The problem in Africa

There are six major problems:

1. The pattern of disease is changing. As the countries of Africa change – economically and socially – so also their health and disease change. The population continues to grow; there will thus be more old people, the very people among whom non-communicable disease (NCD) will become apparent. More and more people move to cities and, while this increases their personal wealth compared with the rural families which they have left, it also enables them to adopt habits, for example, smoking, which promote NCD. Economic growth, which is absolutely essential to provide government with revenue for its public services, produces a rich urban class, which takes little exercise and among whom therefore obesity is endemic.

2. Climate change is making rural life and incomes more unpredictable; environmental degradation is impoverishing fertile land and depleting water resources. Africa is vulnerable to climate change (Fig. 56.1).

3. Civil conflict or war in many countries forces people to flee their homes, so that whole communities are displaced, disconnected from their roots, and potentially deeply traumatised, both by the move and by the death and disorder of conflict, which have led to so much mental ill health.

4. The health services have not yet developed appropriate methods to prevent and to manage chronic disease in towns and in rural areas. Vertical, disease-focused programmes have siphoned staff and resources away from primary health care, so that some areas of health care have gained much – but at the cost of impoverished health systems incapable of maintaining continuity of care. The opportunity to use the strength of vertical programmes to address primary health care needs and build capacity for continuity – so-called ‘diagonal strategies’ – has often been overlooked (Samb et al., 2010). Many health systems have yet to adapt the common principles learned from HIV/AIDS to NCD care.

5. There are inadequate data about population, vital registration and causes of death, unless focused on a specific disease, and very few about NCD in Africa, its prevalence, effects and care. Policy is influenced by patterns of disease in the northern hemisphere, where prominent institutions and authors extrapolate from the very limited local data and concentrate on risk factors with which they are familiar.

6. Multilateral aid follows and magnifies these distortions, resulting in perverse incentives and health systems that reflect international concerns rather than local needs (Abegunde et al., 2007). Chronic non-communicable disease is not explicitly named in the Millennium Development Goals.