National strategies on NonCommnicable Diseases (NCD's) the place of the Private Sector in Kenya. ACORD Round table. Dr. Kibachio Joseph Mwangi; MD, MPH (Lshtm), Msc (Epi), Head; Non Communicable Diseases Control Unit Ministry Of Health,

1. National policies/ strategies on NCDs–
….The place of the private sector
Dr. kibachio Joseph
Division of Non Communicable Diseases

2. Putting NCD in ecconomic
perspective
“If unchecked, NCDs have the potential of crippling
Growing economies; success will only come by focusing
resources on people, not their illnesses; on health, not
their disease”...... Ban Ki Moon
“NCDs are a disaster in slow motion”
…..“These are the diseases that break the
bank”.
Dr. Margaret Chan, Director-General of WHO
“The World Economic Forum ranks NCDs above
climate change and alongside the global financial
crisis in terms of the global threat they pose.
Cost of inaction > cost of action
“NCDs are a disaster in slow motion”
…..“These are the diseases that break the
bank”.
Dr. Margaret Chan, Director-General of WHO

3. A country in transition…
From Uhuru (1963) to Uhuru (2015)
National diseases specific programs integrated model
espousing wellness

4. Health projections 2011-2030
Dr. kibachio joseph DNCD

5. The news and agenda paradox….
Dr. kibachio joseph DNCD

6. $0.00
$0.10
$0.20
$0.30
$1.00
$2.00
$2.70
$0.00
$0.08
$0.10
$0.20
$0.20
$0.60
$0.70
$1.30
$1.80
$1.93
$2.10
$4.75
Water Education/Training
Water resources protection
Waste management/disposal
River development
Basic drinking water supply & sanitation
Water Policy/Management
Water supply/sanitation-large systems
Health Education
Health Training
Basic Nutrition
Family Planning
Medical Services
Medical Research
Basic Health Infrastructure
Reproductive Health Care
Basic Health Care
Health Policy/Management
Infectious Disease Control
STD & HIV/AIDS Control
Total ODA for Health : US$ 21 billion
$21 billion ODA invested in health, where are NCDs?
(expressed in US$ Billions)
$0.00
$0.10
$0.20
$0.30
$1.00
$2.00
$2.70
$0.00
$0.08
$0.10
$0.20
$0.20
$0.60
$0.70
$1.30
$1.80
$1.93
$2.10
$4.75
Water Education/Training
Water resources protection
Waste management/disposal
River development
Basic drinking water supply & sanitation
Water Policy/Management
Water supply/sanitation-large systems
Health Education
Health Training
Basic Nutrition
Family Planning
Medical Services
Medical Research
Basic Health Infrastructure
Reproductive Health Care
Basic Health Care
Health Policy/Management
Infectious Disease Control
STD & HIV/AIDS Control
Source WHO NCDnet

7. Framework for Kenya health Policy
directions 2012-2030

8. Risk factors
Obesity
♦ Overall 18.7% of population is
overweight while 5% obese
♦ Nakuru
 Overall prevalence – 13 %
 Urban > Rural: Overweight 20 vs
10%; Obesity 30 vs 19%. Also
higher mean WHR
♦ Garissa
 Overweight – 23.9% (21.9-25.9)
 Obesity by BMI – 12.6% (11.3-
14.3)
 Central obesity – 20.4% (18.5-
22.3)
♦ Kibera
 Overweight 28.7%
 Obesity (BMI) – 16.3%
 Central obesity – 13.1%
Tobacco
♦ Male 19 % ( down from 23%)
♦ Female 2% (up from 2)
♦ Total 11.6%
Alcohol
♦ Proportion of drinkers -25%
♦ total adult capita consumption of
alcohol was 4.1 litres of pure alcohol
(or 28 litres per drinker)
♦ heavy episodic drinking among the
drinkers is at 5.2%
Physical inactivity and Diet
♦ <50% of population leads a relatively
sedentary life and consume
unhealthy diets with high refined
sugars, salt and trans fats
Obesity
♦ Overall 18.7% of population is
overweight while 5% obese
♦ Nakuru
 Overall prevalence – 13 %
 Urban > Rural: Overweight 20 vs
10%; Obesity 30 vs 19%. Also
higher mean WHR
♦ Garissa
 Overweight – 23.9% (21.9-25.9)
 Obesity by BMI – 12.6% (11.3-
14.3)
 Central obesity – 20.4% (18.5-
22.3)
♦ Kibera
 Overweight 28.7%
 Obesity (BMI) – 16.3%
 Central obesity – 13.1%
Tobacco
♦ Male 19 % ( down from 23%)
♦ Female 2% (up from 2)
♦ Total 11.6%
Alcohol
♦ Proportion of drinkers -25%
♦ total adult capita consumption of
alcohol was 4.1 litres of pure alcohol
(or 28 litres per drinker)
♦ heavy episodic drinking among the
drinkers is at 5.2%
Physical inactivity and Diet
♦ <50% of population leads a relatively
sedentary life and consume
unhealthy diets with high refined
sugars, salt and trans fats

