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Joint Mission of the
United Nations Interagency Task Force on the
Prevention and Control of
Noncommunicable Diseases
Kenya
29 September–3 October 2014
WHO/NMH/NMA/17.92
© World Health Organization 2017
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Contents
Background Page 2
The context Page 2
Findings of the Mission Page 4
Recommendations for Action Page 6
Annexes
1. Participants in the joint mission Page 10
2. Joint Mission Terms of Reference Page 11
3. Joint Mission Programme Page 14
4. Evidence-based cost-effective interventions for the prevention and control of NCDs Page 15
5. National commitments as set out in the Outcome Document of the High-Level Meeting
of the General Assembly on the Review of the Progress Achieved in the Prevention and
Control of NCDs Page 16
6. Statement by the H.E. Mr Acharia Kamau Ambassador/Permanent Representative
Permanent Mission of the Republic of Kenya at the Comprehensive Review and
Assessment, 10-11 July 2014. Page 19
7. Luanda commitment on NCDs in Africa: policies and strategies to address
risk factors Page 21
8. NCD Policy and Practice across government in Kenya Page 22
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Executive Summary
A joint mission of the United Nations Interagency Task Force on the Prevention and Control
of Noncommunicable Diseases (NCDs) to Kenya was held 29 September to 3 October 2014.
NCDs in Kenya are an increasing concern and cause premature mortality: NCDs are
estimated to account for 27% of total deaths suffered by Kenyans, equivalent to almost 100
000 people per year and the probability of dying prematurely from an NCD in Kenya is
estimated as 18%. This premature mortality, primarily among men of working age, has
significant socioeconomic consequences and is a drain on the national economy. The main
risk factors for NCDs in Kenya are exposure to tobacco use, physical inactivity, unhealthy
diets and the harmful use of alcohol due to the effects of globalisation on marketing and
trade, rapid urbanization and population aging. Acting alone, ministries of health are limited
to remedial action, treating the sick; a whole-of-government approach is required for the
societal causes of NCDs to be addressed. The key findings of the mission are: (i) that
elements are in place for a whole-of-government response to NCDs; (ii) that the UNCT has
included in the UNDAF 2014-2018 under the Delivery as One (DaO) approach to support the
Government of Kenya prevent and control NCDs; and (iii) that a multi stakeholder response
exists that has real potential to support the Government deliver on NCDs. The Joint Mission
concludes with 12 areas for action in the following areas: (i) strategy; (ii) governance; (iii)
financing; and (iv) data collection, monitoring and evaluation. In addition, the Joint Mission
recommends that there is a follow up mission to review progress in April 2015.
1
Joint Mission of the United Nations Interagency Task Force on the Prevention and Control of
Noncommunicable Diseases to Kenya, 29 September–3 October 2014
1. A joint mission of the United Nations Interagency Task Force (UNIATF) on the Prevention and
Control of Noncommunicable Diseases to Kenya was held 29 September–3 October 2014. In
alphabetical order, the following agencies participated in the mission: UNAIDS, UNDP, UNFPA,
UNICEF, World Bank and WHO (Annex 1). Terms of Reference for the Joint Mission are included as
Annex 2 and the programme is Annex 3. The Joint Mission is grateful to the Ministry of Health and
other government ministries that met with mission members. The Mission also expresses its
gratitude to the civil society and other stakeholders that participated in discussions during the week.
Background
2. The UNIATF was formed by the United Nations Economic and Social Council (ECOSOC) in
2013. In 2014, ECOSOC approved the UNIATF’s terms of reference.1 As part of this, a Division of
Tasks and Responsibilities was adopted by the UN agencies, funds and programmes to support the
implementation of the six objectives of the WHO Global Action Plan for the Prevention and Control
of Noncommunicable Diseases (NCDs),2 2013–2020 were agreed. Activities identified in the UNIATF’s
2014-15 work-plan3 include a series of joint missions to selected countries to support governments
and UN Country Teams (UNCTs) scale up their response to (NCDs). The Mission to Kenya was the
second of these joint missions. The need for UNCTs to prioritise the provision of support to
governments around NCDs has been set out in two joint letters from the UNDP Administrator and
the Director-General of WHO to UN Resident Coordinators and UN Country Teams in 2012 and
2014.4
The context
At the global level there are clear frameworks to guide national action…
3. The 2011 Political Declaration of the High-level Meeting of the General Assembly on the
Prevention and Control of NCDs called upon UN agencies and key international organizations to
work together in a coordinated manner to support national efforts to prevent and control NCDs and
mitigate their impacts.5 The WHO Global Action Plan for the Prevention and Control of NCDs, 2013–
2020 also highlights the role of the UN system in supporting Member States and highlights
interventions for the prevention and control of NCDs (Annex 4) in four key areas: (i) tobacco control;
(ii) harmful use of alcohol; (iii) unhealthy diet; and (iv) physical inactivity.6 These interventions save
lives. They also save individuals, communities and governments money in both the short and long
term. They are all evidence-based, high impact, cost effective, affordable and feasible to implement. .
1E/2014/55, Appendix. http://www.who.int/nmh/events/2014/ecosoc-20140401.pdf?ua=1 (pages 11–18)
2 The 6 objectives are: (i) to raise the priority accorded to the prevention and control of NCDs in global, regional and national agendas and
internationally agreed development goals, through strengthened international cooperation and advocacy; (ii) to strengthen national
capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of
NCDs; (iii) to reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting
environments; (iv) to strengthen and orient health systems to address the prevention and control of NCDs and the underlying social
determinants through people-centred primary health care and universal health coverage; (v) to promote and support national capacity for
high-quality research and development for the prevention and control of NCDs; (vi) to monitor the trends and determinants of NCDs and
evaluate progress in their prevention and control. 3 http://www.who.int/nmh/UN_Task_Force_on_NCDs_Workplan_2014_2015.pdf
4 http://www.who.int/nmh/media/undaf_20120329.pdf and
http://www.who.int/nmh/UNDP_WHO_Joint_letter_on_NCDs_24Feb2014.pdf 5 Paragraph 51 of the Political Declaration “calls upon WHO, as the lead UN specialized agency for health, and all other relevant UN
system agencies, funds and programmes, the international financial institutions, development banks and other key international
organizations to work together in a coordinated manner to support national efforts to prevent and control NCDs and mitigate their
impacts”. http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf?ua=1 6 http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1
2
Acting alone, ministries of health are limited to remedial action, treating the sick; a whole-of-
government approach is required for the societal causes of NCDs to be addressed…
4. Although these interventions are simple to execute, a number require political commitment
and coordinated action across government. Acting alone, ministries of health are limited to remedial
action, treating the sick; a whole-of-government approach is required for the societal causes of NCDs
to be addressed. In parallel, a whole-of-UN approach must support a comprehensive national
response. In addition, strategic engagement with civil society, academia, professional bodies and
selected private entities are also important when it comes to tackling NCDs.
5. In July 2014, Member States undertook a comprehensive review and assessment on the
prevention and control of NCDs and progress since the 2011 Political Declaration on NCDs.7 Key
national commitments agreed at that meeting include: (i) setting national targets for NCDs for 2025;
(ii) developing national multisectoral policies and plans to achieve the targets; (iii) considering
establishing a national multisectoral mechanism for engaging policy coherence and mutual
accountability of different spheres of policy-making that have a bearing on NCDs; (iv) reducing NCD
risk factors by implementing interventions identified in the WHO NCD Global Action Plan, 2013–2020.
The full set of national commitments is set out in Annex 5. The Government of Kenya provided a
statement at the Comprehensive Review and Assessment and this is included as Annex 6.
At the Regional level there is also a great commitment...
