Kenya starts to shift focus to chronic diseases while not relenting in HIV fight

A patient at a rural health camp in Mwae County, Kenya has his blood pressure checked as part of a full physical exam. If he needs hypertension treatment, he will get it as part of the cost of the camp. Photo: Bedad Mwangi

This was originally published on Global Health TV on June 28, 2016.

For some time, huge disparities between global health spending and the global disease burden have raised concerns that this funding was not being allocated based on the evidence. That is, money was not always going where the disease burden was greatest.

The Institute for Health Metrics and Evaluation (IHME) has pointed out that the disparities are most extreme in HIV/AIDS on the high end and non-communicable diseases (NCDs) on the low end.

As the toll from communicable diseases like AIDS and malaria decline and people live long enough to get NCDs, we need to invest more in fighting NCDs (also called “chronic diseases”) and reduce these glaring disparities between global health spending and disease burden. Countries like Botswana, Eritrea, Kenya Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia — all countries that increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS — now have to pivot to NCDs without taking their eyes off of HIV.

Kenya is an excellent case in point.

Life expectancy there peaked in 1987, and then went down in the 1990s, as AIDS made its presence felt. But as more Kenyans have gotten AIDS treatment and new infections declined, life expectancy started going up again, and is expected to return to its historic peak of 60 years in 2017, according to a World Bank blog.

That’s great news but that silver lining contains some bad news: Some people are now living long enough to get an NCD like cardiovascular and respiratory disease, diabetes and cancer.

Annually, 28 million people die from NCDs in low- and middle-income countries, representing nearly 75% of deaths from NCDs globally. Health programs, therefore, must turn their attention to this new pandemic without losing focus on the existing AIDS pandemic. And donors and governments must follow suit with funding that is in synch with the disease burden and not based on 1990s realities.

Dr. Samuel Mwenda is a seasoned soldier against both pandemics. For 13 years, as the general secretary and CEO of the Christian Health Association of Kenya, a network of Protestant church facilities in Kenya, he has led CHAK’s approach to HIV/AIDS prevention, care and treatment.

CHAK has made significant contributions to the national fight against AIDS in the four most populous provinces of the country and now supports over 41,000 clients with antiretroviral therapy, representing about 9% of the total number of patients nationally. Kenya now has the second largest treatment program in Africa (after South Africa), with nearly 900,000 people on treatment at the end of 2015.

CHAK has helped Kenya become an AIDS success story. UNAIDS says that Kenya is one of the countries “showing the most remarkable progress in expanding access to antiretroviral medicines and reducing the number of new infections.”

Several years ago, CHAK turned its attention to the emerging pandemic of NCDs, and began working on hypertension and diabetes. Seventy percent of the global cancer burden is in low- and middle-income countries like Kenya, where the probability of dying between the ages of 30 and 70 from one of the four main NCDs is 18%. NCDs account for 27% of deaths in Kenya, according to the World Health Organization.

In 2015, with the support of Novartis Access, CHAK started offering a portfolio of products to treat diabetes, hypertension, asthma and breast cancer at an end price not to exceed $1.50 per treatment per month. The program is currently in three counties of Kenya and is expected to be in all 47 counties by the end of 2017, and followed soon by Ethiopia, Rwanda and Senegal. The program hopes to be in 30 countries by 2020, depending on government and stakeholder demand.

Novartis Access calls its program a “social business,” which it expects to eventually create value, not only for society but also for Novartis.

“A key learning from HIV programs was that you cannot build awareness until there is treatment,” said Mwenda. “It's the same with NCDs. It's access to treatment that gets individuals and families to learn about heart disease and diabetes and to come forward for diagnosis. When people see others in their communities living long, healthy and productive lives despite NCDs, it makes them more willing to invest their own time and resources in treatment.”

“Africa is rapidly overcoming the challenges of infectious diseases,” said Mwenda. “Much of that is due to the commitment of faith-based organizations, that  provide about half of all health care in the countries south of the Sahara. I believe that the same God-given mandate that we had to conquer polio and AIDS requires us to get serious about diabetes and cancer.”

On June 19, Mwenda became the third recipient of the Christian International Health Champion Award, which honors an individual who has dedicated his/her life to global health from a Christian perspective and has made significant contributions to the field and to Christian Connections for International Health (CCIH), which presented him with the award. Full disclosure: David J. Olson is a board member of CCIH.