Addressing Africa's Chronic Disease Burden: Recommendations and Opportunities

Addressing Africa's Chronic Disease Burden: Recommendations and Opportunities

Abstract

Africa is facing a growing burden of chronic diseases, which are projected to become the leading causes of death on the continent over the next decade. Despite this, African health systems are poorly equipped to manage chronic diseases, and national investments in healthcare training and service delivery continue to prioritize infectious and parasitic diseases. This editorial reviews eight original papers submitted to a Globalization and Health special issue themed: "Africa's chronic disease burden: local and global perspectives". The review highlights the challenges faced by African countries in addressing the chronic disease burden and proposes steps that African governments can take to improve chronic disease care and research.

Introduction

Africa is facing a double burden of infectious and chronic diseases. According to the World Health Organization (WHO), infectious diseases still account for at least 69% of deaths on the continent, but age-specific mortality rates from chronic diseases as a whole are actually higher in sub-Saharan Africa than in virtually all other regions of the world, in both men and women. Over the next ten years, the continent is projected to experience the largest increase in death rates from cardiovascular disease, cancer, respiratory disease, and diabetes.

The burden of chronic diseases in Africa is compounded by the weakness of African health systems, which are poorly equipped to manage chronic diseases. For example, in Kenya, the health system is not adequately equipped to bear the burden of chronic diseases. There are few very expensive specialized care facilities and trained healthcare professionals. This lack of capacity is reflected in the high rates of premature death from chronic diseases in Kenya, with cardiovascular diseases and cancer being the leading causes of death.

National investments in healthcare training and service delivery in Africa continue to prioritize infectious and parasitic diseases, with fewer than 2% of all global health research funding being allocated to non-communicable diseases in low- and middle-income countries, where 80% of global chronic disease deaths occur. This lack of funding is particularly problematic for Africa, which faces significant challenges in chronic disease research, practice, and policy.

Therefore, there is a strong consensus that African governments must take urgent action to address the chronic disease burden.

Findings

The eight original papers submitted to the Globalization and Health special issue on "Africa's chronic disease burden: local and global perspectives" highlight several challenges faced by African countries in addressing the chronic disease burden. The following are some of the key findings:

1. Lack of capacity for chronic disease care

The papers highlight the lack of capacity for chronic disease care in Africa, with a shortage of trained healthcare professionals, specialized care facilities, and essential medicines. For example, in Kenya, the health system is poorly equipped to manage chronic diseases, with a shortage of trained healthcare professionals and specialized care facilities.

2. Lack of funding for chronic disease research

The papers also highlight the lack of funding for chronic disease research in Africa. Fewer than 2% of all global health research funding is allocated to non-communicable diseases in low- and middle-income countries, where 80% of global chronic disease deaths occur. This lack of funding is particularly problematic for Africa, which faces significant challenges in chronic disease research, practice, and policy.

3. Importance of community engagement:

The papers highlight the importance of community engagement in addressing the chronic disease burden in Africa. For example, a study conducted in Ghana found that community-based interventions can improve health outcomes for people with hypertension. The study found that community health workers were able to effectively diagnose and manage hypertension in the community, leading to improved blood pressure control and reduced cardiovascular risk.

4. Need for policy and system-level interventions:

The papers also highlight the need for policy and system-level interventions to address the chronic disease burden in Africa. For example, a study conducted in South Africa found that the introduction of a sugar tax could reduce the consumption of sugary drinks, which are a major contributor to obesity and diabetes. The study found that a 20% tax on sugary drinks could lead to a reduction in the prevalence of obesity and diabetes, and could also generate revenue that could be used to fund chronic disease prevention and management programs.

5. Potential for technology-based interventions:

The papers highlight the potential for technology-based interventions to improve chronic disease care in Africa. For example, a study conducted in Kenya found that a mobile health intervention could improve adherence to medication among people with hypertension. The study found that participants who received text message reminders to take their medication had higher adherence rates than those who did not receive the reminders.

Based on the findings there are several recommendations that can be made to address the chronic disease burden in Africa. The following are some examples of recommendations that have been implemented elsewhere to solve similar problems:

1. Increase funding for chronic disease research:

One of the key challenges highlighted by the papers is the lack of funding for chronic disease research in Africa. To address this, African governments can increase their investment in chronic disease research, and international donors can prioritize funding for chronic disease research in low- and middle-income countries. In addition, public-private partnerships can be established to support research and innovation in chronic disease prevention and management. For example, the Global Alliance for Chronic Diseases is a partnership of research funding agencies that supports collaborative research on chronic diseases in low- and middle-income countries. However, the research findings need to be utilized to inform policy and implementation.

2. Strengthen primary healthcare systems:

The papers highlight the importance of primary healthcare systems in addressing the chronic disease burden in Africa. To strengthen primary healthcare systems, governments can invest in training and retaining healthcare professionals at the grassroots level such as the community health workers. It is important also to improve infrastructure and equipment, and ensuring adequate supplies of essential medicines at all levels. In addition, community-based interventions can be developed and implemented to improve the delivery of chronic disease care at the primary healthcare level. For example, in Brazil, the Family Health Strategy is a community-based program that provides primary healthcare services to underserved populations, including people with chronic diseases.

3. Implement policy and system-level interventions:

The papers highlight the need for policy and system-level interventions to address the chronic disease burden in Africa. To implement these interventions, governments can work with stakeholders from multiple sectors to develop and implement policies that promote healthy lifestyles and prevent chronic diseases. For example, in Mexico, the implementation of a tax on sugary drinks has led to a reduction in consumption of these drinks and a decrease in the prevalence of obesity and diabetes. It's predicted that over 10 years, the Mexican SSB tax would prevent 239,900 cases of obesity. Of these, 39% would be cases of obesity prevented in children. This drop in obesity is predicted to avoid 5,840 disability-adjusted life-years. Other examples of policy interventions include smoke-free policies and restrictions on the marketing of unhealthy food and beverages to children. An economic review of the evidence estimated that indoor smoke-free policies are cost-effective,[4] and do not reduce profits for hospitality businesses.[4,25,27] The policies, which have implementation costs of $25 or less per person,[4] lead to reduced mortality and health care costs,[4] and save quality adjusted life years (QALYs),[4,28] The policies have the potential to avert health care costs of $150,000 to $4.8 million per 100,000 persons. Australian modeling estimated that eliminating all unhealthy food and beverage television advertising during daytime hours would result in a reduction in healthcare expenditure of AUD 78.3 million (approximately USD 56.5 million). UK modeling estimated that eliminating all unhealthy food and beverage television advertising during daytime hours would result in a reduction in healthcare expenditure of £7.4 billion (approximately USD 10 billion).

4. Leverage technology-based interventions:

The papers highlight the potential for technology-based interventions to improve chronic disease care in Africa. To leverage technology-based interventions, governments can invest in the development and implementation of mobile health and telemedicine programs that enable remote monitoring and management of chronic diseases. For example, in India, the Apollo Telemedicine Networking Foundation provides telemedicine services to remote and underserved areas, enabling people with chronic diseases to receive specialist care remotely.

Call for action

Africa is facing a significant challenge in addressing the double burden of infectious and chronic diseases. African governments must prioritize chronic disease care and research to prevent a further increase in mortality rates from chronic diseases. Increased funding for research, building capacity for chronic disease care, strengthening health systems, implementing preventative measures, improving access to medications, fostering international partnerships, increasing public awareness, and advocating for policy change are critical steps that African governments must take to address the chronic disease burden.

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