legislation, taxation and other fiscal measures, urban and environmental policies, health promotion, mass media, schools, workplaces, communities, vaccination, screening and risk assessment.[8][9][25]
• Develop an integrated primary health-care NCD model providing community education, screening, follow-up and commodity distribution, supported by trained community health assistants, community health volunteers and service providers.[15][26]
• Define an essential NCD management package; strengthen specialised services, referral pathways, trauma care, rehabilitation, palliative care, survivorship support and patient support groups.[15][10][27]
• Improve affordability and availability of medicines, diagnostics, supplies, laboratory technologies and assistive devices through quantification, pooled procurement, cost negotiations, local manufacturing, pharmacovigilance and ring-fenced county commodity funds.[15][27][28]

The plan is underpinned by a stakeholder-developed theory of change and logical framework linking activities, causal pathways, indicators and impact targets.[7]Implementation learning is intended to inform annual, mid-term and end-term reviews, with annual county support supervision expanding from 10 counties in 2021 to all 47 counties in 2025.[29]

Monitoring is organised through a Monitoring, Evaluation, Accountability and Learning Plan and a Common Results and Accountability Framework, which specify indicators, responsibilities, timing, reporting frequency and collective review processes.[30]The framework contains 15 high-impact indicators, informed by World Health Assembly targets, the Global Action Plan for Non-Communicable Diseases and Kenya’s health-sector strategic plan; data should be disaggregated by sex and age.[30][31]

Resource requirements were estimated using Activity-Based Costing and the One Health Model.[32]The estimated total requirement over the plan period is Kenya Shillings 377 billion, of which health-system response represents Kenya Shillings 361,097.8 million.[33]Available resources are estimated at Kenya Shillings 20,777 million, leaving a Kenya Shillings 356,406 million funding gap, or 94% of requirements; potential additional sources include donors, the private sector and households.[34]

Monitoring & Evaluation

The plan establishes surveillance, monitoring, evaluation, accountability and research as a dedicated strategic pillar, supported by a monitoring, evaluation, accountability and learning plan and a Common Results and Accountability Framework.[35][30]It combines routine reporting with performance reviews, surveys, research, data-quality audits and programme learning to support evidence-based decisions and modifications to implementation.[30]

• Track 15 high-impact indicators in the Common Results and Accountability Framework, using 2025 targets informed by World Health Assembly targets, the Global Action Plan for Non-Communicable Diseases and the Kenya health sector strategic plan.[31]
• Measure progress through impact indicators and targets for 2025/26, including disease prevalence, treatment and counselling coverage, essential medicine availability, screening, immunisation, disease control, injury and mortality measures.[36][37]
• Use annual work plans, weekly surveillance reports, monthly facility reports and expenditure returns, quarterly data reviews and divisional reports, annual performance reviews, and periodic surveys and assessments.[38]
• Conduct a mid-term review and end evaluation to assess progress towards strategic-plan results and objectives.[38]
• Strengthen surveillance through integrated electronic medical records, disease-specific registries, electronic tools, annual burden estimates, annual facility-level data-quality audits and periodic county support supervision.[30][12][39]
• Disaggregate collected, analysed and reported data by sex and age to support gender integration and identify differential programme effects.[30]
• Use joint periodic data and performance reviews, an implementation tracking plan, resource-tracking tools, annual resource tracking and private-sector reporting mechanisms to reinforce transparency and accountability.[7][8][30]
• Use data sources including the Kenya Health Information System, facility assessments, STEPS surveys, cancer registries, research repositories, health information reports and relevant committee portals.[14][37][38]

Costing & Financing

The strategy is costed through Activity-Based Costing, using a bottom-up approach that links unit costs, quantities and frequencies to activities, outputs, objectives and the overall budget.[32]Where comprehensive quantification data were unavailable, costs were estimated with the One Health Model using strategic targets, published unit-cost evidence and expert interviews.[32]Total requirements substantially exceed identified available resources, leaving a major financing gap.[34]

• Estimate total strategy requirements at Kenyan shillings 377,183 million over the planning period, with health-system response for NCD management representing the largest pillar cost at Kenyan shillings 361,097.8 million.[33]
• Estimate commodity requirements at Kenyan shillings 320,440.7 million, principally for cardiovascular disease and diabetes, cancers, injuries, epilepsy and renal disease.[40]
• Identify Kenyan shillings 20,777.1 million in available resources, comprising Kenyan shillings 8,167.7 million from domestic sources and Kenyan shillings 12,609.4 million from external sources.[34]
• Identify a funding gap of Kenyan shillings 356,406 million, equivalent to 94% of total requirements, and seek additional resources from donors, the private sector and households.[34]
• Increase the proportion of government allocation to NCDs from a 48% baseline in 2020 to a 60% target in 2025.[31]
• Increase the planned share of total health expenditure allocated to NCDs from a 6.5% baseline in 2015 to 31.5% in 2025, while ring-fencing county NCD commodity funds and advocating for NCD prioritisation in Ministry of Health budgets.[28][41]
• Mobilise resources through national and county budget processes, sin-tax allocations, donor proposals, public-private partnerships, resource mapping and engagement with civil-society, faith-based and community organisations.[42][16]
• Reduce affordability barriers through national quantification and costing of NCD products and technologies, cost-reduction negotiations and pooled procurement.[15][28]