This essay was submitted to Open Philanthropy's Cause Exploration Prizes contest.
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Editorial note on this Document
On 21st June 2022 I was diagnosed with Type 2 Diabetics. The immediate reaction was that I felt very low, shocked and felt very overwhelmed by these diagnosis. For about two months I experienced tiredness, urinated a lot, was always very thirsty, had blurry vision and experienced pangs of hunger continuously. All along I was unaware that I had diabetes and after the diagnosis depression set in and had episodes of hopelessness.
The prevalence of Diabetes is very high in low- and middle- income countries. In my own understanding Diabetes is a chronic condition which occurs when the pancreas does not produce enough insulin. Foods and the liver produce glucose which is a source for energy for the cells that make up muscles and other important tissues in the body. The role of insulin is to lower the level of sugar in the bloodstream.
Executive Summary
Non communicable diseases (NDC) are the leading causes of death globally. In 2019, diabetes was the ninth leading cause of death with an estimated 1.5 million deaths directly caused by diabetes. (WHO)
Close to about 95% of the people suffering from diabetes have diabetes type 2, the Kenya health system is ill prepared to tackle diabetes epidemic and other NCDS. Whilst the country is still grapping with how to handle NCDS, this occurrence has placed a huge burden on the country’s health care system coupled with inadequate training of health care workers.
It is therefore important to mainstream a very complete multidisciplinary diabetes approach in the national health care system as part of its response to NCDS.For technical support and to ensure cost effectiveness and sustainability philanthropists need to focus on how to sustainably contribute to diabetes management in sub-Saharan Africa where such diseases are adversely neglected.
Sources of uncertainty
My major sources of uncertainty were:
That urbanization and Western lifestyles have led to a high prevalence of diabetes, whilst well known factors such as poor dietary intakes and lack of physical activities are key contributors for the disease.
Secondly there are well trained health care workers helping the prevalence of such conditions whilst well known that few workers have specialized trainings around diabetes.
That certain risk factors such as race are predominantly visible for the spread of the disease whilst sedentary lifestyles are the biggest risk factors.
Summary
What is the problem?
Kenya has a very high burden of disease. With communicable disease playing are very huge toll on the health care system of the country. Disease such as malaria and HIV are accounting for about 69% of Deaths in the country. The average life expectancy in 2016 was 62.2 years, up from 51 years in 2004. The population growth rate has remained high at 2.7% per year, with a large number of young and dependent populations that is increasingly urbanized. The burden of disease has led the life expectancy of the country to be around 57 years of age. Over the years the Government together with stakeholders have managed to contain communicable disease through concerted efforts but unfortunately non-communicable diseases have proved to take a huge toil on the country’s health care system. The World Health Organization (WHO) estimates that the prevalence of diabetes in Kenya at 3.3%.The huge demand for both CD and NCD has slowed down Kenya’s effort in achieving the Millennium Development Goals. It is imperative that the country review the huge burden of diabetes and provide cost effective strategies for its deterrence and control.
The financing of Kenya’ health system is far from been good. The health care infrastructure is wanting with almost 65% of rural folk unable to access health facilities. Close to about 43% of Kenya’s health care system is operated by private business, government operates closely to 41% and non state actors about 15%.
The Total Health Expenditure (THE) in Kenya was Kshs 346 billion (USD 3,476 million) in 2015/16, up from Kshs 271 billion (USD 3,188 million) in 2012/13. Total health spending in 2015/16 accounted for 5.2% of GDP down from 6.8% in 2012/13. The government expenditure on health as a percent of total government expenditure increased from 6.1% in 2012/13 to 6.7 % in 2015/16. (A Case for Increasing Public Investments in Health)
In East Africa the average total annual cost for care of a type 1 diabetic is 229US$ with 60-70% of this being used to purchase insulin. Kenya does not have adequate funds for diabetes prevention or care. Kenyans who can, independently fund their care, leaving many diabetics and their families at risk of poverty and poorer health (Tiffany L.E. Jones)
Sources of uncertainty
Unstructured health system
Prevalence of unstructured health systems exists to address diabetes. Mainly level 4 and level 5 hospitals provide some support for diabetes patients. However local dispensaries and health centers don’t have the expertise or the resources to intervene. Widespread disparities in provision may be attributed to socio-economic, gender and geographical differences, with only 77% of Kenyans who are ill utilizing the healthcare available. Health worker distribution is also uneven, with greater numbers in hospitals and urban areas. Hospitals often have public and private levels co-existing, managed by the by the same staff. Conditions within public wards are poor compared to the unaffordable private wards. (Tiffany L.E. Jones)
Administration of diabetes in Kenya
Managing diabetic patients in the country usually is a long term treatment process. It’s a chronic condition that only can be managed, with no cure except exceptional cases. Unfortunately the health care infrastructure including staff has inadequate preparations including trainings for staff and treating emergencies. Lack of expertise and skills at local health centers has exposed many uninformed patients to hyperglycemia, a condition where the level of sugar in your blood is too high.