6. In April 2011, the 47 member states of the WHO African Region adopted the Brazzaville
Declaration which called for the development and implementation of strategies, policies, guidelines,
legislation and regulatory framework for the prevention and control of NCDs. Member States were
called upon to strengthen their health systems including health financing, training and retention of
health workers. Member States were further urged to allocate resources commensurate with the
burden of NCDs. In Resolution AFR/RC62/R7, the WHO Regional Committee for Africa in November
2012 endorsed the Brazzaville declaration and further urged member states to strengthen
monitoring and surveillance systems for NCDs to generate reliable data and use evidence to raise
awareness of NCDs and strengthen political commitment for effective national actions.
7. African Health Ministers attended a meeting jointly convened by the African Union Commission
and WHO in April 2014 in Luanda, Angola. The meeting adopted the Luanda commitment on NCDs
in Africa: policies and strategies to address risk factors. The commitments and undertakings made by
minsters is included in Annex 7.
8. Kenya currently represents 47 nations as the African Bureau member of the WHO Framework
Convention on Tobacco Control Conference of the Parties.
NCDs in Kenya are an increasing concern, cause premature mortality, and are a drag on the
economy…
9. According to the Health Management Information System (HMIS) cardiovascular diseases
and cancer are the second and third leading causes of death respectively in Kenya (population 45
million). NCDs are estimated to account for 27% of total deaths suffered by Kenyans, equivalent to
almost 100 000 people per year. The probability of dying prematurely8 from an NCD in Kenya is
estimated as 18%.9 This premature mortality, primarily among men of working age, has significant
7 http://www.un.org/en/ga/68/resolutions.shtml
8 defined as the probability of dying between ages 30 and 70 from cardiovascular diseases, diabetes, cancer or chronic respiratory disease.
9 For further details see Noncommunicable Diseases Country Profiles 2014 (http://www.who.int/nmh/publications/ncd-profiles-2014/en/)
3
socioeconomic consequences and is a drain on the national economy. The main risk factors for NCDs
in Kenya are exposure to tobacco use, physical inactivity, unhealthy diets and the harmful use of
alcohol due to the effects of globalisation on marketing and trade, rapid urbanization and population
aging. NCDs contribute to over 50% of inpatient admissions and 40% of hospital deaths, which
dominate health care budgets in Kenya and again contribute to the drain on the national economy.
10. Total tobacco smoking is estimated at 26% among Kenyan men, although less than 2%
among women. Worryingly, among those aged 13-15 years, 15% currently consume some form of
tobacco product, and more than a quarter of youth are exposed to second hand tobacco smoke at
home and the smoking rate between girls and boys is almost the same. Prevalence of insufficient
physical activity for adults aged 18 and over is estimated to be 10% in men and 14% in women in
2010. Around 30% of Kenyan adults are overweight and around 9% are obese, and 18% percent of
Kenyan pre-school children are obese. The total estimated consumption of pure alcohol in Kenya
is 4.3 litres per adult aged 15+ per year, much higher than the African average, with significant
reporting of heavy episodic drinking.
11. Despite the estimates above, reliable data on NCD prevalence are lacking. A STEPS survey to
measure data on NCD behavioural risk factors has been planned for several years and has been
repeatedly postponed. It is now planned for 2015 and will provide comprehensive information on
NCD risk factors. Kenya’s third iteration of the Global Youth Tobacco Survey is currently under way.
12. The African Population and Health Research Centre shared the results of surveys carried out
among people living in some of the slums of Nairobi. These studies clearly demonstrate high levels of
NCDs amongst these populations, clearly contradicting the still widely held myth that NCDs are not
an issue among poor people in Kenya.
Findings of the Mission
Elements are in place for a whole-of-government response to NCDs…
13. NCDs are well reflected in the National Medium Term Plan 2014-2018 and the National
Health Sector Strategic Plan 2014-2018. The mission reviewed the draft National Integrated Strategy
for the Prevention and Control of NCDs 2014-2019 (National NCD Strategy). This includes a national
monitoring framework that consists of 10 national targets for 2020 that clearly reflect the voluntary
global targets of the WHO Global NCD Action Plan 2013-2020. The Joint Mission highlighted the
importance that the final strategy being as focussed as possible with SMART indicators throughout,
as well as fully costed. The implications for NCD prevention and control of the newly formed
devolved system of government where government is devolved to the 47 political and
administrative counties need to be factored into the Strategy.
14. Cross-government NCD technical working groups (TWGs) on tobacco control and diabetes
exist and TWGs on hypertension and physical activity are currently being formed.
15. All ministries acknowledged NCDs as an increasing concern in Kenya and that urbanisation,
globalisation and Kenya’s economic transition will only make the situation worse. As Kenya
continues to develop, the levels of NCDs and premature mortality will only escalate, unless
immediate action is taken. The results of this will be a significant socioeconomic drag for Kenya,
which is just emerging as a low-middle income country, and an additional burden for a health system
that it can ill afford. Kenya only spends 4.6% of the total annual government budget on health
(approximately US$45 per capita), well behind the target set out in the Abuja Declaration of 2001 of
allocating at least 15% of the annual budget to health. Public health spending accounts for only 2%
4
of GDP, which is far below the recommended 5% of GDP, required to facilitate progress towards
Universal Health Coverage.
16. Overall, government ministries that the Mission met with, recognised they had a role to play
in the prevention and control of NCDs. Ministries expressed a significant desire to contribute to the
finalization of the National NCD Strategy. It is important that this is done if government is to produce
a truly multisectoral plan. In addition, full engagement across all government departments would
bring clarity to the roles and responsibilities of the individual ministries (currently often referred to
in the Strategy as “other ministries”).
17. For Kenya to stem the impact of NCDs, a number of key issues that should drive policy-
making across all sectors were identified. They include: (i) a focus on premature death, which has
the greatest socioeconomic impact; (ii) a firm focus on the most cost-effective interventions (these
are all evidence-based and feasible); (iii) raising awareness on NCDs at the highest levels of
government; and (iv) identifying opportunities for linking the promotion of NCD prevention and
control into existing programmes in both the health sector10 and other sectors such as education,
labour and urban development. The Joint Mission reviewed the situation in Kenya with regards the
most cost-effective interventions for the four key risk factors as set out in the WHO Global NCD
Action Plan 2013-2020 (Annex 8).
18. In order to strengthen the MoH’s leadership role in working across government and
engaging with partners an even stronger NCD multisectoral unit is recommended. The Joint Mission
also strongly recommends in the context of devolution, that county structures be established for the
prevention and control of NCDs.
19. Ministries are acutely aware of the need to evolve policy within the East Africa regional
context, especially regarding tax policy coordination and price harmonization. This presents both
risks of being held back by regressive policies of neighbouring countries, or opportunities by being
progressive and demonstrating the benefits of policy changes across a regional context. The
importance of international cooperation and policy harmonisation was stressed through the
Mission’s discussions regarding Kenya’s membership of the East African Community. An East African
Community Strategy for the Prevention and Control of NCDs is being finalized for launch later this
year.
A UNCT that is now ready to work as one to support the Government of Kenya prevent and control
NCDs…
20. In 2010 the Government of Kenya requested that Kenya become a Delivering as One country
to enable the UN family to provide development assistance in a more coordinated way. The UNCT in
Kenya currently consists of 25 resident agencies.11 In March 2014, United Nations Development
Assistance Framework (UNDAF) IV covering the period 2014-2018 was signed off. The prevention
and control of NCDs under human capital development form part of the results framework (Output
2.2.4) with two NCD indicators included (one on blood pressure and one on screening for cervical
cancer). The UNDAF commits to more joint programmes, more joint evaluation, more pulling
together of scarce resources to minimise transaction costs and enhance development assistance.
The WHO Country Cooperation Strategy 2014-2018 includes the prevention and control of NCDs as
a key component.
