 Kwa kia k pictu huzi, kwa kia kintu mwaa kisha u secondly maik existe? Ida. T teammates kwa kua kwa kia wiki huzi, mwaa kwa kwa kiza u jiwa. NCD Alliance of Kenya. She will help us to understand how the situation has been during this COVID-19 or since COVID-19, how have they been faring on the people with non-communicable diseases and what needs to be put in place as far as the government is of concern and the Ministry of Health. Send us your comments to all our social media platforms, the Y254 channel on Facebook and Instagram, at Y254 channel on Twitter. My name is Dereva Hilayi. Welcome to the broadcast. Good morning, Datari. Good morning. It's a pleasure to have you here. Thank you. Now, um, I think it sounds a joke, but many people do not know what non-communicable diseases are. Uh, nese skia tum tamese mwa gondzhengi nola fukwa like, is it communicable? No, I know a number of them, but why don't you tell us, our viewer, what non-communicable diseases are? Non-communicable diseases are diseases that you get not from one person to another. They are chronic conditions and the best way to explain this is by giving examples. For instance, diabetes, we all know about diabetes. Most people know about diabetes, high pretension, cardiovascular diseases. We have asthma, which is quite common, especially among children. And then you have kidney failures, kidney diseases, just to use simple terms so that we can all understand. And sometimes when we use the term non-communicable diseases, it can be very confusing, especially for a lot of our people in the communities. You also have sicko cell, which is also another big NCDs. And currently we are also looking at mental illness as part of the diseases that we consider non-communicable. In fact, WHO now considers them non-communicable diseases and mental health. So they've been packaged into one. In terms of prevalence of non-communicable diseases, over time the numbers of people suffering from non-communicable diseases have gone high. Every one of us knows somebody who has diabetes. We know somebody who has hypertension. We know somebody who has cancer. Or we know somebody who has cancer. We know many children who have sicko cell. Some people are undergoing dialysis. A lot of us have contributed to some of these medical expenses. So non-communicable diseases are arising conditions that are really disenfranchising many countries in the world. Kenya is one of those countries whose prevalence and levels of premature death to non-communicable diseases is going up. You told me just before, you also have a close person in your family with hypertension and diabetes. My mother has hypertension. So each one of us has a story to tell of somebody or a relative or friend or ourselves who are taking treatment for non-communicable diseases. We are in a pandemic which is COVID-19 and for a couple of times we have had officials from the Minister of Health and even the WCHO saying there are people with underlying conditions. I would want to know, maybe do you have the statistics how COVID-19 patients have been fearing on especially with underlying conditions in our country? How is the situation? Do we have guidelines for them? Do we have protocols for these particular persons now that we've been told over time of underlying conditions? Yes, and this is just not in Kenya. It's global that there's a realization through this pandemic that globally we haven't paid adequate attention to NCDs. Tedros in launching this week for NCD activities talked about the pandemic really exposing our level 1 preparedness to deal with non-communicable diseases. If you look at the almost 33% to 35% of the fatalities of people who have passed on in Kenya have been due to non-communicable diseases as an underlying condition. That said, I think we've seen some level of stigma towards people with an underlying condition or some level of brevity of people saying because I don't have an underlying condition I shall not get COVID-19. And as CS Cargo says, we all can get it. What the problem, the challenges being is that the severity and the outcomes for people with underlying conditions are worse than if you do not have an underlying condition. And therefore I have some statistics here which I didn't want to, I carried with me so that we can look at what has happened over time that almost 33% of the fatalities have been due to non-communicable diseases. High potential has accounted for around 17%. Diabetes 15%, chronic lung disease 10%, cancer 10% and HIV 4% of the fatalities. It doesn't mean that if you have diabetes and you get COVID, you will die. I think we need to clarify that. It just means that the outcomes will be a bit more severe than if you didn't have. But also what has happened, Hillary, is the fact that then people who have these conditions are scared to go to a health facility or even families are worried that you see them start having a cold, a cough and you think, oh, COVID has arrived. So what do we do? You go into a panic. I think what we are assuring people is that the government has released protocols on how to prevent yourself from getting COVID-19. We know about social distancing. We know about wearing masks. So whether you have an underlying condition or not, you need to wear a mask. You need to social distance. You need to sanitize. And also if you do not have this condition and you live with someone with that condition, you should protect this person from getting exposed to COVID by protecting yourself. So it's a whole of society action. It's a whole of society behavior change that you are protecting ourselves and you are protecting our loved ones from getting infected with COVID-19. But for those with underlying conditions, especially non-communicable diseases, there are protocols that have been released by the government. What we want to tell them is that go for your routine care. Access, find mechanisms of getting access to your regular treatment. Make your visits to your physicians. If you cannot make the visits in person, have calling with your physician to ensure that you do not miss your routine care from the physicians. Again, for people without these conditions, we've seen a lot of... In terms of our behavior change perspective, we've seen a lot of negligence on the part of many people. Right. People have stopped wearing masks or if they wear them, they wear them on their chains. People have stopped washing hands. People have stopped caring. You walk around, you drive around and you basically are wondering, has COVID ended? We really flattened the curve. Are we believing that the curve has flattened? Especially now the numbers are going down. Especially now the numbers are going down and why are the numbers going down? I think we still cannot lower our guard currently because the infection is still with us and we need to protect each other from getting exposed to COVID-19. Before we get to the agenda of the year on NCDs, do you think people or persons with non-communicable diseases during this particular period of time have been given keen attention by the government or it was before? How is the situation now? Have they been catered for better compared to before COVID or it's now even worse? I think what COVID has done and I started by saying what Ted draws. Dr. Ted draws was the general director of WHO Global. Say it is true to Kenya. He mentioned the fact that the pandemic has actually shown us we haven't paid enough attention to NCDs. If you look at budget allocation by the government around 6% of the health budget goes into NCDs. The numbers may have changed but we checked as of July that was the rate. I think what has happened