Low availability and the high costs of insulin
Though the Kenya Government together with donors has almost zero rated insulin to reduce its huge price through subsidies, there is always low availability of insulin supplies. The private sector is still not very regulated in terms of price and always takes advantage of diabetic patients exploiting them exarbating their already vulnerable socio economic conditions. Majority of private pharmaceutical companies always put a markup of about 60% profit for insulin.
High Diabetic hospital admissions
Over 50% of all adult admissions and 55% of deaths are diabetic related in Kenya. Many patients in the country have very poor glycamic control.
Knowledge towards diabetes
There is a low level (perhaps under 30%) of public awareness and knowledge about diabetes in Kenya. Knowledge differs according to education and region. Most patients have poor behaviors’ towards diabetes, 41% show an unwillingness to adopt healthier lifestyles. Although an increased level of knowledge is associated with good practice for diabetes prevention, 49% with adequate knowledge failed to put this into practice. (Tiffany L.E. Jones)
Tractability
In my view diabetes is tractable with the right interventions. Data on diabetes is readily available but reouces and readily available interventions are either too costly or inadequate.
Prevention, early detection and control of diabetes
Awareness and knowledge on the prevention of diabetes is very important in the control of disease. People suffering from diabetes need a lot of knowledge on its prevention. A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
Establishing of diabetic clinics
The prevention of diabetes is closely linked to the availability of health care services for patients. A Diabetes Education Programme has to be implemented for healthcare staff (Tiffany L.E. Jones)Access to these clinics especially in rural settings has remained to be a challenge for patients. Logistical challenges are very rampant in the rural areas.
Resource allocations
More resources need to be deployed if prevention and control must happen. Effective primary care should lower hospital admissions and reduce overall cost.
Possible interventions
Establishing of diabetes clinics at local hospital, dispensaries
Capacity for diabetes patients at local health centers should be established to assist patients access health care.
Low cost of insulin and drugs
Government should enforce policies around cost for diabetic patients. Insulin should be available and accessible to diabetic patients.
Database for diabetic patients
There should be a database for patients and statics to promote prevention. This helps in allocating necessary budgets, zoning for clinics and overall diabetic programming. The lack of clear data on the epidemiology of diabetes makes informed policy decisions difficult
Training of health care providers
Adequate training should be provided at local levels for health care providers .This will help disseminate information and enhance treatment of health provision.
Increase funding
Funding programs needed to b increased. Funding is still a major challenge for success of implementation. Funding needs to be reassessed and allocated appropriately, with a greater proportion to NCDs especially diabetes. A lower financial burden on individuals by increasing public funding should
- Reduce poverty,
- Increase treatment compliance,
- Improve diabetic control and
- Reduce complications, thus
- Reducing further burden on healthcare services.
Conclusion
Kenya has a challenging health landscape with the burden of diabetes and other NCDs adding to the existing challenge of CDs. Tackling the burden of diabetes presents many difficulties. There remains inadequate funding for the effective implementation of an effective strategy for the prevention, detection and management of diabetes. Lack of awareness and an increasing prevalence of diabetic risk factors are critical obstacles to overcoming diabetes in Kenya
References
https://www.who.int/news-room/fact-sheets/detail/diabetes
How serious is the Impact of Type II Diabetes in Rural Kenya? Hemed El-busaidy
A Case for Increasing Public Investments in Health Raising Public Commitments to Kenya’s Health Sector, Njuguna David
https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
Diabetes Mellitus: the increasing burden of disease in Kenya. Tiffany L.E. Jones
https://www.worlddiabetesfoundation.org/projects/kenya-wdf09-436