10
E.g. programmes for sexual and reproductive health and maternal and child health, especially at the primary health-care level, as well as
communicable disease programmes, such as those addressing HIV/AIDS and tuberculosis. 11
In alphabetical order: FAO, ILO, IFAD, IMF, IMO, IOM, OCHA, UNCRD UNDP, UNEP, UNICEF, UNFPA, UN Women, UNESCO, UNIDO,
UNODC, UNHCR, UNAIDS, UN-Habitat, UNHCR, UNISDR, UNIC, UNIDO, UNOPS, UNFPA, UNAIDS, UNV, WFP, WHO and World Bank
5
21. There is now a clear opportunity for the UN Country Team (UNCT) to support NCD
prevention and control as One in a highly strategic manner. For this to happen the UNCT will need to
show even greater determination to be bold and ambitious in supporting the Government’s NCD
strategy once finalized, its engagement with the East African Community, and its engagement with
development partners.
22. There are Health, HIV/AIDS, Gender and Human Rights and Devolution UN Joint Programmes
(the equivalent of UNCT thematic groups). NCDs are not currently included in the Health Group.
There is currently no NCD Joint Programme.
A multi stakeholder response that has real potential to support the Government deliver on NCDs...
23. Comprehensive NCD prevention and control ultimately demands a whole-of-society
response, including in addition to government: civil society, private sector, academia and
international development partners, as well as the media are all important in influencing attitudes
leading to behavioural change. The National Tobacco Control Board is an exemplar of multisectoral
action.
24. NGOs engaged in the area of NCDs are enthusiastic and committed to action but are looking
for ever greater interaction with the Government and UNCT. The Joint Mission considered that there
remain needs for capacity building in the NGO sector and opportunities for greater coordination
between NGOs working in the area of NCDs in terms of strategy and action if their impact is to be
maximized. At the same time, there remains the opportunity for the Government to utilise the
existing capacity of civil society to the fullest extent. To this end, strengthening capacity within
government ministries for effective stakeholder engagement is important as Kenya scales up a
whole of society response to NCDs. NGOs, including faith-based organisations own 15% of Kenya’s
health facilities and it is important that they are undertake action to support implementation of the
National NCD strategy.
25. The private sector is an important actor with regards NCDs in Kenya. As 34% of Kenya’s
health facilities are owned by the private sector, it is important too that they are engaged effectively
in support of the National NCD strategy.
26. Unsurprisingly, we heard evidence around the manipulative tactics of the tobacco industry.
It is worth noting that BAT for instance has moved its manufacturing hub to Nairobi. With regards
the harmful use of alcohol, the country has licenced and unlicensed alcohol manufactures. An
Alcoholic Drinks Control Act exists but uncoordinated government agencies often enforce the Act to
the advantage of the alcohol industry. For example, while the Act prohibits irresponsible
advertisement, one arm of government, he Kenya Film Commissioner will be licensing the industry
to advertise. Fast food restaurants are increasingly popular as towns and cities grow. Many are
providing food that is more expensive than traditional food and targeting the aspiring middle class,
and increasingly the poorer communities that can little-afford income spent on such calorie-rich,
nutrition-poor diet. Advertising for fast food is widespread.
Recommendations for Action
The NCD policy framework in Kenya is robust and there is strong leadership from the Ministry of
Health. Now is the time to secure ownership for multisectoral action right across government, the UN
system and other stakeholders for the control and prevention of NCDs…
6
27. The Mission suggests the following actions, some of which are already underway, to be
undertaken during the next 12 months. The Government should take the opportunity and present
the outcomes at future Africa Regional Commission meetings. The UNCT is committed to providing
the necessary technical assistance to support the Government in this work over the next 12 months.
Strategy
i. The Joint Mission welcomes the development of the draft National NCD Strategy that is due
to be finalized by November 2014. The mission notes that the strategy is aligned to the Global NCD
Action plan 2013-2020 and that national targets have been set. However, most government
ministries are not aware of the strategy and have not yet been consulted. While some NGOs and
academic institutions are aware of the strategy, many are not and this is also likely to be the case
with relevant private sector entities. The Mission recommends that to ensure that the Strategy is
truly a multisectoral, whole-of-government and whole-of-society one with the full buy-in of all of
government and other partners:
• A full consultation is undertaken before the Strategy is finalised, including meetings between
the MoH and each of the relevant individual ministries;
• A consultative workshop is undertaken with civil society partners;
• The strategy is fully costed and activities prioritised in line with resources available;
• The mapping exercise in Annex 8 is built on and used to support finalisation of the National
NCD Strategy to help prioritize actions and ensure roles and responsibilities agreed;
• Is approved at cabinet level.
The UNCT will provide support in these processes.
ii. The Joint Mission also welcoming the intention to develop a national strategy for physical
activity and recommends that the strategy is developed in close collaboration with relevant
government and non-government stakeholders.
iii. The Joint Mission commends the high priority that the Government is giving to the
prevention of cervical cancer, a major killer of women, noting in particular the collaboration
between the Ministry of Health, Ministry of Education and a number of international organizations
for introducing HPV vaccine for girls at school. The Joint Mission now encourages the Government to
expand this programme to girls not in school. The Joint Mission also encourages the Government to
integrate its HPV vaccination programme with a screening programme for women of reproductive
age to detect and treat precancerous lesions of the cervix. Such an approach has the potential to
eliminate more than 90% of cervical cancers and related deaths and will make Kenya a pioneer in
cervical cancer prevention in Africa.
iv. As part of the National NCD Strategy, the Joint Mission recommends the development of a
cross-government costed NCDs communications strategy. Key elements of the strategy should
include raising awareness among parliamentarians, governors and officials at county level, engaging
the wider development community, relevant professional groups and the media, community leaders
and the public. The Joint Mission also recommends that a one-day workshop is hosted by the
Government and UNCT for county governors to encourage political leadership at the highest level
for preventing and controlling NCDs. Finally, the Joint Mission also recommends Kenya considers
joining the UN Be Healthy, Be Mobile mHealth initiative in 2016.
v. The Joint Mission commends the Government of Kenya for its contribution as chair of the
East African Community in developing an East African Community Strategy for the Prevention and
Control of NCDs. The Mission recommends that the UNCT be provided with the opportunity to
review the Strategy to ensure that an ambitious and coherence role for the UN system is in place to
support the implementation of the Strategy.
7
Governance
vi. The Joint Mission welcomes the recently established Interagency Coordinating Committee
(ICC) for NCDs that is designed to encourage coherence in policy across Government. The Joint
Mission considers it important that this includes representation for the counties. The Joint Mission
now recommends that a ministerial group across government provide oversight of the work of the
ICC, including implementation of the multisectoral National NCD Strategy and ensure that the
linkages are made with the Regional East African Community NCD Strategy described below. The
ministerial group should in addition receive reports through the ICC such as the investment case and
results of STEPS and other surveys as described below. The cross-government ministerial group
should ensure there is policy coherence across government for the prevention and control of NCDs
and should also foster and mobilise national funds and donor interest to meet the national NCD
targets. The Joint Mission recommends that the cross-government ministerial group is chaired at a
very high level, for example by the deputy president, to encourage the most effective cross-
government working possible. The UNCT is committed to providing technical support to the work of
the cross-government ministerial group. We recommend that the TWGs should include relevant
members of the UNCT as well as relevant donor agencies, civil society, patient groups, youth groups
and selected private entities.
vii. The Joint Mission recommends the establishment of an NCD UN Joint Programmes to
support government deliver the National NCD Strategy and delivery of the UNDAF. In the first
instance the UNCT NCD theme/working group should build on the mapping exercise in Annex 7.
viii. The Joint Mission recommends that capacity of the NCD Department in the Ministry of
Health should be strengthened to enable effective coordination for the whole of government and
whole of society response to NCDs. In addition, each county should as a minimum have a focal point
for NCDs. The Joint Mission also recommends that in the context of devolution, county structures
are established for the prevention and control of NCDs .
