Kenya National Strategy for the Prevention and Control of Non-Communicable Diseases 2015 - 2020

Objectives

Kenya’s National Non-Communicable Diseases (NCD) Strategic Plan 2015–2020 provides a national and county framework for preventing and controlling NCDs, with a vision of a nation free from their avoidable burden. Its goal is to reduce preventable morbidity, mortality, disability, risk factors and related costs through evidence-based, life-course interventions that improve population wellbeing, productivity and sustainable socioeconomic development.[1][2][3]The strategy supports Kenya Vision 2030, the Kenya Health Policy 2012–2030 and wider health reform.[4][5]

• Raise the priority of NCD prevention and control across national and county governments and integrate action throughout government sectors.[6][7]
• Strengthen legislation, policies, plans, standards and enforcement for NCD prevention and control at both levels of government.[6][8]
• Reduce modifiable risks, particularly tobacco use and exposure, harmful alcohol use, unhealthy diets, physical inactivity, overweight and obesity.[6][9][10]
• Address environmental, occupational, genetic and biological risks, including carcinogenic exposures and infections that predispose people to NCDs.[11][12][13]
• Improve prevention, early diagnosis, treatment, rehabilitation, palliative care and long-term management for cardiovascular diseases, cancers, diabetes and chronic respiratory diseases.[6][14][15]
• Include other conditions of public-health importance, including mental disorders, violence and injuries, oral and eye diseases, haemoglobinopathies, rheumatic heart disease and conditions related to renal, hepatic, neurological, endocrine, musculoskeletal and disability needs.[6][16][17][15]
• Strengthen health systems, including workforce capacity, primary health care, clinical guidelines, referral systems, medicines, technologies, chronic-care models and palliative care.[18][11][19][20]
• Advance research, surveillance, monitoring and evaluation, while developing local and international partnerships and strengthening advocacy, communication and social mobilisation.[6][12][21][22]

The framework combines upstream action on social and environmental determinants, midstream action for communities and groups, and downstream services for individuals.[4]It is guided by multisectoral action, equity, human rights, attention to vulnerable groups and a life-course perspective.[3][23][5]Priority action areas include policy development, health promotion, risk-factor reduction, service reorientation, community mobilisation, research, surveillance and cross-sector networks.[2]

The national monitoring framework aligns with the World Health Organization framework and seeks, by 2020, a 20% reduction in premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases; reductions in harmful alcohol use, physical inactivity, salt or sodium intake and tobacco use; and a halt in the rise of diabetes and obesity.[24][25]

Implementation

Implementation uses a whole-of-government and whole-of-society model spanning national, county, sub-county, facility and community levels.[2][3][7]It seeks comprehensive, people-centred and integrated delivery through primary health care and existing platforms for community health, maternal and child health, school health, HIV and AIDS, tuberculosis, malaria, nutrition and disease surveillance.[4][6][26]

• Establish coordination through a National NCD Prevention and Control Steering Committee, an NCD Inter-Agency Coordinating Committee, technical working groups and focal units.[22][26][27]
• Report the Inter-Agency Coordinating Committee through the Cabinet Secretary for Health to the Cabinet; chair it through the Director of Medical Services, with the County Health Executives Forum chair as deputy and NCD Alliance Kenya hosting the secretariat.[27]
• Assign national government responsibility for policy formulation, review, national monitoring and evaluation, evidence generation, partnership-building, resource-mobilisation conditions and integration of NCDs into national planning.[8][12][21]
• Assign county governments responsibility for local prioritisation, planning, legislation, resource mobilisation and allocation, service delivery, multisectoral partnerships, surveillance and use of evidence in decision-making.[8][10][21]
• Engage health and non-health ministries, development partners, civil society organisations, private providers, academia, research institutes, media, patient groups, communities and professional stakeholders.[4][28][29][27]
• Implement legislative, regulatory, fiscal, educational and service-delivery measures, including tobacco-control enforcement, alcohol-harm reduction, food labelling and marketing controls, healthy-school and workplace programmes, and community action.[10][30][31][32]
• Develop regional centres of excellence, strengthen public-private partnerships, mainstream NCD activities into other health programmes and reinforce the NCD component of the community strategy.[22][26]

Operational delivery includes strengthening pre-hospital, trauma and rehabilitation services; expanding workforce training and mentorship; developing integrated clinical protocols; piloting primary-care chronic-care and wellness models; streamlining referrals; and improving access to screening, diagnostics, essential medicines, supplies and treatment technologies.[18][11][33][19][20]Environmental and occupational risk reduction is to use legal protection, public awareness, workplace and household programmes, vaccination, screening, early detection and treatment.[12][13]

Monitoring and implementation review are to adapt global NCD targets and indicators to Kenyan circumstances, embed standardised tools in health information systems, collect data not routinely captured, hold intra-county, county and national review meetings, and use data disaggregated by age, sex, socioeconomic status and geographical area.[12][21][34]The approach draws on population surveys, registries, facility records and monitoring systems, including the Global Adult Tobacco Survey, Global Youth Tobacco Survey, STEPS survey, Kenya Demographic and Health Survey, cancer registries, vital registration and verbal autopsy where appropriate.[24][25][35]

