This World Diabetes Day, WDF highlights how patience, resilience and partnership can unify decades-long efforts into strong and sustainable national responses to NCDs.
On 14 November, the Ministry of Health in Kenya (MoH) launched a new four-year project, ‘Integrating Diabetes and Hypertension Prevention and Control into Primary Health Care’, aiming to improve healthcare across Kenya's 47 counties.
With a grant of EUR 7.1M from the Novo Nordisk Foundation (NNF) and WDF combined with partner in-kind contributions and co-funding, bringing the budget to EUR 12M, the national scale-up represents the largest WDF-supported project in terms of grant size. The significant funding and advancements made in Kenya will continue the strengthening of national healthcare at a primary healthcare level – vital in decentralisation of health services.
The launch is part of the national celebration of World Diabetes Day (WDD), celebrated annually on 14 November. This year’s campaign stresses the importance of prevention, early diagnosis and timely treatment, and access to accurate information and care – areas that the scale-up is focusing on.
DF's Sanne Frost Helt (pictured above) and Emil Morell were invited to the launch event held in Elgeyo Marakwet County, alongside key partners.
WDF's Sanne Helt with Hon. Nakhumicha S. Wafula, Cabinet Secretary for the Ministry of Health, during the festivities of the day.
‘This new project takes NCD services down to the primary health care level, which is crucial as people living with diabetes must be able to access care as close to their homes as possible', shares Sanne Frost Helt, our Senior Director of Policy, Programme and Partnerships.
‘With this project, Kenya will be at the forefront of countries in Africa to translate global commitments from the United Nations and the World Health Organization into actual improved care for communities. Having been part of the journey since WDF’s first project in Kenya in 2004, I am so proud of how far NCD prevention and care has been taken by the Kenya MoH, the Kenya Diabetes Management and Information Centre and other key partners.’
The scale-up builds on the outcomes of the first two phases, completed in 2009-2014 and 2016-2020, respectively, leveraging the decade-long collaboration with Kenya MoH and the Kenya Diabetes Management and Information Centre (DMI), a leading civil society organisation in diabetes training and research and fund manager for the project.
The first phase marked a transition from smaller scale to more sustainable engagements in supporting the national NCD response, through capacity building of secondary and tertiary care. This became one of the most successful MoH-level NCD response collaborations in the history of WDF at that time. The second phase continued with rewarding results, advancing the improvements based on the NCD strategic plan set by MoH for 2015-2020.
Despite such notable progress over the past decade, Kenya is still facing challenges in terms of NCD management at the primary care level and in the community. At least 30% of the population is affected by poverty and limited access to basic health services, while NCDs, particularly diabetes and hypertension, account for almost 40% of the disease burden.
The third phase (running until 2027) will address these gaps by aligning with Kenya's decentralised reform, bringing together national and international stakeholders and resources, and building on the universal health coverage advocacy momentum.
Kenya celebrated World Diabetes Day with cultural activities, excitement and key speeches from MoH representatives and national stakeholders.
Primary care is the first point of contact with healthcare for most people. Through capacity building and awareness, diabetes can be detected early, and complications prevented. It is therefore a core part of any sustainable programme looking to strengthen national NCD responses.
The new project is a major step towards implementing Kenya’s National NCD Prevention and Control Strategic Plan 2021-2026, developed by Kenya’s MoH and stakeholders in the NCD space. It is also one of the largest WDF investments in primary care with the ambition to catalyse NCD care and NCD integration into the universal healthcare coverage process.
This ambitious plan covers three dimensions that the new project will focus on:
Governance and decentralisation. This involves sustainable financing solutions and engagement at national and county levels. Part of Kenya’s decentralisation process is to return the power and authority to county structures responsible for primary and secondary care and community health promotion. The scale-up extended to all 47 Kenyan counties, empowering county health departments to ensure access to care by having technical working groups focused on diabetes and hypertension.
