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

Objectives

Kenya’s National Strategy for the Prevention and Control of Non-Communicable Diseases 2015–2020 provides a five-year roadmap to reduce preventable morbidity, mortality, disability, risk factors and costs associated with non-communicable diseases, improve quality of life, support Vision 2030 and advance sustainable socioeconomic development.[1][2][3]Its vision is a nation free of avoidable non-communicable disease burden, and its goal is to achieve the highest attainable standards of health and productivity throughout the life course through collaboration between national and county governments.[4][3]

• Address cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, their shared behavioural risks, and a broader range of conditions including mental disorders, haemoglobinopathies, violence and injuries, oral and eye diseases, congenital conditions and rheumatic heart disease.[2][5]
• Raise the priority of non-communicable diseases at national and county levels and integrate prevention and control within policies across all government sectors.[6][7]
• Formulate, implement, disseminate and periodically update legislation, policies, plans, standards and guidelines for prevention and control at both levels of government.[8][9]
• Promote healthy lifestyles and reduce modifiable risks from unhealthy diets, physical inactivity, tobacco use and harmful alcohol use through regulatory, fiscal, educational and community-based interventions.[10][11][12]
• Prevent violence and injuries, reduce environmental, occupational, genetic and biological risks, and protect people from hazardous exposures in homes, workplaces and public environments.[13][14][15]
• Strengthen health systems to provide prevention, screening, early diagnosis, treatment, chronic care, palliative care, rehabilitation, essential medicines, technologies and effective referral pathways.[13][14]
• Advance research, surveillance, monitoring and evaluation, partnerships, advocacy, communication and social mobilisation as core components of national and county action.[16][17]
• Work towards domesticated 2020 targets, including relative reductions in premature mortality, tobacco use, salt intake, insufficient physical activity and harmful alcohol use, alongside halting rises in diabetes and obesity.[18][19]
• Expand access to cardiovascular risk drug therapy and counselling for eligible people and achieve 80% availability of affordable essential medicines and basic technologies for major non-communicable diseases.[20]

Implementation

The strategy adopts a whole-of-government, whole-of-society, life-course and people-centred approach, combining upstream action on social and environmental determinants, midstream interventions for communities and groups, and downstream services for individuals.[1][3][21]It emphasises evidence-based, cost-effective interventions, primary health care, equity, human rights, community empowerment and the management of conflicts of interest.[2][21]

• Coordinate implementation through national and county governments, aligning accountability, reporting, management and delivery with their respective functional responsibilities.[1]
• Establish an Inter-Agency Coordinating Committee involving government sectors, county governments and health development partners to support planning, programming, monitoring and evaluation.[7]The committee reports to the Cabinet Secretary for Health and ultimately to the Cabinet, is chaired by the Director of Medical Services, and is supported by a secretariat hosted at NCD Alliance Kenya.[22]
• Support governance through a national prevention and control Steering Committee, technical working groups, sub-committees and focal units or focal persons at all levels.[17][23][22]
• Assign the national government responsibilities for policy formulation, review, monitoring and evaluation, resource mobilisation, evidence generation, national planning integration and partnership-building.[7]Assign county governments responsibilities for prioritising non-communicable diseases in county agendas, allocating resources, integrating action into county planning and building county-level multisectoral partnerships.[7]
• Integrate prevention and control into existing primary health care and community platforms, including maternal and child health, school health, HIV, tuberculosis, malaria, surveillance and other health programmes.[2][23]
• Engage sectors beyond health, including agriculture, education, finance, planning, transport, environment, infrastructure, trade and industry, to address determinants of disease and risk.[7]Engage civil society, communities, research and academic institutions, private providers, non-governmental organisations, development partners and patient-support groups in delivery and advocacy.[1][24]
• Implement risk-reduction measures through legislation, regulation, enforcement, taxation and pricing policies, food standards and labelling, school initiatives, workplace and community programmes, smoke-free environments, cessation support, alcohol rehabilitation and healthy-lifestyle campaigns.[25][11][12][26]
• Strengthen service readiness by training health workers, revising curricula, issuing integrated clinical guidelines, establishing chronic-care and wellness models, improving pre-hospital and trauma care, streamlining referrals and embedding palliative care in primary health care.[27][28][29]
• Ensure affordable access to quality diagnostic, screening, treatment and monitoring technologies, essential medicines and supplies, supported by public-private partnerships and universal health coverage financing mechanisms.[14]
• Finance action through prioritised national and county fiscal budgets, sustained resource mobilisation, partnerships and potential use of sin-tax revenue for prevention and control.[7][14]The source does not specify monetary allocations, a total budget, funding gaps or a detailed costing framework.[14]
• Operate monitoring through locally adapted targets and indicators, routine health information systems, surveys, surveillance, data-review platforms, supportive supervision and periodic joint reviews.[30][31]Specific monitoring sources include tobacco surveys, STEPS surveys, demographic and health surveys, salt-consumption surveys, cancer registration, International Classification of Diseases coding and verbal autopsy where vital registration is limited.[18][19][20]