Financing the NCD response
ix. It is important to make the economic and business case for investing in the prevention of
NCDs to enable government to prioritize funding for preventing NCDs. This is not about the health
sector’s investment, rather the investment of other parts of government in developing and
implementing cost-effective policies that will make a rapid impact on the levels of NCDs and their
underlying causes. The Joint Mission recommends that the UNCT provides technical assistance for
the development of a joint government-UN report to document the impact of NCDs on the economy
and society. The work for this should start immediately and be completed by the end of June 2015.
x. Notwithstanding the above, the Ministry of Finance indicated to the Joint Mission that it
would welcome a costed proposal from the Ministry of Health to support its work in preventing
NCDs as part of the Ministry of Finance’s budget review that is currently taking place. We urge the
Ministry of Health to do this immediately. The proposal should be based on the very cost effective
policy options outlined in Annex 5 and taking forward the recommendations in this report. The UNCT
will make itself available to provide technical assistance as required.
xi. The Joint Mission welcomes the commitment from the Government to continue to increase
tax on tobacco products and alcohol year on year. Despite the Ministry of Finance policy to not to
earmark revenues, the Joint Mission believes that there may be an opportunity to do this for NCDs
from the taxes obtained from tobacco and alcohol, through conditional grants, a financing approach
that is legally provided for in the constitution. To this end the Joint Mission recommends that the
Government works with the UNCT to set out the arguments for and against such an approach.
8
Data collection, monitoring and evaluation
xii. Overall, the Joint Mission agrees with the Ministry of Health assessment that there are
insufficient data that describe the NCD epidemic. The Joint Mission encourages the Ministry of
Health to proceed with the STEPS survey without further delay and the Global Youth Survey, in
collaboration with WHO. These data will be important for tracking progress on the national NCD
targets to be set out in the finalized NCD Strategy. The Joint Mission also recommends that a review
of survey, surveillance and monitoring capacity across government and its partners for monitoring
NCDs be undertaken in the next 6 months.
Follow up
xiii. The Joint Mission recommends that there is a follow up mission to review progress in April
2015.
= = =
9
Annex 1.
Participants in the joint mission (agencies and individuals in alphabetical order)
UNDP
CHOKERAH, Julius. Strategy and Policy Unit, Kenya Country Office
Tarlton, Dudley. Programme Specialist, Health and Development, Geneva
WHO
BANATVALA, Nick. Senior Adviser, Office of Assistance Director-General, NCD and Mental
Health Cluster, Geneva
GARWOOD, Paul. Communication Offices, New Media, Geneva
KULIKOV, Alexey. External Relations Officer, WHO Office to United Nations, New York
KIBOGONG, Duncan. Kenya Country Office
KISA, Christine. HPR, Kenya Country Office
LAVUSSA, Joyce. FRH, Kenya Country Office
MANDLHATE, Custodia. WHO Representative in Kenya
NATO, Joyce. Program Officer, Prevention and control of NCDs, Mental Health and Tobacco
Control, Kenya
SHONGWE, Steven. NCD Focal Point, WHO Regional Office for Africa, Brazzaville
UNAIDS
RANGAIYAN, Gurumurthy. Senior Advisor, Strategic Information, Kenya Country Office
UNFPA
OKORO, Dan. Kenya Country Office
ORTAYLI, Nuriye. Senior Adviser, Sexual and Reproductive Health, New York
UNICEF
OUMA, Chris. Kenya Country Office
WORLD BANK
CHUMA, Jane. Health Economist, Kenya Country Office
RAMANA, Gandham. Program Leader, Kenya, Rwanda and Eritrea Country Department,
Kenya
10
Annex 2.
Joint Mission Terms of Reference
Rationale
1. Data from WHO estimate that in 2011 the vast majority of the premature deaths of
individuals from NCDs (85% or 11.8 million) between the ages from 30 to 70 years occurred in
developing countries. The probability of dying from any of the major NCDs between these
ages is as high as 60% in developing countries. It is estimated that up to two thirds of
premature deaths are linked to exposure to risk factors and up to half of these deaths are
linked to weak health systems.
2. Heads of State and Government agreed in September 2011 that the global burden and threat
of NCDs constitutes one of the major challenges for development in the 21st century and that
business-as-usual was no longer an option. Accordingly, the 2011 Political Declaration of the
High-level Meeting of the General Assembly on the Prevention and Control of Non-
communicable Diseases called upon WHO, as the lead UN specialized agency for health, and
all other UN system agencies and international financial institutions to work together in a
coordinated manner to support national efforts to prevent and control NCDs and mitigate
their impacts through a whole-of-government and a whole-of-society effort, as appropriate.
3. Based on the outcomes of the High-level Meeting, Member States have committed to take
action by (i) considering the development of national targets and indicators based on national
situations, (ii) developing, implementing and allocating a budget for a national multi-sectoral
NCD policy and plan; (iii) prioritizing the implementation of very cost-effective and affordable
interventions for all Member States (“best buys”); and (iv) strengthening national surveillance
systems for NCDs and measuring results.
4. At the same time, WHO was requested to complete a number of global assignments that
would further shape the global NCD agenda and accelerate implementation of national
efforts. There is now a global agenda in place based on 9 concrete targets for 2025, 25
outcome indicators, and 9 progress indicators, organized around the WHO Global NCD Action
Plan 2013-2020 that was endorsed by the World Health Assembly in May 2013, as well as
regional action plans. The global action plan comprises a set of actions which, when
performed collectively by Member States, international partners and WHO, will achieve a
global target of a 25% reduction in premature mortality from NCDs by 2025 and attain the
commitments made in the Political Declaration. The Global NCD Action Plan 2013-2020 calls
on United Nations Country Teams to provide technical support to countries in implementing
of strengthening nationwide action to: (i) reduce risk factors for NCDs and their determinants;
(ii) enable health systems to respond; and (iii) map the NCD epidemic, monitor progress and
measure results. In particular, the Global Plan calls on WHO and other UN Agencies to
mobilize the United Nations Country Teams (UNCTs) to strengthen the links among NCDs,
universal health coverage (UHC) and sustainable development, integrating them into the
United Nations Development Assistance Framework’s (UNDAF's) design processes and
implementation.
11
5. Demand from governments is high for “how to” policy advice to support their national efforts
to address NCDs. An analysis of 144 WHO country cooperation strategies found that 136
strategies included requests to support NCDs yet current bilateral and multilateral support
remains inadequate. The Economic and Social Council (ECOSOC), at its substantive session of
2013, was a defining moment to set out an approach for ways that the United Nations system
responds to country demand for technical assistance, when it adopted resolution 2013/12
requesting the Secretary-General to establish a United Nations Interagency Task Force on the
Prevention and Control of NCDs by expanding the mandate of the existing Ad Hoc
Interagency Task Force on Tobacco Control. The Task Force is convened and led by WHO, and
reports to the Council through the Secretary-General. Draft terms of reference and division of
tasks and responsibilities for the Task Force have now been developed. These were endorsed
by Member States during an ECOSOC coordination and management meeting on 12-13 June
2014.
6. The importance of a coherent UN System response to scale up technical assistance in support
of national efforts to address NCDs in line with the Global NCD Action Plan 2013-2020 was
highlighted in two joint letters from the UNDP Administrator and the WHO Director-General
to UN Country Teams (26 March 2012 and 24 February 2014).
7. In July 2014, Member States undertook a comprehensive review and assessment on the
prevention and control of NCDs and progress since the 2011 Political Declaration on NCDs.
Key national commitments agreed at that meeting include: (i) setting national targets for
NCDs for 2025; (ii) developing national multisectoral policies and plans to achieve the targets;
(iii) considering establishing a national multisectoral mechanism for engaging policy
coherence and mutual accountability of different spheres of policy-making that have a
bearing on NCDs; (iv) reducing NCD risk factors by implementing interventions identified in
the WHO NCD Global Action Plan, 2013-2020.
