Hidden in Plain Sight: East Africa’s Battle Against Non-Communicable Diseases
Non-communicable diseases (NCDs) – the chronic health conditions resulting from complex interactions between genetic predisposition, physiological factors, environmental exposures, and behavioral patterns – have emerged as the most pressing public health challenge of the 21st century. While they account for a staggering 71% of all global deaths annually (approximately 41 million lives lost), nowhere is this crisis more acute than in Sub-Saharan Africa, where NCDs are advancing at an alarming rate. Current projections indicate that they will surpass the combined burden of communicable, maternal, neonatal, and nutritional diseases as the leading cause of mortality by 2030.
The region faces a particularly devastating quartet of NCDs: cardiovascular diseases (responsible for 17.9 million deaths annually), various forms of cancer (9.0 million), chronic respiratory diseases (3.9 million), and diabetes (1.6 million). Together, these account for more than 80% of all premature NCD deaths worldwide. The East African Community (EAC) mirrors this troubling trend, whereby in 2015, NCDs contributed to 40% of the deaths in Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda. According to the WHO disease burden and mortality estimates, the proportion of all deaths in the WHO Africa region attributable to NCDs increased from 22.8% (2.2 million) in the year 2000 to 34.2% (3.0 million) in the year 2016. Of these, 27% were from Kenya, followed by 32% from Burundi, 33 % from Rwanda and Uganda each, and 44% from Tanzania. Cardiovascular diseases caused 13% of all NCD-related deaths, followed by malignant neoplasms (5.9%), respiratory diseases (2.1%) and diabetes mellitus (1.9%).
The epidemiological transition in Sub-Saharan Africa has been remarkably rapid; between 1990 and 2017, the proportion of all disability-adjusted life years attributable to NCDs surged from 19% to 30% of the total disease burden. This dramatic increase has been fueled by multiple interconnected factors including rapid urbanisation, shifting dietary patterns towards processed foods, increasingly sedentary lifestyles, rising air pollution levels, and the growing prevalence of key risk factors such as hypertension, obesity, diabetes, and dyslipidemia.
The financial implications of this health crisis are staggering in their magnitude. While up to 80% of NCD cases could theoretically be prevented or have their onset significantly delayed through relatively low-cost public health interventions, the global response has been woefully inadequate. Development assistance for health has consistently allocated only 1-2% of its resources to NCD prevention and control over the past two decades. This paltry investment stands in stark contrast to the $1.8 trillion spent annually on fossil fuel and agricultural subsidies worldwide, highlighting the profound imbalance in global spending priorities. Furthermore, treatment of the five leading NCDs – cardiovascular disease (CVD), chronic respiratory disease, cancer, diabetes and mental health conditions – have been estimated to cost US$ 47 trillion between 2010-2030, an average of more than US$ 2 trillion per year.
For individuals and families across sub-Saharan Africa, the economic impact of NCDs is nothing short of catastrophic. In Uganda, for instance, the monthly cost of managing diabetes and hypertension approximately amounts to a figure representing fully one-third of the average monthly income. This creates an impossible dilemma between healthcare and other necessities like food and shelter. The situation is particularly dire in low- and middle-income countries, which bear 85% of the global burden of premature NCD deaths (occurring between ages 30-70) yet lack the healthcare infrastructure and financial resources to mount an effective response. Compounding these challenges is the severe shortage of reliable epidemiological data in many African nations, making it difficult to develop evidence-based investment cases or implement targeted prevention strategies.
The human and economic costs of continued inaction are too grave to ignore. Without urgent and coordinated intervention at both national and international levels, NCDs threaten to reverse decades of hard-won health gains and perpetuate cycles of poverty across the region. There is a need for decisive action before this slow-moving epidemic becomes an irreversible catastrophe for Sub-Saharan Africa's health systems and economies.
Reasons for the Rise of NCDs
The escalating burden of NCDs in East Africa stems from a complex interplay of behavioural, metabolic, and environmental factors, compounded by rapid societal and demographic shifts. At the heart of this crisis lies the region’s increasingly sedentary lifestyles, driven by urbanisation, globalised trade, and shifting work patterns. As populations migrate to cities, physical activity declines, replaced by desk-bound jobs and prolonged inactivity, while unhealthy diets high in salt, sugar, and processed fats become more accessible. These behavioural risks fuel metabolic disorders like hypertension (linked to 25% of global NCD deaths), diabetes, and obesity, creating a vicious cycle that exacerbates disease susceptibility.