Advocacy and research. This refers to strengthening the NCD response framework and accountability and advancing the implementation research. Advocacy activities will support the prioritization and resource allocation for NCD prevention and control at the national and county levels, engaging civil society and key stakeholders such as NCD Alliance Kenya in nurturing the dialogue around health and access to care. Counties will also be empowered to develop their own action plans contributing to the universal health coverage process, alongside developing NCD-inclusive national plans and policies.
The MoH's NCD Department and key stakeholders will get support in translating the monitored data over the years into investment reports and research publications. The implementation reports could prove crucial at a broader and even global level.
Health system capability. This includes training healthcare professionals and volunteers and involving civil society in health promotion, screening, and other community-centred activities.
In Kenya, community health workers play a vital role in transforming healthcare and achieving universal health coverage - Emil Morell, WDF's Regional Advisor
The project aims to train more than 2,000 healthcare professionals, building capacity for over 350 health centres across more than 35 counties. By 2025, it also aims at having 5 out of 10 patients within blood glucose control targets and within blood pressure control targets, and affordable NCD medicines available in 80% of health facilities.
At the community level, more than 3,500 community health workers and 1,800 peer advocates are to be trained and equipped, and over 350 patient support groups are to be created in at least 35 counties.
‘In Kenya, community health workers play a vital role in transforming healthcare and achieving universal health coverage’, says Emil Morell, WDF's Regional Advisor in Kenya. ‘By providing essential services and education to underserved communities, they help to bridge the gaps between patients and healthcare services.’
‘They also reduce the burden on the system, particularly in rural settings where access to care is limited. This is why investing in community health workers is not just a cost-effective solution, but a sustainable one with lasting and far-reaching impact.’
Given the nationwide scale of the project, the targets set forth are also ambitious, aiming for the screening of 500,000 people at risk of diabetes and hypertension and ensuring the care of 120,000 patients with diabetes and 200,000 patients with hypertension.
During the launch event, the guests visited the Iten County Referral Hospital, which offers NCD care services and talked to the healthcare staff about their activity and training.
Founded on the accomplishments and lessons learned from more than 15 projects supported by WDF in Kenya since 2004, the current national scale-up has the potential to become a model for similar programmes across Sub-Saharan Africa and beyond.
It is also the latest one in a series of WDF-supported scale-up efforts in the NCD space.
For over 20 years, WDF has had a key role in diabetes care and prevention in low- and middle-income countries (LMICs). Now, the focus of the projects is on leveraging long-term partnerships and exploring opportunities to elevate their impact through scale-up.
In Tanzania, WDF’s activities serve as a best practice model and inspiration for similar large-scale engagements. The partnership has reached nationwide implementation by scaling up Tanzania’s national NCD programme (WDF11-593) launched in 2012. This second phase (WDF19-1680) is currently consolidating multisectoral collaboration and advancing an integrated NCD response at the primary care and referral level, a major milestone being that 90% of healthcare centres (level 3) have received training of healthcare professionals and medical equipment, and now report on NCDs and deliver care in communities.
Another promising example comes from Jordan. The ongoing WDF project (WDF19-1732) strives to integrate a sustainable NCD-humanitarian response supporting the refugee and host populations through capacity building at the primary care level, improved access to care for diabetes and hypertension, and prevention campaigns.
Malawi made similar great strides with an ambitious large-scale programme. The third phase of the national NCD programme implementation was just launched this autumn to advance the positive outcomes brought about by the two phases completed in the past decade. The scale-up focuses on patients with chronic conditions and the expansion of care to the primary level.
WDF's Sanne Helt joined the celebrations of the national tree planting holiday (13 November) set up by the Kenyan government to tackle the climate crisis.
The progress shows that on the horizon there is a future of sustainability and equity in health.
‘Expanding NCD services towards primary care and community levels is more important than ever, given the rising burden of NCDs affecting low- and middle-income countries’, shares WDF’s Managing Director Leif Fenger Jensen with this occasion.
‘In this sense, the large-scale engagements in countries like Tanzania, Jordan and now also Kenya and Malawi stand as noteworthy models for improved access to care’, he adds.
‘As we embark on more scalable partnerships to strengthen health systems, we are confident that we are on the right path towards improving the situation for many people living with NCDs (especially diabetes) in low- and middle-income countries.’