KIGALI, Rwanda – At least two-thirds of the cost of treating non-communicable diseases (NCDs) is carried by patients, and civil society advocates are pressurising governments to step up.

Over 700 NCD advocates from 89 countries have gathered in Kigali for the Global NCD Alliance Forum to press for meaningful targets to be adopted at the United Nations High-Level Meeting (HLM) on NCDs in September.

One billion people are living with obesity, 1.3 billion with hypertension, a billion are living with a mental health disorder, and half a billion people living with diabetes and chronic respiratory diseases. 

“In the five short years since we last held the forum, in Sharjah in the UAE, we have lost 215 million people to NCDs. To put that in context, that is the population of Nigeria,” said NCDA CEO Katie Dain.

“We live in an era of polycrisis, with pandemics, climate change, conflicts and humanitarian crises locking horns across the globe.

“The Trump administration’s recent freeze on development aid and the potential dismantling of USAID has sent a shockwave through the global health community,” added Dain at a media briefing on Thursday shortly before the forum opened.

“It is paralysing health programmes that are providing lifesaving medication and treatment to people and turning upside down the health financing landscape as we knew it. Any hit to global health financing is a hit for all health issues, including NCDs.”

Describing the last five years as a “policy success but an implementation failure”, Dain outlined the NCDA’s five priorities for the HLM.

The first is the accelerated national implementation of evidence-based NCD policies.

Breaking down silos in global health, sustainable financing, accountability for delivery and community engagement make up the other priorities.

Kenyan cancer survivor Prisca Githuka drew attention to the “financial toxicity” faced by African patients living with NCDs, highlighting that her breast cancer treatment cost around $35,000.

“African patients are told to go and buy their own drugs. Where do you get chemotherapy drugs in Kenya? There are also problems with the radiation machines. You can wait three months to get treatment then the machine breaks down,” Githuka told the media briefing.

Rwanda’s NCD successes

Rwanda was chosen as the first African country to host the forum because of its success in addressing NCDs.

Just this week, the government doubled its tax on tobacco products and imposed a 65% tax on beer, Dr Yuvan Butera, Rwanda’s Minister of State for Health, told the opening plenary.

Through taxes and curbs on smoking in public, the number of smokers has been reduced from 13% in 2012 to only 7% currently. It has also managed to reduce diabetes slightly.

Almost 60% of Rwandans are now dying from NCDs, and the country has reoriented its health system from treatment to prevention, said Butera.

The health system has been decentralised to ensure people can get treatment close to their homes at health posts (primary health clinics staffed by a few nurses). Staff at district hospitals have been trained to manage NCDs.

The bottom rung of the health system is community health workers, over 58,000 of them spread in over 14,000 villages 

Over 90% of people are covered by Community-Based Health Insurance (CBHI), with a sliding payment scale based on income. The country is incrementally increasing what the CBHI can cover and recently extended coverage to kidney dialysis and heart surgery.

Focus on prevention

Over 95% of Rwandans get the required exercise of at least 150 minutes a week, although this is mostly through their work, explained Dr Uwinkindi Francois, NCD Division Manager at the Rwanda Biomedical Center.

But exercise features big in the country’s NCD programme. Since 2016, the capital city of Kigali has held “car-free days” in the city – currently twice a month – to reduce air pollution and promote exercise. During this time, screenings are also offered for various NCDs. Every Friday, work ends at 3pm in the city to enable people to exercise.

NCD awareness is also integrated into school health programmes.

But it is struggling to contain alcohol consumption and hypertension.

In preparation for the HLM, Butera urged stakeholders to work together to take action against NCDs.

“Governments need to increase financing and integrate prevention and treatment of NCDs into universal health coverage,” said Butera, while urging the private sector to invest in innovative solutions to bridge access gaps to treatment.

“Civil society must amplify patients’ voices.”

Image Credits: Rwandan Biomedical Center.