8. There is high political support in prioritizing NCDs in Kenya. This is as it is envisioned in the
National Medium-Term Plan 2013-2017 (MTPII); the National Health Strategic Plan 2013-
2017; the just launched United Nations Development Assisted Framework 2014-2018
(UNDAF); and the Kenya third generation of WHO Country Cooperation Strategy 2014-2019
(CCSIII). The planned UN Interagency task force joint mission will contribute immensely in
supporting the government of Kenya, the UN family and other stakeholders in the
implementation of activities aiming to tackle NCDs and their risk factors.
Overall approach
9. The mission is designed to support the UN Country Team support the Government scale up
their national efforts to address NCDs, taking into account the WHO Global NCD Action Plan
2013-2020 and relevant regional WHO action plans.
10. The mission will be carried out in line with the terms of reference of the UN Interagency Task
Force. Taking into account that a coherent UN response to NCDs is still in its infancy, a key
element of the mission will be learning lessons and better understanding entry points for
engaging with government and other partners on preventing and controlling NCDs.
Purpose and objectives of the mission
11. The Purpose of the integrated UN mission is to support the resident UN Country Team:
12
• understand the relevance of NCDs to their individual human development efforts in the
country and support their implementation;
• integrate NCDs and their determinants into their bilateral plans with countries and into the
UNDAF for the country where relevant;
• establish a working mechanism to coordinate support by the UNCT to the Government's
efforts to address NCDs;
• collect experiences and examples of good practice of UNCT work in NCDs in order to inform
other countries and regional and global efforts.
12. Specific objectives of the mission are to support the Government of Kenya:
12.1 Map on-going bilateral and multilateral processes to support the Government in their
national efforts to address NCDs within the context of national health and development
planning, coordination, financing, monitoring, accountability, and conflicts of interest
management.
12.2 Describe the rationale and opportunities for increasing multi-sectoral investment for NCDs
at the country level. The mission will highlight: (i) the relationship between NCDs, poverty
and development; (ii) the impact of policies on the determinants of risk factors for, and
consequences of NCDs; and (iii) approaches for effective, evidence-based policy-making. The
mission will also assess barriers for investment and ways that these barriers can be
overcome.
12.3 Establish a roadmap that lays out a set of steps and milestones over the next 12 months
which will result in: (i) finalization, dissemination and implementation of the national
multisectoral integrated NCD strategy and action plan (including national NCD targets); (ii)
finalization, dissemination and monitoring of the Kenya STEPs survey; and (ii) initial
implementation of the national multisectoral action plan. The road map will identify the
support that the Government requires from WHO, other UN agencies, as well as the World
Bank.
13. Proposed dates: 29 September to 3 October 2014.
13
Annex 3.
Joint Mission Programme
Monday, 29 September 2014
10:00 – 16:00 Desk review of government, UN and civil society policies, programmes and budgets
Tuesday, 30 September 2014
09:00 – 11:00 Meeting with Ministry of Health (Principal Secretary for Health, Director of Medical
Services, and Head of Directorate of Preventive and Promotive Health Services, and
members of the Division of NCDs)
11:30 – 13:30 Meeting with donors, development partners, civil society and academia under the NCD
alliance Kenya
14:00 – 15:00 Briefing of the mission members with UN Resident Coordinator and the UNCT
16:00 – 18:00 Internal meeting to review findings to date
Wednesday, 01 October 2014
09.00 – 10.00 Team 1: Meeting with Ministry of Sports,
Culture and the Arts
Team 2: Meeting with Ministry of East
African Affairs, Commerce and Tourism
11.00 – 13.00 Team 1: Meeting with PS Ministry of
Labour, Social Security and Services
Team 2: Meeting with PS The National
Treasury
14.00 – 16.00 Team 1: Meeting with Ministry of
Information, Communication and
Technology
Team 2: Meeting with PS Ministry of Land
Housing and Urban Development
17:00 – 18:00 Internal meeting to review findings to date
Thursday 02 October 2014
08:00 – 9.30 Meeting with PS Ministry of Education
10:00 – 11:00 Meeting the Tobacco Control Board
Meeting NACADA
11:30 – 13.30 Internal meeting to agree key recommendations
15:00 – 16:00 Meeting the Cabinet Secretary, Principal Secretary and Heads of Directorates, MoH
Friday 03 October 2014
07:45 – 08:30 Representative from Joint Mission and MoH participate on Kenya Citizen Breakfast TV
09:30 – 10:15 Meeting with DFID
11:00 – 13:00 Meeting with Africa population and Health Research Centre
14:00 – 18:00 Drafting of final report
14
Annex 4.
“Set of evidence-based cost-effective and affordable interventions for all Member States”
(also known as the “best buys”) for the prevention and control of NCDs12
Tobacco use13
• Reduce affordability of tobacco products by increasing tobacco excise taxes
• Create by law completely smoke-free environments in all indoor workplaces, public places
and public transport
• Warn people of the dangers of tobacco and tobacco smoke through effective health
warnings and mass media campaigns
• Ban all forms of tobacco advertising, promotion and sponsorship
Harmful use of alcohol
• Regulating commercial and public availability of alcohol
• Restricting or banning alcohol advertising and promotions
• Using pricing policies such as excise tax increases on alcoholic beverages
Unhealthy diet
• Reduce salt intake (and adjust the iodine content of iodized salt, when relevant)
• Replace trans fats with unsaturated fats
• Implement public awareness programmes on diet and physical activity
12
Taken from the WHO NCD Global Action plan 2013-2020
(http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1, pages 66 and 67).The measures listed are recognized
as very cost-effective i.e. generate an extra year of healthy life for a cost that falls below the average annual income or gross domestic
product per person. In addressing each risk factor, governments should not rely on one single intervention, but should have a
comprehensive approach to achieve desired results. 13
These measures reflect one or more provisions of the WHO Framework Convention on Tobacco Control (WHO FCTC). The measures
included are not intended to suggest a prioritization of obligations under the WHO FCTC. Rather, these measures have been proven to be
feasible, affordable and cost-effective and are intended to fulfil the criteria for assisting countries to meet the agreed targets as quickly as
possible. The WHO FCTC includes a number of other important provisions, including supply-reduction measures and those to support
multisectoral actions, which are part of any comprehensive tobacco control programme.
15
Annex 5.
National commitments as set out in the Outcome Document of the High-Level Meeting of
the General Assembly on the Review of the Progress Achieved in the Prevention and
Control of NCDs
(a) Enhance governance:
(i) By 2015, consider setting national targets for 2025 and process indicators based on
national situations, taking into account the nine voluntary global targets for non-
communicable diseases, building on guidance provided by the World Health Organization, to
focus on efforts to address the impacts of non-communicable diseases and to assess the
progress made in the prevention and control of non-communicable diseases and their risk
factors and determinants;
(ii) By 2015, consider developing or strengthening national multisectoral policies and plans
to achieve these national targets by 2025, taking into account the WHO Global Action Plan
for the Prevention and Control of Non-communicable Diseases 2013-2020;
(iii) Continue to develop, strengthen and implement, as appropriate, multisectoral public
policies and action plans to promote health education and health literacy, with a particular
focus on populations with low health awareness and/or literacy;
(iv) Raise awareness about the national public health burden caused by non-communicable
diseases and the relationship between non-communicable diseases, poverty, and social and
economic development;
(v) Integrate non-communicable diseases into health planning and national development
plans and policies, including the United Nations Development Assistance Framework design
processes and implementation;
(vi) Consider establishing, as appropriate to the respective national context, a national
multisectoral mechanism, such as a high-level commission, agency or task force for
engagement, policy coherence and mutual accountability of different spheres of policy
making that have a bearing on non-communicable diseases, in order to implement health-in-
all-policies and whole-of-government and whole-of-society approaches, and to monitor and
act on the determinants of non-communicable diseases, including social and environmental
determinants;
(vii) Enhance the capacity, mechanisms and mandates, as appropriate, of relevant
authorities in facilitating and ensuring action across government sectors;
(viii) Strengthen the capacity of Ministries of Health to exercise a strategic leadership and
coordination role in policy development that engages all stakeholders across government,
non-governmental organizations, civil society and the private sector, ensuring that non-
communicable disease issues receive an appropriate, coordinated, comprehensive and
integrated response;
(ix) Align international cooperation on non-communicable diseases with national non-
communicable diseases plans, in order to strengthen aid effectiveness and the development
impact of external resources in support of non-communicable diseases;
16
(x) Develop and implement national policies and plans, as relevant, with financial and human
resources allocated particularly to addressing non-communicable diseases, in which social
determinants are included.
