An Analysis of the Policy Environment Surrounding Noncommunicable Diseases Risk Factor Surveillance in Kenya

Rosemary Mamka Anyona; Maximilian de Courten; Rosemary Mamka Anyona; Maximilian de Courten

doi:10.3934/publichealth.2014.4.256

AIMS Public Health

2014, Volume 1, Issue 4: 256-274. doi: 10.3934/publichealth.2014.4.256

Previous Article Next Article

Research article Special Issues

An Analysis of the Policy Environment Surrounding Noncommunicable Diseases Risk Factor Surveillance in Kenya

Rosemary Mamka Anyona ¹,
Maximilian de Courten ^{2
,
,}

1.
School of Global Health, University of Copenhagen, Copenhagen, Denmark;
2.
Centre for Chronic Disease, College of Health & Biomedicine, Victoria University, Melbourne, Australia

Received: 01 October 2014 Accepted: 27 October 2014 Published: 01 December 2014

Kenya is a developing country in sub-Saharan Africa, facing a triple disease burden, with an increase in non-communicable diseases (NCDs); uncontained infectious diseases; coupled with significant morbidity and mortality from environmental causes such as droughts and flooding. The limelight has been on infectious diseases, leaving few resources for NCDs. As NCDs start to gain attention, it is becoming apparent that essential information on their epidemiology and risk factor trends—key in evidence-based decision-making—is lacking. As a consequence, policies have long relied on information derived from unreliable data sources such as vital registries and facility-level data, and unrepresentative data from small-scale clinical and academic research. This study analyzed the health policy aspects of NCD risk factor surveillance in Kenya, describing barriers to the successful design and implementation of an NCD risk factor surveillance system, and suggests a strategy best suited for the Kenyan situation. A review of policy documents and publications was augmented by a field-study consisting of interviews of key informants identified as stakeholders. Findings were analyzed using the Walt and Gilson policy analysis triangle. Findings attest that no population baseline NCD burden or risk factor data was available, with a failed WHO STEPs survey in 2005, to be undertaken in 2013. Despite the continued mention of NCD surveillance and the highlighting of its importance in various policy documents, a related strategy is yet to be established. Hurdles ranged from a lack of political attention for NCDs and competing public interests, to the lack of an evidence-based decision making culture and the impact of aid dependency of health programs. Progress in recognition of NCDs was noted and the international community and civil society's contribution to these achievements documented. While a positive outlook on the future of NCD surveillance were encountered, it is noteworthy that overcoming policy and structural hurdles for continued success is imperative.
- Kenya,
- policy,
- noncommunicable diseases,
- chronic diseases,
- risk factors,
- NCD surveillance,
- risk factor surveillance
Citation: Rosemary Mamka Anyona, Maximilian de Courten. An Analysis of the Policy Environment Surrounding Noncommunicable Diseases Risk Factor Surveillance in Kenya[J]. AIMS Public Health, 2014, 1(4): 256-274. doi: 10.3934/publichealth.2014.4.256

Related Papers:

Abstract

Kenya is a developing country in sub-Saharan Africa, facing a triple disease burden, with an increase in non-communicable diseases (NCDs); uncontained infectious diseases; coupled with significant morbidity and mortality from environmental causes such as droughts and flooding. The limelight has been on infectious diseases, leaving few resources for NCDs. As NCDs start to gain attention, it is becoming apparent that essential information on their epidemiology and risk factor trends—key in evidence-based decision-making—is lacking. As a consequence, policies have long relied on information derived from unreliable data sources such as vital registries and facility-level data, and unrepresentative data from small-scale clinical and academic research. This study analyzed the health policy aspects of NCD risk factor surveillance in Kenya, describing barriers to the successful design and implementation of an NCD risk factor surveillance system, and suggests a strategy best suited for the Kenyan situation. A review of policy documents and publications was augmented by a field-study consisting of interviews of key informants identified as stakeholders. Findings were analyzed using the Walt and Gilson policy analysis triangle. Findings attest that no population baseline NCD burden or risk factor data was available, with a failed WHO STEPs survey in 2005, to be undertaken in 2013. Despite the continued mention of NCD surveillance and the highlighting of its importance in various policy documents, a related strategy is yet to be established. Hurdles ranged from a lack of political attention for NCDs and competing public interests, to the lack of an evidence-based decision making culture and the impact of aid dependency of health programs. Progress in recognition of NCDs was noted and the international community and civil society's contribution to these achievements documented. While a positive outlook on the future of NCD surveillance were encountered, it is noteworthy that overcoming policy and structural hurdles for continued success is imperative.

