Amref point of view: Africa's Pivot Moment on NCDs

The investments made in HIV/AIDS, tuberculosis (TB), and malaria have saved millions of lives. Between 2000 and 2022, AIDS-related deaths in Africa declined by 65%, malaria mortality rates fell by 37%, and TB deaths dropped by more than 35%. These gains demonstrate what is possible when political will, financing, and community engagement align.

But even as those successes continue, another crisis has accelerated to become one of Africa’s most urgent health and development challenges: non-communicable diseases (NCDs). Cancer, hypertension, diabetes, asthma, and other chronic conditions are rising fast, and health systems built for infectious diseases are struggling to adapt.

The numbers tell the story. In the World Health Organization’s African Region, NCDs now account for around 37% of all deaths, up from 24% in 2000. In many African hospitals, NCDs are responsible for a quarter or more of admissions, consuming nearly 40% of inpatient time. Out-of-pocket costs are crushing: in Nigeria, households spend nearly US$400 per year on NCD care—about 24% of average food expenditure. Across the continent, 80% of chronic care is funded directly by patients, leaving families vulnerable to poverty when illness strikes.

This rising burden is driven by urbanisation, changing diets, and weak regulation. African markets are often flooded with processed foods and sugar-sweetened drinks with fewer restrictions than in their source countries. Without stronger action on prevention—nutrition standards, agricultural reform, and public education—the health and economic costs will grow unsustainable.

There is an urgent need for African health systems to pivot toward chronic care and prevention. Dialysis should not be the first encounter with the health system for a patient with kidney disease. Instead, people must be reached earlier—through screening, education, and prevention.

Prevention first, care closer to home
Investing in prevention and downstaging disease saves lives and money. Chronic illnesses should be managed in communities, not just hospitals. Community Health Workers (CHWs) already reach remote households weekly, armed with mobile phones, blood pressure cuffs, and glucose monitors. Many travel by bicycle or motorbike, bridging the gap between clinics and villages. Properly supported, they can detect early warning signs, monitor adherence, and provide essential referrals—building the foundation of integrated NCD management.

Building trust and countering misinformation
Chronic care patients often feel hopeless and overlooked, making them especially vulnerable to misinformation. Rebuilding trust is essential. Digital health tools, including artificial intelligence, have potential, but only if rooted in strong community relationships and deployed ethically. Trust must be built from the ground up, with communities engaged as partners in their own health.

Three imperatives for Africa’s NCD response

1. Focus on health creation, not just treatment. Regulation of food production, stronger nutrition education, and healthier urban environments are as critical as hospital care.
2. Redesign health systems for lifelong, integrated care. Services must link prevention, early detection, and chronic care, while bridging physical and mental health.
3. Strengthen leadership and financing. NCDs cannot remain 80% out-of-pocket. Governments must integrate chronic care into national insurance schemes, with partners aligning behind sustainable, sovereign systems.

The stakes could not be higher. If left unaddressed, NCDs will undermine Africa’s progress against infectious diseases and widen inequalities. But this is not inevitable. With prevention-first strategies, community-driven care, stronger regulation, and political leadership, Africa can build resilient health systems fit for the future.

Africa stands at a pivot point. The path chosen now will determine whether NCDs become an unchecked crisis—or an opportunity to reimagine health systems that drive equity, resilience, and prosperity.