9. Wellness VS Health
♦ Critical balancing act
– Aging=experience=degeneration=less
motivation to stay healthy
– confidentiality vs exposure
– Preexisting conditions vs work related ills
– Voluntary vs compulsory participation
– Absenteeism Vs “Presenteeism”
♦ Critical balancing act
– Aging=experience=degeneration=less
motivation to stay healthy
– confidentiality vs exposure
– Preexisting conditions vs work related ills
– Voluntary vs compulsory participation
– Absenteeism Vs “Presenteeism”

10. NCDs aren't just about the individual
Source: Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute of Futures Studies,
1991; cited in Acheson D, 1998.

11. “Whole of life” approach to NCDs
prevention and control

12. Levels of ADA prevention

13. Discussion between CEO and the COO on
investing in Staff Wellness
COO
♦“Should we invest in a wellness program for
our staff ? …….Supposing we do and they
leave soon after?”
CEO
♦“Supposing we don’t and they choose to
stay?”
COO
♦“Should we invest in a wellness program for
our staff ? …….Supposing we do and they
leave soon after?”
CEO
♦“Supposing we don’t and they choose to
stay?”
kibachio _dncd 2015

14. Bare minimums
♦ Deal with holistic primordial prevention
♦ Innovative ways beyond fitness..
– think nutrition
– Encourage carrying food to work culture
♦ Health promoting environments/work places
– Eg Lit stairs, standing desks
♦ Health promoting infrastructure
– Bathroom/changing room, flexible hours
♦ Awareness programs- start at the top
♦ Lower the threshold of the sick off
♦ Integration while encourage PPPs and outsourcing
♦ Deal with holistic primordial prevention
♦ Innovative ways beyond fitness..
– think nutrition
– Encourage carrying food to work culture
♦ Health promoting environments/work places
– Eg Lit stairs, standing desks
♦ Health promoting infrastructure
– Bathroom/changing room, flexible hours
♦ Awareness programs- start at the top
♦ Lower the threshold of the sick off
♦ Integration while encourage PPPs and outsourcing

15. NCDs Integration and systems
strengthening

16. In so far as the bottom line goes…
If you miss the first
buttonhole (employee),
you will not succeed in
buttoning up your
coat……
Jonathan Von Goethe
If you miss the first
buttonhole (employee),
you will not succeed in
buttoning up your
coat……
Jonathan Von Goethe

17. Determinants of ill health
Health Behaviors
50%
Environment
20%
Genetics 20%
Access to Care
10%
♦ Healthy or unhealthy
behaviors impact an
individuals health
more than anything
else.
• Physical Activity
• Nutrition
• Tobacco/Alcohol/
Drugs
• Stress Management
• Health seeking
behaviour
Health Behaviors
50%
Environment
20%
Genetics 20%
Access to Care
10%
♦ Healthy or unhealthy
behaviors impact an
individuals health
more than anything
else.
• Physical Activity
• Nutrition
• Tobacco/Alcohol/
Drugs
• Stress Management
• Health seeking
behaviour

18. Success will only come by investing
in all dimensions of wellness
1. Emotional
2. Environmental
3. Intellectual
4. Occupational
5. Physical
6. Spiritual
7. Social
1. Emotional
2. Environmental
3. Intellectual
4. Occupational
5. Physical
6. Spiritual
7. Social

19. Kenya NCD strategy 2015-2020
♦ Raise the priority accorded to NCDs at national and county levels
♦ Integrate NCD prevention and control into policies across all government
sectors
♦ legislations, policies and plans for the prevention and control of NCDs
♦ Promote healthy lifestyles to reduce the modifiable risk factors for
NCDs
♦ Promote and conduct research and surveillance on NCDs
♦ Sustainable local and international partnerships for the prevention and
control of NCDs
♦ Embrace universal health care
♦ Reduce exposure to environmental, occupational and biological risk
factors
♦ Strengthen health systems for NCD prevention and control
♦ Promote and strengthen advocacy, communication and social mobilization
for NCD prevention and control
♦ Raise the priority accorded to NCDs at national and county levels
♦ Integrate NCD prevention and control into policies across all government
sectors
♦ legislations, policies and plans for the prevention and control of NCDs
♦ Promote healthy lifestyles to reduce the modifiable risk factors for
NCDs
♦ Promote and conduct research and surveillance on NCDs
♦ Sustainable local and international partnerships for the prevention and
control of NCDs
♦ Embrace universal health care
♦ Reduce exposure to environmental, occupational and biological risk
factors
♦ Strengthen health systems for NCD prevention and control
♦ Promote and strengthen advocacy, communication and social mobilization
for NCD prevention and control
Dr. kibachio joseph DNCD

20. All government
sectors
Community
groups
Think tanks
Better health
Medical
practitioners
Public/private
Business
community
pharma