References

[1]	Omran A. (1971) The epidemiologic transition: a theory of the epidemiology of population change. Milbank Memorial Fund Quarterly 49: 509-538. doi: 10.2307/3349375
[2]	Martens P. (2002) Health transitions in a globalizing world: towards more disease or sustained health? Futures 34: 635-648. doi: 10.1016/S0016-3287(02)00005-8
[3]	World Health Organization. (2012) Global status report on non-communicable diseases 2012. Geneva: World Health Organization.
[4]	United Nations. (2011) UN Statement on triple burden of disease, 11th round table meeting, 2011.
[5]	Ministry of Health. (2007) Annual health sector status report 2005–2007. Nairobi: Ministry of Health.
[6]	WHO Regional Office for Africa. (2011) NCD Country Profiles 2008, Kenya. Available from http://www. afro. who. int/en/kenya/country-health-profile.
[7]	Kowal P, Kahn K, Ng N, et al. (2010) Ageing and adult health status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration. Global Health Action Supplement 23. DOI:10. 3402/gha. v3i0. 5302.
[8]	Holmes MD, Dalal S, Volmink J, et al. (2010) Non-communicable diseases in Sub-Saharan Africa: the case for cohort studies. PLoS Med 7(5). DOI:10. 1371/journal. pmed.
[9]	WHO. (1968) Report of the technical discussions at the twenty-first World Health Assembly on National and Global Surveillance of Communicable Diseases. A21/Technical Discussions/5.
[10]	McQueen, Campostrini S. (2011) White paper on surveillance and health promotion. world alliance for risk factor surveillance, international union for health promotion and education. Available from http://www. iuhpe. org/uploaded/Activities/Scientific_Affairs/GWG/WARFS_white_paper_draft_ may_2011.
[11]	The NCD Alliance (Kenya). (2011) The Naivasha call for action on noncommunicable diseases. first national forum on noncommunicable diseases. Available from http://ncdalliance. org/sites/default/files/Final%20Draft%20Call%20for%20Action.
[12]	Buse K, Mays N, Walt G. (2005) Making health policy, In: Black N, Raine R (Editors) Understanding public health. London: Open University Press.
[13]	Walt G, Gilson I, Buse K. (1994) Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan 9: 353-370. doi: 10.1093/heapol/9.4.353
[14]	Hennink M. (2007) International focus group research, a handbook for the health and social sciences. Cambridge: Cambridge University Press.
[15]	Leichter HM. (1979) A comparative approach to policy analysis: healthcare policy in four nations. Cambridge: Cambridge University Press.
[16]	Cheluget B, Baltazar G, Orege P, et al. (2006) Evidence for population level declines in adult HIV prevalence in Kenya. Sex Transmit Infect 82: 21-26. doi: 10.1136/sti.2005.014662
[17]	Kenya National Bureau of Statistics. (2009) Kenya demographic and health survey 2008–09. Nairobi, KNBS. Available from http://www. measuredhs. com/pubs/pdf/GF17/GF17.
[18]	Manya A. (2011) Report: National roll out of District Health Information Software (DHIS 2), central server and cloud based infrastructure in Kenya. Nairobi: MoH. Available from http://aitec. usp. net/AfriHealth,%20Nairobi,%2030%20Nov-1%20Dec%202011/MinistryOfHealt h_AyubMunya_Arihealth2011.
[19]	Ministry of Medical Services, Ministry of Public Health and Sanitation. (2011) Kenya national health accounts 2009/10, In: System of Health Accounts. Geneva: WHO. Available from http://www. who. int/nha/country/ken/kenya_nha_2009-2010.
[20]	WHO. (2010) The Abuja declaration: ten years on. Geneva: WHO. Available from http://www. who. int/healthsystems/publications/Abuja10.
[21]	Ministry of Health, Kenya. (2013) Health sector strategic and investment plan III: July 2013–June 2017. Geneva: WHO. Available from http://www. who. int/pmnch/media/events/2013/kenya_hssp.
[22]	23. Bonita R, Beaglehole R. (2011) Priority actions for the non-communicable disease crisis. Lancet377: 1438-1447.
[23]	24. Kuruvilla S. (2005) CSO participation in health, research and policy: A review of models, mechanisms and measures. London: Overseas Development Institute. In Press. Available from http://www. odi. org. uk/sites/odi. org. uk/files/odi-assets/publications-opinion-files/162.
[24]	25. WHO. (2013) NCD Global Monitoring Framework. Geneva: WHO. Available from http://www. who.
[25]	26. Standard reporter. (2011) Bitter truth on cancer as Nyong'o returns with new mission. East African Standard. Accessed on 07 March 2011.
[26]	27. Division of noncommunicable diseases. (2013) Draft national noncommunicable diseases strategic plan 2012-2017.
[27]	28. Orton L, Lloyd-Williams F, Taylor-Robinson D, et al. (2011) The use of research evidence in public health decision making processes: Systematic review. PLoS ONE 6:
[28]	29. Hennink M, Stephenson R. (2005) Using research to inform health policy: barriers and strategies in developing countries. J Health Commun 10: 163-180. doi: 10.1080/10810730590915128
[29]	30. Bräutigam BA, Knack S. (2004) Foreign aid, institutions, and governance in Sub‐Saharan Africa. Econ Dev Cult Change 52: 225-228.
[30]	31. Leach-Kemon K, Chou DP, Schneider MT, et al. (2012) The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. Health Aff 31:228-235. doi: 10.1377/hlthaff.2011.1154
[31]	32. Crichton J. (2008) Changing fortunes: analysis of fluctuating policy space for family planning in Kenya. Health Policy Plan 23 (5): 339-350.
[32]	33. True JL, Jones BD, Baumgartner FR. (1999) Punctuated-equilibrium theory. In: Sabatier PA, Theories of the policy process. Boulder: Westview Press, 97-115.
[33]	34. Shiffman J, Beer T, Wu Y. (2002) The emergence of global disease control priorities. Health Policy Plan 17(3): 225-234.
[34]	35. Sabatier PA. (1999) Theories of the policy process. Boulder: Westview Press.
[35]	36. United Nations General Assembly. (2011) Political declaration of the High-level Meeting of the General Assembly on the prevention and control of non-communicable diseases.
[36]	37. WHO. (2008) Action plan for the global strategy for the prevention and control of non-communicable diseases, 2008–2013. Geneva: WHO.

Reader Comments

Your name:*

Email:*
© 2014 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)