Africans Could Lose Gains in Longevity
NAIROBI, Kenya — Hannah Wanjiru was plagued by dizzy spells and headaches for years. After a half-dozen costly trips to the doctor, she was finally diagnosed with high blood pressure. It took two more years — and some fainting spells — before she started to take medication. By then, her husband, David Kimani, had been shuttling between doctors himself and ended up with a diagnosis of diabetes, another condition the couple knew nothing about.
Not far from their apartment in the Kenyan capital, there is a public hospital where treatments for H.I.V. and tuberculosis are free. Posters for free H.I.V. prevention services paper the streets in their low-income neighborhood.
There is no such program for high blood pressure, diabetes, cancer or chronic respiratory conditions. The health systems in Kenya and much of sub-Saharan Africa — and the international donations that support them — are heavily weighted to the treatment of communicable diseases like H.I.V. and malaria.
The medications and supplies Ms. Wanjiru, 44, and Mr. Kimani, 49, need to control their conditions cost $60 each month, a huge portion of the income from their small convenience store. Both skip their medication on months when school fees are due for their four children.
Success in fighting H.I.V., tuberculosis and other deadly infectious diseases has helped countries in sub-Saharan Africa achieve extraordinary gains in healthy life expectancy over the past two decades — 10 additional years, the largest improvement in the world, the World Health Organization reported recently.
“But this was offset by the dramatic rise in hypertension, diabetes and other noncommunicable diseases and the lack of health services targeting these diseases,” the agency said. It warned that the rise in life expectancy could be erased before the next decade is out.
Noncommunicable diseases now account for half of hospital bed occupancy in Kenya and more than a third of deaths. The rates are similar across the rest of sub-Saharan Africa, and people in this region are being affected at younger ages than in other parts of the world.
Routine screening for conditions such as high blood pressure is rare, diagnosis rates are low and care is often available only at specialized centers in urban areas. The public is not aware of the ailments — everyone can recognize malaria, but few connect blurry vision or exhaustion with hypertension — and primary care health workers often do not know what to check for.
A fraction of Kenya’s health budget goes to noncommunicable disease — 11 percent in 2017-18, the latest figures in the government’s strategic plan — and those funds are mostly earmarked for expensive curative services such as radiation machines at cancer clinics and kidney dialysis centers.
“But people come with cancers that are already Stage 4, with very little chance of survival, because they cannot get diagnosed,” said Dr. Gershim Asiki, a research scientist at the African Population and Health Research Center, an independent organization in Nairobi.
Dr. Asiki speculated that the government had been slow to roll out screening programs because there was no way it could respond to the extent of the problem.
“If you screen, you will pick cases that are treatable,” he said. “But do we have the resources to treat them?”
Common illnesses go undiagnosed and untreated.