(b) By 2016, as appropriate, reduce risk factors for non-communicable diseases and underlying social
determinants through implementation of interventions and policy options to create health-
promoting environments, building on guidance provided by Appendix 3 of the WHO Global Action
Plan for the Prevention and Control of Non-communicable Diseases 2013-2020.
(c) By 2016, as appropriate, strengthen and orient health systems to address the prevention and
control of non-communicable diseases and the underlying social determinants through people-
centered primary health care and universal health coverage throughout the lifecycle, building on
guidance provided by Appendix 3 of the WHO Global Action Plan for the Prevention and Control of
Non-communicable Diseases 2013-2020.
(d) Consider the possible linkages between non-communicable diseases and some communicable
diseases, such as HIV/AIDS, call for the integration, as appropriate, of responses to HIV/AIDS and
non-communicable diseases, and in this regard call for attention to be given to people living with
HIV/AIDS, especially in countries with a high prevalence of HIV/AIDS, in accordance with national
priorities.
(e) Continue to promote the inclusion of non-communicable disease prevention and control within
programs for sexual and reproductive health and maternal and child health, especially at the
primary health-care level, as well as communicable disease programs, such as TB, as appropriate.
(f) Consider the synergies between major non-communicable diseases and other conditions as
described in Appendix 1 of the WHO Global Action Plan for the Prevention and Control of Non-
Communicable Diseases 2013-2020 in order to develop a comprehensive response for the
prevention and control of non-communicable diseases that also recognizes the conditions in which
people live and work.
(g) Monitor the trends and determinants of non-communicable diseases and evaluate progress in
their prevention and control:
(i) Assess progress towards attaining the voluntary global targets and report on the results
using the established indicators in the Global Monitoring Framework, according to the
agreed timelines, and use results from surveillance of the twenty five indicators and nine
voluntary targets and other data sources to inform and guide policy and programming,
aiming to maximize the impact of interventions and investments on non-communicable
disease outcomes;
(ii) Contribute information on trends in non-communicable diseases to the World Health
Organization, according to the agreed timelines on progress made in the implementation of
national action plans and on the effectiveness of national policies and strategies,
coordinating country reporting with global analyses;
(iii) Develop or strengthen, as appropriate, surveillance systems to track social disparities in
non-communicable diseases and their risk factors as a first step to addressing inequalities,
and pursue and promote gender-based approaches for the prevention and control of non-
communicable diseases founded on data disaggregated by sex and age and disabilities, in an
effort to address the critical differences in the risks of morbidity and mortality from non-
communicable diseases for women and men.
17
(h) Continue to strengthen international cooperation in support of national, regional and global
plans for the prevention and control of non-communicable diseases, inter alia, through the exchange
of best practices in the areas of health promotion, legislation, regulation and health systems
strengthening, training of health personnel, development of appropriate health-care infrastructure
and diagnostics, and by promoting the development and dissemination of appropriate, affordable
and sustainable transfer of technology on mutually agreed terms for the production of affordable,
safe, effective and quality medicines and vaccines, while recognizing the leading role of the World
Health Organization as the primary specialized agency for health in that regard.
31. Continue to strengthen international cooperation through North-South, South-South and
triangular cooperation, in the prevention and control of non-communicable diseases to promote at
the national, regional and international levels an enabling environment to facilitate healthy lifestyles
and choices, bearing in mind that South-South cooperation is not a substitute for, but rather a
complement to, North-South cooperation.
32. Continue to explore the provision of adequate, predictable and sustained resources, through
domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative
financing mechanisms.
18
Annex 6.
Statement by the H.E. Mr Acharia Kamau Ambassador/Permanent Representative
Permanent Mission of the Republic of Kenya at the Comprehensive Review and
Assessment, 10-11 July 2014.
MR. PRESIDENT, I would like to thank you for convening today's High Level meeting on the
comprehensive review and assessment of the progress achieved in the prevention and control of
non-communicable diseases (NCDs). My delegation aligns itself with the statement delivered by Bolivia on
behalf of the G-77 and China. I wish to thank the Secretary General for his report on this important
issue, which recognizes NCDs as a new frontier in the fight to improve global health. Further, I also wish to
recognize the distinguished Permanent Representatives of Belgium and Jamaica for their able leadership as
co-facilitators of the process culminating in the successful conclusion of the outcome document of this
High level Meeting.
Mr. President, my delegation recognizes that over time, and largely unnoticed, NCDs have emerged to
become not only a major global public health issue of epidemic proportions, but also a major
impediment to international development, meriting our collective and urgent attention. An issue that in
2008, as poignantly highlighted in the secretary General's report, exacted a toll of 36 of 57 million global
deaths, is all the needed wake up call for our collective, international, multi-sectoral and immediate action.
Although manifestly preventable and controllable, these diseases are projected to claim 52 million lives in
2030. Surely, we cannot remain passive or indecisive in the face of such bleak prospects. Today's high level
meeting comes at a significant juncture as the international community accelerates the push to reach
the goals of the 2011 political declaration on NCDs, achieve the Millennium Development Goals and
embark on the formulation of the Post-2015 Development Agenda and its ambitious targets.
Mr. President, in 2011 the political declaration on this issue made a rallying call for the recognition
of the irrefutable global burden and threat of NCDs and their threat to international development
objectives in the twenty first century, and urged the international community, through a raft of measures,
to give particular focus to the preventable socio-economic impacts of NCDs, especially on developing
countries. While some progress has been achieved in the number of countries with an operational
national policy on NCDs, from 32 percent in 2010 to 50 per cent in 2013, the progress in the prevention
and control of NCDs has been insufficient and highly uneven, due in part to their complexity and
challenging nature, especially for developing countries. It is worth noting the demographic reality that
NCDs affect the young and productive segments of the population, with up to 9 million annual
deaths occurring in persons under 60 years of age. With many developing countries already reeling
under the burden of poverty, this initiates a vicious cycle where NCDs worsen poverty and poverty results
in rising rates of these diseases. The result is reduced productivity and further strain on already burdened
healthcare systems.
Mr. President, also worthy of note is the intricate linkage between women and children's health and NCDs,
since poor nutrition during pregnancy and early life, a common problem in less privileged parts of the
world, contributes as a predisposing factor to some NCDs. In this regard, my delegation would like to
recognize the key role of prevention, particularly, affordable interventions that reduce environmental and
occupational health risks, in accordance with national contexts, in reducing the socio economic burden of
NCDs.
Mr. President, I would now like to highlight Kenya's progress in addressing the challenge of NCDs:
• Kenya's new constitution positions health as a right, and the government continues to develop policy
measures and action plans to ensure that citizens have access to the highest quality of care.
• Kenya has signed and ratified the WHO Framework Convention on Tobacco Control and thereafter
implemented a comprehensive tobacco control legislation and the National Tobacco Control Action Plan
as an implementing tool for the act.