Monitoring & Evaluation

The strategy establishes a national monitoring, evaluation, surveillance and accountability architecture for non-communicable diseases (NCDs), combining a national framework aligned with the World Health Organization global framework, domesticated voluntary targets, routine health-information reporting, surveys, research and review mechanisms.[14][30][18]

• Adapt the global NCD monitoring and evaluation framework to locally relevant targets and indicators, including the national framework covering mortality and morbidity, behavioural and additional risk factors, essential medicines and technologies, and cardiovascular risk treatment.[30][18][19][20]
• Measure progress towards 2020 targets, including a 20% relative reduction in premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases; a 30% reduction in tobacco use; a 15% reduction in mean salt or sodium intake; a 10% reduction in insufficient physical activity; at least a 10% reduction in harmful alcohol use; and halting increases in diabetes and obesity.[18][19]
• Track health-system targets of at least 50% coverage of eligible people with drug therapy and counselling to prevent heart attacks and strokes, and 80% availability of affordable essential medicines and basic technologies for major NCDs in public and private facilities.[20]
• Strengthen capture and reporting of NCD indicators through the District Health Information System, standardised tools and a restructured health information system that provides reliable, timely, complete and quality data.[6][14][30]
• Establish a central repository for NCD data and mechanisms to collect, report, analyse and use non-routine data, supported by intra-county, county and national data-review and information-sharing platforms.[14][30]
• Conduct situational analyses, burden and risk-factor assessments, baseline and periodic surveys, routine surveillance and priority research, with data disaggregated by age, sex, socioeconomic status and geographical area.[16][15][32]
• Use surveillance sources including the Global Adult Tobacco Survey, Global Youth Tobacco Survey, STEPS survey, Kenya Demographic and Health Survey, salt-consumption surveys, national and sub-national surveys, and national and county health records.[18][19][20]
• Improve mortality monitoring through cancer registration, International Classification of Diseases coding and certification, verbal autopsy where vital-registration data are limited, and modelling or estimates where required.[18][20]
• Monitor implementation through indicators for policy and legislation, county sensitisation, NCD budget allocation, multisectoral partnerships, service readiness, health-worker training, medicines and supply availability, advocacy, tobacco and alcohol control, violence and injury prevention, and environmental-risk interventions.[33][9][34][26][27][28][29][15]
• Hold periodic implementation reviews, joint review meetings and county support-supervision visits, and use evaluation findings and research evidence in national and county policy formulation.[30][16][31]
• Assign national government responsibility for monitoring and evaluation, evidence generation and dissemination, while county governments support local prioritisation, planning, reporting and use of findings.[7][16]
• Coordinate accountability through the NCD Prevention and Control Steering Committee, Inter-Agency Coordinating Committee, technical working groups and focal units; the Inter-Agency Coordinating Committee reports to the Cabinet Secretary for Health and ultimately to the Cabinet.[17][23][22]

Costing & Financing

Financing is framed as a requirement for sustained, equitable NCD prevention and control, with national and county governments expected to prioritise NCDs in fiscal budgets, mobilise resources and use partnerships, fiscal measures and innovative financing to support implementation.[1][7][14][33]

• Include NCD prevention and control initiatives in national and county fiscal budgets and prioritise their financing during 2015–2020.[33]
• Mobilise and allocate county resources, and seek adequate, predictable and sustained funding for county NCD programmes.[8][10]
• Strengthen budgetary, technical and legislative support for multisectoral coordination and resource mobilisation.[7]
• Develop innovative, sustainable and equitable universal health coverage financing mechanisms, including guidance for financing primary health care approaches that incorporate NCD prevention and control.[14]
• Create mechanisms to use sin-tax revenue for NCD prevention and control, while using taxes, subsidies, tax and price measures as incentives for healthier food choices and reduced tobacco demand.[14][11][12]
• Use public-private partnerships and local and international partnerships to mobilise financial and technical resources, including support for essential medicines, technologies, surveillance, research and programme implementation.[14][16][17]
• Address inadequate financing, weak prioritisation in planning and budgeting, and limited resources for awareness and healthy-lifestyle promotion, which are identified as implementation barriers.[6]
• Monitor financing-related indicators, including the proportion of national health budgets allocated to NCDs, counties with NCD budgets, health-budget allocation for NCD medicines and supplies, and the NCD budget share for surveillance and research infrastructure.[33][29][32]
• Recognise health-system resource constraints, including that 50% of primary health facilities lacked a functioning glucometer and average availability of essential NCD medical supplies was 27%.[6]
• Use funding from the Ministry of Health, the Ministry of Health/Centers for Disease Control and Prevention Cooperative Agreement, the International Association of National Public Health Institutes, Kenya Red Cross and the World Health Organization for strategy-related support.[35][24]

No total programme budget, activity-level monetary allocation, quantified funding gap, costing methodology, expenditure ceiling or economic assumptions are specified in the supplied text.[35][14][18]