The region’s environmental landscape further accelerates this trend. Air pollution – both indoor (from biomass fuels) and outdoor (from vehicular and industrial emissions) – contributes to 6.7 million global NCD deaths annually, including respiratory and cardiovascular diseases. Meanwhile, climate change intensifies food insecurity, limiting access to fresh produce and perpetuating poor nutrition. Adding complexity is the intersection with infectious diseases. Improved HIV survival rates have led to an ageing population of people living with HIV (PLWH), who face heightened risks of diabetes and coronary artery disease.
The COVID-19 pandemic further disrupted NCD management, as lockdowns restricted physical activity, limited healthcare access, and exacerbated mental health stressors. Underpinning these factors are commercial and social drivers, such as aggressive marketing of tobacco and alcohol, which exploit regulatory gaps in low-income settings. Without systemic interventions targeting these root causes – from urban planning to integrated HIV-NCD care – East Africa’s NCD crisis will continue its unchecked rise, straining health systems and reversing decades of progress.
Current Efforts to Combat NCDs
Tanzania exemplifies the multi-tiered approach required to address the growing burden of NCDs in East Africa, where coordinated national and regional strategies are proving critical. At the national level, Tanzania’s Ministry of Health has launched an NCD program, supported by partnerships with local and international stakeholders. This initiative has produced evidence-based guidelines, strengthened healthcare worker capacity, and amplified community awareness through annual National NCD Week campaigns, all under the high-level coordination of the Prime Minister’s Office to ensure political commitment and multi-sectoral engagement. Tanzania’s efforts highlight the importance of aligning NCD interventions with local resources, such as integrating NCD screenings into existing HIV/AIDS programs, to maximize reach and sustainability.
Regionally, the East Africa NCD Alliance has established an NCD desk at the EAC Secretariat, marking a pivotal step toward unified action. Chaired by public health specialist Dr. Michael Katende, this initiative aims to elevate NCDs as a standalone agenda item at EAC summits, advocate for policy prioritization, and develop a five-year regional NCD framework–drawing on best practices from member states like Kenya, Uganda, and Rwanda. By fostering collaboration across technical working groups and ministerial councils, the Alliance seeks to address cross-border challenges such as air pollution and unhealthy diets through policies spanning health, agriculture, and transport sectors.
Challenges facing the battle against NCDs
The COVID-19 pandemic severely disrupted East Africa's fight against NCDs, exposing and exacerbating systemic weaknesses. Health services for hypertension and diabetes were interrupted in 59% and 56% of African countries respectively, and substandard medicines further compromised care whereby 20% of hypertension drugs in Rwanda failed quality tests.
The diversion of resources to pandemic response strained already fragile systems, where 7.2 million healthcare worker shortages and fragmented infrastructure left NCD patients vulnerable.
Economic shocks intensified the crisis, as families facing reduced incomes struggled to afford chronic care as illustrated by how diabetes treatment in Uganda consumed one-third of the average monthly income. The pandemic's legacy underscores an urgent need to rebuild resilient, integrated systems that prioritize NCDs alongside infectious diseases.
Conclusion
The disconcerting rise of NCDs in Africa demands timely and resolute action that addresses both systemic weaknesses and emerging opportunities for collaboration. As they currently account for about 40% of deaths in East Africa and are projected to become the region's leading mortality cause by 2030, half-measures cannot suffice. The critical gaps exposed by the COVID-19 pandemic, such as medication shortages and disrupted hypertension care in over half of African nations, underscore the need for resilient health systems. Tanzania's integrated NCD program and the East Africa NCD Alliance's regional framework demonstrate promising approaches, leveraging multi-sectoral collaboration and existing HIV infrastructure.
However, with NCD care consuming 22-33% of household incomes and global health aid allocating just 1-2% to NCDs, transformative steps are imperative, establishing regional drug procurement systems, and empowering civil society to drive accountability–as seen in HIV advocacy. Climate action must be incorporated, given the role of air pollution in NCD deaths, while universal health coverage frameworks should prioritize primary care strengthening. By combining political will, cross-border cooperation, and community-centered solutions, the region can turn the tide against this slow-moving epidemic before it becomes irreversible. Much as the solutions exist, collective participation by stakeholders is needed to implement them at scale.
