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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iii

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

iv

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.

20

Annex 7.

Luanda commitment on NCDs in Africa: policies and strategies to address risk factors

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