Financing is to prioritise NCD initiatives in national and county fiscal budgets, mobilise financial and technical resources through partnerships, support universal health coverage through innovative, sustainable and equitable mechanisms, use sin-tax revenue for NCD action, and link medicine availability to financing arrangements.[7][11][21][29]The supplied material does not provide an overall costed budget, monetary allocations, financing gap or economic assumptions.[24][25][35]

Monitoring & Evaluation

The strategy establishes monitoring, evaluation, surveillance and research as core components of Kenya’s non-communicable disease (NCD) response. It aligns the national monitoring framework with the World Health Organization global framework, covering mortality and morbidity, risk factors and national systems response.[12][21][24]

• Adapt global NCD monitoring arrangements to national targets and locally relevant indicators, and incorporate standardised monitoring and evaluation tools into health information systems at every level of care.[12][34]
• Collect, report, analyse and use disaggregated NCD data by age, sex, socioeconomic status and geographical area to inform equitable policy, implementation and resource allocation.[12][21]
• Conduct burden and risk-factor assessments, baseline and periodic surveys, and epidemiological, behavioural, biomedical, clinical and health-system research.[12][21][36]
• Integrate national and global surveys into surveillance, including the Global Adult Tobacco Survey, Global Youth Tobacco Survey, STEPwise approach to Surveillance survey, Kenya Demographic and Health Survey, cancer registries, vital registration and verbal autopsy where appropriate.[24][25][35]
• Hold intra-county, county and national review meetings; use shared information platforms; and disseminate surveillance and research findings for decision-making.[12][21]

The framework specifies 25 indicators and targets spanning premature mortality, behavioural and metabolic risk factors, cancer incidence, access to essential medicines and technologies, cardiovascular risk-reduction treatment, palliative care, vaccination and cervical-cancer screening.[24][25][35]By 2020, it aims to reduce premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases by 20%; reduce harmful alcohol use and insufficient physical activity by at least 10%; reduce salt or sodium intake by 15%; reduce tobacco use among adolescents and adults by 30%; and halt increases in diabetes and obesity.[24][25]

Implementation monitoring includes health-facility reporting rates, the proportion of indicators reported, the proportion of facilities generating reports, the proportion of counties receiving monitoring tools, implementation reports, supervisory visits, committee records and review-meeting documentation.[34]Specific implementation indicators also track establishment of coordination structures, county sensitisation, budget allocation, policy integration across sectors, advocacy forums and multisectoral partnerships.[29]

Accountability is distributed across national and county governments and partners. National government leads policy review, monitoring and evaluation, national surveillance and the research agenda, while county governments strengthen local systems, conduct priority research, use evidence and disseminate findings.[8][12][21]The Inter-Agency Coordinating Committee reports to the Cabinet Secretary for Health and ultimately to the Cabinet, supported by technical working groups and sub-committees, including one for monitoring and evaluation.[26][27]

Important information-system gaps include poor capture and reporting of NCD indicators in the District Health Information System.[7]The strategy responds through a central NCD data repository, strengthened information-system capacity, mechanisms to collect data not routinely captured, and surveillance of environmental, occupational and biological contaminants.[11][12]

Costing & Financing

The strategy calls for sustained, adequate and predictable financing for NCD prevention and control, with national and county governments expected to prioritise NCD initiatives in fiscal budgets and mobilise resources.[4][7][8][10][29]It does not provide an overall costed implementation plan, total budget, quantified funding gap, financing targets or economic assumptions in the supplied material.[4][22][24]

• Allocate national and county budget resources to NCD prevention and control during 2015–2020, and track the proportion of the national health budget and counties with an NCD budget.[29]
• Mobilise financial and technical resources through local and international partnerships, including development and implementing partners.[21][22][29]
• Use innovative, sustainable and equitable universal health coverage financing mechanisms and develop primary-healthcare financing guidance for national and county levels.[11]
• Use sin-tax revenue for NCD prevention and control, and apply fiscal measures, taxes, subsidies, price measures and other incentives to support healthy diets and reduce tobacco and alcohol demand.[10][30][11]
• Strengthen public-private partnerships to support sustainable access to essential medicines, supplies and technologies, linking availability to financing mechanisms.[11][20]
• Allocate resources for routine and periodic surveillance, research and related infrastructure at national and county levels.[36]

Funding support for development, printing, launch and dissemination of the strategy came from the Kenya Red Cross, the International Association of National Public Health Institutes and the Ministry of Health and Centers for Disease Control and Prevention cooperation arrangement.[28]The publication also acknowledges funding support from the Ministry of Health, the Ministry of Health and Centers for Disease Control and Prevention cooperative agreement, the International Association of National Public Health Institutes, the Red Cross and the World Health Organization.[37]

Several implementation tables contain apparent allocations, but their currency, units, costing methodology and financing envelope are not identified.[31][38][32]These values should therefore not be interpreted as confirmed monetary budgets.[31][38][32]