• Non-communicable diseases are a key component of Kenya's Second Health Policy Framework (2011-
2030) and, Kenya's Second Medium-term Plan for Health 2013-2017 has prioritized the halting and
19
reversing of the rising burden of non-communicable diseases; and, national diabetes and cancer
strategies have been developed. NCDs are now receiving attention in both planning and budgeting
processes in the Ministry of Health
• The National Nutrition Action Plan 2012-2017 is aligned to the government's Medium Term Plans to
facilitate mainstreaming of nutrition budgeting process. It provides a framework for coordinated
implementation of high impact nutrition interventions to address, among others, diet-related NCDs
• In line with the WHO Global NCD Action Plan 2013-2020, aimed at reducing the preventable mortality
from NCDs by 25% by the year 2025, Kenya has developed a draft non communicable diseases strategy to
drive the NCD agenda in a coordinated and strategic manner; giving emphasis to, cardiovascular diseases,
diabetes, cancers, chronic respiratory diseases, haemoglobinopathies, mental disorders, violence and
injuries, oral and eye diseases.
• Kenya's country capacity to respond to NCDs includes a department in the Ministry of Health responsible
for NCDs with funding available for treatment and control. There is a national reporting system for NCO
cause-specific mortality and morbidity. In addition, the Ministry of Health has an integrated policy and
action plan currently operational for diabetes.
Recognizing that NCDs risk factors and causal linkages go beyond the health sector, Kenya's NCO strategy
has embraced multi-sectoral action by identifying and promoting actions across sectors that have a stake
in the prevention and control of non-communicable diseases and aims at integrating NCD prevention and
control in the existing and well established primary care platforms in Kenya.
Mr. President, my delegation believes that access to safe, affordable, effective and quality treatment
and palliative care would go a long way in mitigating the impact of non-communicable diseases and
their complications. We recognize the key role played by generic drugs in this regard and acknowledge the
value of the TRIPS flexibilities as reflected in the Doha declaration on TRIPS and Public Health. My delegation
further acknowledges the need for the effective implementation of the Global Strategy and Plan of Action
on Public Health with a view to strengthening national capacities in developing countries and to ensure
universal access to medicines and medical technologies. Among measures to ensure an effective and
sustainable addressing of the challenge of NCDs, my delegation would like to underscore the need to
have effective systems to assess and address the impact as well as monitor and evaluate progress in
their treatment, prevention and control. We however note, that developing countries face challenges in
building these capacities due to inadequate resources.
Mr. President, while recognising efforts and mechanisms already underway, we believe that new and
innovative global partnerships should be established, while strengthening existing ones through the
North South, South-South and Triangular cooperation. In the same vein, we call for the
fulfilment of development assistance commitments to enable developing countries to more effectively
meeting the challenge of NCDs. My delegation welcomes the establishment of the UN Interagency Task Force
on the Prevention and Control of NCDs to coordinate the activities of the relevant UN funds, programmes and
specialized agencies and other intergovernmental organizations, to support the realization of the
commitments made by Heads of State and Government in the UN Political Declaration on NCDs.
Finally Mr. President, there is need to improve the tracking of resources allocated to NCDs. In this respect, we
welcome the invitation made to the Development Assistance Committee to consider developing a purpose
code for NCDs.
Mr. President, in conclusion, my delegation would like reiterate the undeniable moral and socio-economic
imperative before us to tackle the challenge of NCDs. We, as the international community, not only have
the unprecedented technological capacity to fully analyse and understand the problem, but also the
knowledge and resources required to greatly reduce the epidemic toll of the scourge of NCDs and its
impeding effects on the progressive march of global development. I thank you.
21
Annex 8.
NCD Policy and Practice across government in Kenya
NCD Policy and Practice across government in Kenya
“Set of evidence-
based cost-effective
and affordable
interventions for all
Member States”
(also known as the
“best buys”) for the
prevention and
control of NCDs”14
Lead
government
agency
Other
government
agencies
involved (+ve
and -ve)
Key achievements and
coherence
Challenges and
incoherence
Achievements,
constraints and
role for UNCT and
its individual
members
Roles/issues for NGOs
and private sectors
Next steps and
recommendations
Tobacco
Reduce affordability
of tobacco products
by increasing
tobacco excise taxes
MoH/MoF National
Treasury
Kenya Revenue
Authority
Ministry of
Trade
Research
Institutions
FCTC (2004), ITP (2013).
Kenya Tobacco Control Act
(2007) calls for effective
taxation of tobacco products,
Current tax rate at 49% >RSP,
efforts in place to
consistently and regularly
increase tobacco tax to 75%
RSP by 2020
Inadequate awareness
among key players
(OGDs).
Keeping increased tax on
agenda.
Inadequate evidence for
economic costs of
tobacco use and trade
arguments,
Assist in
economic
modelling and
economic studies
of tobacco
initiatives
Integrate tobacco
control in their
areas of
Vigilance against
Tobacco industry
interference,
Negative – tobacco
Industry, Kenya
Association of
Manufacturers are both
negative forces.
Professional
organizations ( health,
Economic study on
impact on tobacco and
NCDs – never been done
(MoF, MoH)
Models of effects of
increased tobacco
taxation in Kenya
WB, WHO and UNDP
14The measures listed above (with the exception of diversification from tobacco crop production) are recognized as very cost-effective i.e. generate an extra year of healthy life for a cost that falls below the average annual income or gross
domestic product per person. In addressing each risk factor, Member States should not rely on one single intervention, but should have a comprehensive approach to achieve desired results. The tobacco control measures reflect one or more
provisions of the WHO Framework Convention on Tobacco Control (WHO FCTC). The measures included are not intended to suggest a prioritization of obligations under the WHO FCTC. Rather, these measures have been proven to be feasible,
affordable and cost-effective and are intended to fulfil the criteria for assisting countries to meet the agreed targets as quickly as possible. The WHO FCTC includes a number of other important provisions, including supply-reduction measures and
those to support multisectoral actions, which are part of any comprehensive tobacco control programme
22
MOF and Kenya Revenue
Authority participating in
the development and
implementation of Article 6
for FCTC , implementation of
the ITP, capacity to
implement article 6 ( KRA
and MoF Officials trained),
TWG on taxation
Earmarking levies/taxes
for public health
interventions for
tobacco control and
tobacco related health
consequences,
EAA regional coherence,
efforts and willingness
to embrace and
implement taxation at
the same rate
operations
Mainstream
women and
children targeted
tobacco control
initiatives among
members dealing
with this these
vulnerable groups
economic, social),
Civil society: Advocacy,
capacity building,
resource mobilisation
Create by law for
complete smoke-
free environments in
all indoor
workplaces, public
places and public
transport
MoH Enforcement
agencies
(police, public
health officers,
labour,
transport)
Judiciary
Public,
transport
authority
Ministry of
Education
Ministry of
Youth and
Gender
FCTC
TCA comprehensive ban on
smoking in all public places,
Planned mass media
campaign on Second hand
tobacco smoke,
Public support for smoke
free policies,
GoK and whole of society
TWG on enforcement
The 2007 Control Act
continues to allow
designated smoking
areas in public places,
workplaces and public
transport.
Funds, Capacity building
for all actors at national
and county level,
guidelines for
enforcement handling
offenders e.g. penalties,
cessation services,
enforcement in
hospitality industry e.g
off work hours for
government officers,
funds, sensitization of
Public awareness
and support in
enforcement
Hospitality industry
Civil society
Advocacy, capacity
building, resource
mobilisation
Capacity building for
enforcement (MOH,
enforcement agencies).
WHO, UNDP, ILO,
UNFPA, UNICEF, UN
Women)
23
county governments,
Coordination of
implementation
Warn people of the
dangers of tobacco
and tobacco smoke
through effective
health warnings and
mass media
campaigns
MoH Ministry of
Education
Ministry of
Information
National
Authority for
the Campaign
Against Drug
and Substance
Abuse
(NACADA)
FCTC and Article 8
Guidelines, TCA requires
mass media campaigns to be
undertaken
Text warnings in place
Health warning in progress,
Mass media campaign – TV,
radio and IEC for Health
service points, relationship
with media, integration of TC
into other public health
programmes
Funds,
Coordination of
implementation, funds
to develop and
disseminate messages,
expertise in
implementing mass
media campaign,
evaluation of
effectiveness, cessation
services, coordination of
actors
Support the mass
media campaigns
Support advocacy
Support with
mass media
expertise
Conducting cost
effectiveness
analysis on the
initiatives
Religious Organization,
civil society, media.
