Reframing Non-Communicable Diseases and Injuries for Equity in the Era of Universal Health Coverage: Findings and Recommendations from the Kenya NCDI Poverty Commission.

Background: Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya. Methods: Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence. Findings: There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030. Conclusions and Recommendations: An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs

Factors associated with school personnel’s support for tobacco control policies in Ugandan schools during 2007 and 2011

BACKGROUND: This study sought to identify factors associated with school personnel’s support for tobacco- free policies in Uganda in 2007 and 2011. METHODS: Data were obtained from the combination of the 2007 (n=515) and 2011 (n=682) Ugandan Global School Personnel Survey (GSPS). Analyses included chi-square statistics and multivariate logistic regression. RESULTS: Of the participants, 92.9% supported the tobacco- free policies and 61.9% (n=727) of the schools had a policy restricting tobacco use within the school premises by personnel and students. However only 52.8% (n=370) of those with school policy reported complete enforcement of the school policy. A greater proportion of non-smokers than smokers were in support of a school policy (94.8% vs. 57.7%; p<0.05). Believing that teacher tobacco use influences student use (OR=8.9; 95% CI= 2.41- 33.47) and supporting increase in price of tobacco products (OR=6.4; 95% CI=1.34- 30.58) were significantly associated with support for policy. Those who supported school tobacco-free policy were also more likely to be of the opinion that tobacco industry should be allowed to sponsor school events (OR=4.4; 95% CI= 1.26- 15.23). CONCLUSIONS: Tobacco control interventions should promote personnel’s enforcement of the policies and raise awareness of Tobacco Industry Advertising Promotion and Sponsorship (TAPS) strategies.Dissertation (MPH)--University of Pretoria, 2015.tm2015School of Health Systems and Public Health (SHSPH)MPHUnrestricte

Devolving tobacco control legislation to local governments for enhanced capacity in tobacco control advocacy and implementation

Background and challenges to implementation Kenya inaugurated a new constitution in 2010 that created a devolved system of government comprising of a National Government and 47 County Governments. This altered the governance structure in all sectors including health, consequently affecting implementation of Tobacco Control (TC). Even though Kenya has Tobacco Control Act, 2007, certain provisions of the Act have to be implemented at the county level. However, the counties had limited awareness and capacity to perform the new roles in TC implementation. Furthermore, Tobacco Industry targeted counties as the next frontier for killing TC. The challenges necessitated technical support and capacity in TC for the counties to develop local legislation. Intervention or response We carried out desk assessment on TC legislation framework to identify gaps to be addressed. Two research studies were done in selected counties to inform advocacy activities. A model county TC Bill benchmarked with the Framework Convention on Tobacco Control (FCTC) was developed for the counties to adapt to their local situations. Key stakeholders were identified- county health executives, assembly members and Civil Society Organisations (CSOs) who were trained on TC legislation development and advocacy. Results and lessons learnt The model law presented to counties how effective TC legislation should be structured. Different approaches worked in different counties; either presenting the law to the County Assembly as a private member's bill or using county health executives to front the bill. Through the project, awareness on TC at the counties increased, capacities enhanced and interest on the topic generated that made the process demand-driven by county stakeholders. Conclusions and key recommendations TC legislation established at the county level, local capacities on TC built and TC implementation devolved to the local level. Such an approach can be applied in other areas of public health, where local governments are given power to develop and enforce laws suiting their situations

Smoking out the lies: documents research on tobacco tax policy in Kenya

Background Tobacco Industry (TI) interference in policy development and implementation in Kenya has been widely reported in both local and international media outlets. A local newspaper, Daily Nation, dated 22 nd November, 2004, reported that when the current tobacco control law was tabled in parliament, British American Tobacco Kenya (BATK) and Mastermind Tobacco Kenya (MTK) organized a weekend-long retreat in Chale Island, for 40 Members of Parliament (MPs) to lobby against the Bill. Despite the passage of the tobacco control law in 2007, the TI still had its way in influencing tobacco tax and price measures using different tactics. We carried out this project therefore, to expose and document these tactics employed by the TI in Kenya. Methods The Truth Tobacco Industry Documents Archive (http://legacy.library.ucsf.edu), a database compiled by the University of California in San Francisco in 2002, served as the primary source of information for the study. Key Informant Interviews were purposively sampled from relevant government ministries and agencies, civil society and other actors. The findings from the library and the KII, were then triangulated with statements from industry and government officials and other related articles in newspaper stories and publications. Results We established that the tobacco industry in Kenya has repeatedly used 6 main tactics to influence tobacco tax and price policies, they include: use of front groups, use of tobacco advertisements, promotion and sponsorship, influencing policy development and legislative processes, Illicit and Deceptive Trade Practices, Intimidation and Litigation, Phony statistics and researches. Conclusions The TI armed with their financial muscle and high-powered political connections, will go any distance to achieve their goal for profit. However, their tactics and strategies in interference has been similar over the years. This implies then, that awareness of these tactics by policymakers will go a long way in preventing future TI interference