It is often described as 'the silent killer' -- a moniker that could apply to the epidemic of non-communicable diseases (NCDs) in developing nations. High blood pressure, or hypertension, kills 9 million people worldwide each year and affects 1 billion. While the global development community has made significant strides to combat major infectious diseases like malaria, tuberculosis and HIV, the toll of illness, disability and death from chronic diseases such as cardiovascular disease, diabetes and cancer threatens to undermine these efforts. As World Hypertension Day approaches (May 17), the question stands before us: how can we come together to meaningfully address the growing burden of NCDs worldwide?
To do so, we must first consider that widespread impact of NCDs in places like Kenya or India affect the global community and economy at large. NCDs in developing nations will generate estimated losses of $47 trillion by 2030. If control efforts remain stagnant, low- and middle-income countries will face a loss of more than US $7 trillion between 2011-2025. These costs are reflected in the form of decreased productivity and earnings which undermines families, businesses, and ultimately, national economic growth. Communities face rising health care expenses, an increased strain on health care systems, and lost productivity due to disability and premature death. These are resources that could otherwise be used to strengthen developing economies and bolster global security.
In Africa, cardiovascular disease is the leading cause of death among those over age 45. The World Health Organization estimates that 46 percent of adults with hypertension are 25 years and older, the prime years of productivity. The disease can keep them and their families from realizing their full potential -- economic and otherwise. Many people do not seek treatment for hypertension because they are not aware they have it, or if they know, it may be too expensive for them to treat. Households often spend a substantial share of their income on hospitalization due to complications of the disease, further impeding economic growth at the household and national level. When a single mother like Fascoline Wanjiku feels unwell and worn down from this preventable disease, her children also suffer the consequences.
"Sometimes, I am unable to do anything in the house for almost a month, even speaking becomes a chore. I am a single mum and the breadwinner in my family, but when I am sick I can't even go out to look for work, so my children are always sent home for lack of school fees. At times like these, they just stay at home until I get better and send them back to school," she said.
If Fascoline's children can't attend school, there are long-term economic and personal impacts as well. As we see, hypertension ultimately affects everyone.
To effectively combat chronic diseases, we must join forces with experienced, strategic partners -- each able to compliment one another's organizational strengths and expertise. This is why PSI and Jhpiego are excited to be working with Kenyan health authorities, Astra Zeneca, and other NGO partners -- including AMPATH, AMREF Kenya, the Christian Health Association of Kenya -- on HEALTHY HEART AFRICA, a dynamic public-private partnership that leverages the reach and scale of a global pharmaceutical leader with organizations that offer expertise and oversight in health, marketing, research and community mobilization. The program aims to identify and treat 10 million African adult men and women with the disease, and is the largest single hypertension program of its kind. The lessons learned through this pilot project will have a broad, positive impact on people living in low- and middle-income countries.
Launched in Kenya in late 2014, HEALTHY HEART AFRICA aims to pilot and ultimately scale-up effective approaches to identify and treat hypertension in Africa, strengthening local health systems so they can sustain positive gains after the program's conclusion. Partners are working in a variety of settings, including village markets, churches, and public and private sector health facilities to reach people like Susan Muthoni Kamau with increased education and awareness of the disease, blood pressure testing, and information on resources available to treat hypertension.
Susan, a 50-year-old mother of six, operates a vegetable stand and small charcoal kiosk in the Tigoni market. Before learning about HEALTHY HEART AFRICA through her market, Susan recalls feeling out of breath and suffering bad headaches. She decided to get screened for hypertension.
"I came to the hospital and I got checked and they found out it was hypertension. My message to other people is that you can be happy. If you have hypertension, just start your doses and you can feel better. I come back to the hospital to have my pressure checked once a month. Until now the doses cost me about 2500 KES, about $27, every month. They say that with this new program I can have good drugs for just $3 per month. That would be very helpful. With my 6 children I have so many things to take care of. That would help me to take care of me so that I can get on with my life and be hopeful."
By working through existing public- and private-sector health care providers, HEALTHY HEART AFRICA is building the capacity of Kenya's frontline workers, the community health workers and nurses, midwives and physicians who are responsible for making a positive impact on the lives and health of people like Susan.
Sister Margaret Wairimu Muchui, a nurse at Tigoni Sub County Hospital, received training through the program that has enabled her to respond better to patient needs, to make them feel more comfortable with screening and understand that hypertension can be managed.
"We have changed the patient flow and now while people are waiting they get a health talk about hypertension. I greet the patient, ask them a question, welcome them and explain what I am doing, so that they can feel calm and I get a good reading. When we do the talk and they find out that hypertension can be handled properly, lowered and managed, [people] are no longer afraid to get the screening. We are screening about 60 patients per day. About 10 patients per day have severe hypertension. We are all excited because we feel like it is touching a real need."
Using this approach to screening and treatment of hypertension will ultimately let us draw lessons for how to tackle NCDs as a whole. Dr. William Maina, NCD Coordinator for Kiambu County, highlights,
"Actually doing screening in the community creates real awareness that this is a problem everyone has to worry about. And when our community health volunteers can talk with entire communities about lifestyle changes then things can change. We see a lot of co-morbidity between hypertension and diabetes. We are using the hypertension screening as an entry point to work around all of the NCDs. Having high quality drugs that are also cheap is also a game changer."
We know that combating any health challenge must involve local community leaders. Our role as development organizations should be to lead by supporting local stakeholders to identify approaches that work in their own communities, as these solutions are the most likely to endure over time. The development community, working with national and regional ministries, as well as the private sector, can leverage substantial resources and infrastructure to improve access to care for women like Fascoline, Susan and their families. Ongoing collaboration with Kenya's Ministry of Health provides opportunity for long-term impact.
"HEALTHY HEART AFRICA is sparking positive action and sustainable partnerships that will confront the rising challenges of hypertension and cardiovascular disease in Kenya," said Dr. Kibachio Mwangi, head of the NCD Division within the Kenyan Ministry of Health. "At the same time, we know that we will only succeed at addressing these health risks in the long run with additional partners, support and capacity-building. Everyone has a role to play in tackling this growing disease burden and in addressing the challenge of non-communicable diseases."
A key ingredient to programmatic success is applying lessons learned from the pilot to further scale up activities in Kenya, as well as regionally. According to Samer Al-Hallaq, AstraVeneca's Vice President of Africa Partnership Program,
"HEALTHY HEART AFRICA is off to a strong start in Kenya. Working together with our partners and the Ministry of Health, we have been able to develop medical protocols, create comprehensive training materials, and collecting the baseline data that will serve as the backbone of our efforts going forward. Partnerships have been key to activate the existing health facilities that will treat up to 50,000 patients through 2016. With this foundation in place, HEALTHY HEART AFRICA is poised to tackle the burden of hypertension in Kenya and, eventually, across the continent."
So, how can we meaningfully address NCDs worldwide? It must be done through strategic partnerships, where we leverage the skills and expertise of each player. It's only then can we build healthier and wealthier communities.
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