After beating communicable diseases, Kenyans now fight NCDs

Will a child born in Kenya today live a better life than its grandparents born in 1963?

On most health metrics, the answer is yes. But it also depends on where this child is born.

Children born in 1963 were expected to live only to about 48 years. Those born today have a life expectancy of about 66 years.

But still, Kenya’s life expectancy is crawling compared to countries that it was at par with at independence. For instance, South Koreans live about 20 years longer than Kenyans.

Kenyans have been punished twice. First by communicable diseases such as cholera and now by non-communicable diseases such as cancer and diabetes.

At independence, after a child survived bouts of pneumonia, malaria and dysentery, diarrhoeal diseases followed them for life.

There were also few places to seek help.

According to Dr Benjamin Nganda, a senior health economist working with the World Health Organisation, at independence, there were 148 hospitals.

“By 1989, there were 183. Increased training and career development opportunities for health personnel have substantially lowered the population-health personnel ratios,” Dr Nganda said in his paper “Structural Reform of the Kenya Healthcare System.”

Due to improvements in health and nutrition, census statistics show that Kenya's population growth rate rose from 2.5 per cent in 1948 to 3.34 per cent in 1989, and peaked at 3.8 per cent in 1979. It now stands at 1.9 per cent.

“This was mainly due to decline in infant and child mortality rates, higher fertility among women in their childbearing ages and improved medical services,” he said.

Infant deaths (per thousand live births) declined steadily from an estimated 184 in 1948 to around 70 by 1990, Dr Nganda said in his thesis at the University of York.

Total fertility – defined as the number of live births a woman gets by the end of her productive life – rose from 6.7 in 1948 to 7.9 in 1979 to three in 2022, the Kenya Demographic and Health Survey 2022 said.

Dr Nganda said although food availability has grown considerably and has almost kept pace with population growth, acute malnutrition and other nutrition deficiency disorders prevalent at independence, persist.

In 1990 the proportion of the population with access to safe drinking water was only 21 per cent in the rural areas and 61 per cent in the urban areas. Currently, on average 60 per cent of Kenyans have access to safe drinking water, the National Economic Survey said.

But despite these gains, which have helped fight communicable diseases, Kenya is now facing a shift in the disease burden.

Kenya, like many other developing countries, is undergoing an epidemiologic transition—from infectious diseases to non-communicable diseases.

Public health specialists Edward Michieka, and Benjamin Onyango, say this shift rides on increased consumption of unhealthy diet, physical inactivity, and tobacco.

“Unhealthy diet and physical inactivity, in particular, are associated with obesity, diabetes, cardiovascular diseases, and cancer,” they say in a paper they published in the Journal of Epidemiology and Global Health.

Currently, the leading NCD contributors to all-cause deaths in Kenya are cardiovascular diseases and cancer, according to the 2022 demographic and health survey.

Diabetes causes a lower proportion of deaths but it is becoming increasingly important.

According to the Ministry of Health, NCDs contribute to more than 50 per cent of inpatient admissions and 40 per cent of hospital deaths.

“NCDs consume a substantial proportion of the health-care budget taking away funds from other development needs,” Michieka and Onyango say.

Their paper is titled, The Rise of Noncommunicable Diseases in Kenya: An Examination of the Time Trends and Contribution of the Changes in Diet and Physical Inactivity.

In 2010, Kenya promulgated a new constitution that shepherded a new dawn in governance and other aspects of society such as health. The healthcare system was moved largely to the 47 counties.

Since then, counties have improved health infrastructure considerably, more than at any time since independence.

Most of the investments have been geared toward fighting NCDs.

The NCDs are largely behind the move to institute Universal health coverage, which is about ensuring that people have access to the health care they need without suffering financial hardships.

President Uhuru Kenyatta launched Kenya’s UHC pilot in 2018 in Kisumu, Nyeri, Isiolo and Machakos counties.

The four were chosen because of high incidences of communicable diseases, non-communicable diseases, maternal and child deaths as well as road accident-related injuries, according to the Ministry of Health.

The pilot ran successfully on a shoestring budget.

In the first year, 2019/2020, the budget was about Sh50 billion and Sh47.7 billion in 2020/2021.

President William Ruto relaunched the UHC at Mashujaa Day celebrations in Kericho this year.

He said the programme, which is anchored on three laws enacted in August, will provide a framework to ringfence medical funds.

Ruto said every Kenyan will be covered by a special social insurance fund card that they will present for treatment when they visit health facilities.

"Each Kenyan will have a social insurance card, either paying by yourself or being paid for by the government," he said when he signed four bills that would underpin UHC.

The President said while every Kenyan will be paying for the card, the poor ones will be catered for by the government.

"If the limit is reached then the chronic illness fund will kick in so that no Kenyan will be turned away," Ruto said.

He said in all level 1, 2 and 3 facilities, all Kenyans will get free medical services.

On emergency and chronic illnesses, he said every Kenyan will be treated in every hospital without any questions or need to make prior payments.

He also signed the Universal Health Care Bills, which are set to support improvement of the UHC plan.

The Acts are, the Social Health Insurance Act, Digital Health Act, Primary Healthcare Act, and the Facility Improvement Financing Act.

The Digital Health Act aims to promote telemedicine and digitise health services by ending written transactions.

The Primary Healthcare Act aims to strengthen preventive health services by co-opting the 100,000 community health promoters commissioned by the President recently.

The Social Health Insurance Act abolishes the NHIF and creates three new funds: a Primary Health Care Fund, a Social Health Insurance Fund and a Chronic Illness and Emergency Fund.

The Facility Improvement Financing Act will restrict funds raised in public health facilities so that they are not put to other uses outside of health.

The current mandatory contributions may be a flashback to 1989 when the government introduced cost sharing between government and individual health service users.