Advocacy, capacity
building, resource
mobilisation
Guidance for mass
media campaigns (WHO,
UNICEF, UNFPA, UN
Women)
Ban all forms of
tobacco advertising,
promotion and
sponsorship
MoH Ministry of
Information,
Media Council
of Kenya
(regulatory
authority)
Research
institutions for
surveillance,
Enforcement
FCTC and guidelines
Comprehensive TCA ban all
forms of TAPS
Internet TAPS, code of
conduct for Public
officers, illicit products,
cross-border advertising,
Monitoring and
surveillance, capacity in
understanding depth
and breadth of TAPS,
county government
capacity to building to
enforce
Support
enforcement
across ICT
platforms like
social medias
Support civil
society in
vigilance and
surveillance
Support county
government in
civil society: advocacy,
capacity building,
resource mobilisation
Impact assessment
(WHO, WB, UNDP)
24
agencies,
Kenya Bureau
of Standards,
government
departments
( by not
supporting CSR
and
implementing
article 5.3)
enforcement
Diversification from
tobacco crop
production
MoH/MOAgric
ulture
County
Government
(parliament),
Ministry of
Environment
Research
institutions,
Ministry of
Planning
National
Environmental
Management
Authority
Kenya
Agricultural
FCTC and draft Guidelines,
TCA requires Ministry of
Agriculture
Expertise, market for
alternative produce,
capacity building, funds
Economic analysis
of the viability
and sustainability
of alternative
crops
Development
oriented
members to
support peasant
farmers towards
alternative
livelihoods
Academia
Civil society: advocacy,
capacity building,
resource mobilisation
Tobacco industry,
Tobacco farmers,
tobacco farmers and
lobby groups are
negative influencers
Economic impact of
tobacco crop production
Viable alternative
approaches developed.
Market for alternative
produce, capacity
building.
Impact evaluation
(FAO, WHO, UNDP, WB,
UNEP, ILO, UNICEF)
25
Research Body
Diet & PA
Reduce salt intake MOH National
Treasury
Kenya Revenue
Authority
Ministry of
Trade
Research
Institutions
Kenya
association of
manufacturers
(negative/positi
ve)
Guidelines on health diet
developed and finalized
Awareness on the need to
reduce salt intake
Awareness in manufacturing
industry on labelling
No policy directions
targeting reduction of
salt intake at the
population level
No structured
campaigns to the
general population
Laxity of manufactures
of processed foods to
reduce salt in their
products
No agreement across
manufacturers on
reduction policies VS
competition and conflict
of interest
Resource
mobilization
Leadership and
technical
direction
Supporting the
government to
initiate and
implement
processes that
will lead to
accelerated public
campaigns
towards
reduction in salt
intake
Technical
expertise on food
industry
engagement and
control
Participatory effort and
technical contribution in
drafting the policy
Educating the public on
the need to reduce salt
intake
Consumer protection
Food processing
companies to be
involved in ensuring the
reduction of salt in the
processed foods
Support advocacy on
legislation and industry
regulation
Capacity building of
HCW
There is a need to have a
policy statement on this
area
There is a need to have
structured public
education programs
directed to the families
on the need to reduce
salt intake and
consumption of low
sodium alternatives like
herbs and spices
Funding the process of
policy development in
this area
Replace trans fats with
unsaturated fats
MOH National
Treasury
Kenya Revenue
Trans fat Regulation on
developed
Discussed with industry and
No public awareness
programs
Lack of funding to
Resource
mobilization
Leadership and
Participatory effort and
technical contribution in
drafting the policy
There is a need to have a
policy statement on this
area
26
Authority
Ministry of
Trade
Research
Institutions
Kenya Association of
Manufactures
The guidelines are awaiting
for ratification by the office
of the attorney general
launch and implement
the regulations
Lack of structured
monitoring systems at
the industrial and
community level on
availability of trans fats
technical
direction
Supporting the
government to
initiate and
implement
processes that
will lead to
elimination of
trans fat use in
Kenya
Educating the public on
the need to use
unsaturated fats
Consumer protection
Fat manufacturing and
processing companies to
be involved in ensuring
the reduction
production and use of
trans fats
There is a need to have
structured public
education programs
directed to the families
and community
members on the need to
reduce the use of trans
fats
Funding the process of
policy development
Implement public
awareness
programmes on diet
and physical activity
Integrating awareness
of physical activity into
all public health
MOH National
Treasury
Kenya Revenue
Authority
Ministry of
Trade
Ministry of
Education
Ministry of
Devolution
County
governments
Research
Guidelines on health diet
developed and finalized
School health policy and
guidelines developed
No structured
campaigns to the
general population
No agreed upon targets
for the country towards
this end
Diets and physical
activity programs not
included in the schools
curricula
No guidelines on built
environments to
promote physical
activities
Resource
mobilization
Leadership and
technical
direction
Resource mobilization
Leadership and technical
direction
Development of
programs geared
towards promotion of
healthy diets and
physical activity
Initiate workplace
programs that will
support the
implementation of
healthy diets and
physical activity
Promoting
There is a need to have a
policy statement on this
area
There is a need to have
structured public
education programs on
promotion of healthy
diets and physical
activities
Funding the process of
policy development in
this area
27
platforms Institutions
empowerment of
women to make right
choices of diet as they
decide on entire family
Alcohol
Regulating commercial
and public availability
of alcohol
MOH/NACA
DA/MOF
National
treasury
KRA
Ministry of
trade
Police
Alcoholic drinks control act
which regulates production,
sale and consumption of
alcohol
Road traffic act which
regulates alcohol use by
drivers of locomotives
County alcoholic drinks
model law
Slow enforcement
Pro trade policies that
favour alcohol trade
Lack of awareness of the
provision of the act
among key players
Continued negative role
of the industry
Resource
mobilization
Leadership and
technical
direction
Resources to
support
enforcement
Resource mobilization
Advocacy
Capacity building
Amendment of the
alcohol laws to put tight
measures on
advertisement
Sensitize the key players
on the provisions of the
act
Lobby for more political
support and
commitment
Restricting or banning
alcohol advertising and
promotions
MOH/NACA
DA
National
assembly
Ministry of
information
science and
technology
Ministry of
education
PRIMETIME TV
Advertisement outlawed
More civil societies on board
to champion this
Creation of NACADA
Amendment of the alcoholic
drinks control act
Slow enforcement
Influence of the alcohol
industry
Weak laws
Lack of awareness of the
provisions of the act on
advertisement
Resources to
support
enforcement
Technical
expertise on
vigilance
Resource mobilization
Advocacy
Capacity building
Coordination of key
players
Amendment of the
alcoholic drinks control
act to put tighter
measures on promotion
and advertisement
Capacity build the law
enforcers
Greater involvement of
consumer protection
actors and civil societies
28
Using pricing policies
such as excise tax
increases on alcoholic
beverages
MOH/MINIS
TRY OF
FINANCE
NACADA
KRA
Ministry of
trade
National
Assembly
AC
Tax on alcoholic products
increased
Illicit product from the
boards which are cheap.
Lack of awareness of the
laws and policies
.Incoherent tax rates in
the region
Economic studies
of effectiveness
to inform sliding
scales of taxation
Advocacy
Resource mobilization
Capacity building
Best practise sharing
and benchmarking
across the globe
Economic survey on the
cost effectiveness of
alcohol control
programmes?
Clinical studies to
support correlation of
the risk factors and the
morbidities