especially with everybody focusing on people with underlying conditions has been most exposed to infections and the outcomes being worse. What has happened is there is more attention to NCDs currently at the national level. The Acting DG for Health in Kenya, Dr. Moth released guidelines very early to all county governments in terms of ensuring that routine clinics for NCDs continue and encouraging and advising people with NCDs on taking extra care to ensure that they do not miss their routine care, they continue the medication so that they can be protected. I think there's a lot more attention to NCDs now than initially. And I think as a country and globally really the rally to focus on NCDs has been going on, the call to action for NCDs. This has come up with the realization that a lot of hospitals are spending a lot of time, health workers are spending a lot of time caring for people with NCDs. We have been told that hospital admissions are 50% for NCDs, deaths account for almost 30% of the deaths are due to NCDs and some statistics actually show hospital deaths 50% are due to NCDs. So I think increasingly and with the pandemic we are now getting a lot more traction to addressing NCDs in a more focused way than we have seen. But again it's not about lip service. It's about investing in the health infrastructure. It's about commitment to addressing the risk factors for NCDs and active participation of people living in NCDs in the fight against NCDs. I understand it's a weak global for NCDs. What is the call for this particular agenda in this week? In 2011 there was a UN summit that addressed NCDs. It was the second one after HIV. In that we were looking at mainly the four NCDs the four risk factors and four NCDs we were looking at diabetes hypertension, diabetes cardiovascular diseases, chronic lung diseases and chronic lung diseases. So after that and the four risk factors which were mainly poor diets, lack of physical activity, harmful use of alcohol and tobacco use. Now increasingly then we added on mental health and also air pollution as a key risk factor. So over time we've had commitments made by government. We have commitments made by private sector. We have commitments made by individuals in terms of supporting the call to action but the annual week therefore is a call for action on NCDs which draws on outrage, energy, inspiration, determination and optimism to focus efforts on ensuring NCD prevention and control, get the attention and the action that's required. So essentially the campaign theme for 2020 is accountability, a crucial force for good governance, political and programmatic change. Again we make commitments. As a government we sign on it. As our president attended the UN summit we said we will commit to strengthening the health system. We'll commit to providing access to essential care but when it comes to implementation we always run short and therefore the call is on accountability pushing for progress that we've made all these commitments over time and we are signatories to all these commitments. However when it comes to implementation we run short and therefore we are calling for accountability, we are calling for governments to recommit to supporting and making an input into fighting NCDs and also given the fact that the pandemic is here and as shown as the flaws in the way we manage NCDs we are then being reminded that this is the time to act and all of us can act on NCDs. Alright now as you make the call to the government who are you targeting who can participate and what is the role of the NCD Kenya? NCD Kenya brings together all stakeholders in NCDs in the country NGOs, government agencies, asoziations, individuals, civil society organization so it's an asoziation that brings together every actor on NCDs and we actually really encourage people living in NCDs and we have a platform for them to come and talk about NCDs in the country and especially how they affect them. So the call is for all of us to take action is for government, setting with the office of the president to the office of the CS to our county leadership, MPs, women reps, MCS every decision maker because we are all affected we are all in this together and the need for all of us to take action and to be part of the accountability process that we've made this commitment every single day we are losing people to NCDs every single day we are having a harambe here or there people are dying of preventable diseases and I think that's what we need to say NCDs are preventable we do not want to lose people to conditions that are preventable and that's why we stand here, we sit here we attend these conversations to tell people that we can prevent NCDs and where we cannot prevent them and take care of our patients better and where we are losing patients we can provide palliative care for our patients and for our sisters and brothers who have NCDs so the call is for all of us to act and act with purpose and act with commitment to ensure that we prevent and if we cannot prevent we provide the adequate care for people living with NCDs you just mentioned that 6% is allocated to the NCDs by the government but I'm also looking into if the government can help us prevent the NCDs what are these particulars that can be done what are these things that need to be done to prevent what is the role of the government and even when it comes to controlling how else can we control the persons with non-communicable diseases in our society so if we look at the key risk factors we start there tobacco use we have tobacco legislation and sometimes it's just enforcement harmful use of alcohol again you have alcohol advertisements running all the time we have a law that limits alcohol advertisements we have a law that limits alcohol consumption for children we have a law that limits the hours of when retailers can sell alcohol so on alcohol there's a lot of enforcement that needs to be done and we say harmful use of alcohol and then you have poor diets again there's the culture of fast food in this country where eateries are just being promoted sugary drinks some countries are putting place as sugar tax and therefore in those countries you begin to see a reduction in the consumption of sugar sugary drinks and then the other one is on air pollution so what are we doing with air pollution in this country where we in terms of globally even in terms of the emissions so these are things we can prevent then physical activity again we've seen a lot of activity around during this COVID period we saw a lot of people take off where they are running shoes begin to run on the streets so encouraging physical activity when children go back to school ensuring that physical activity is part of what they do on a regular basis so if we look at the risk factors they are best buys and best practices that can be implemented with the support of the system and ensuring that we begin to also sensitize our children and our communities on how best they can protect themselves from NCDs again they are called lifestyle diseases and we are all culprits on some of our behaviors in terms of exposing ourselves to NCDs in this country actually you just mentioned something I wanted to bring you on a condition like diabetes is called lifestyle do you think we have good public awareness in terms of what sugar is can do or what they can do to you do we have that discipline of fast foods and what we should be having in terms of diet and nutrition the biggest challenge I think is our health seeking behavior as a people also and as much as we talk about these things is do we really think we are at risk do we go for screening for instance only 44% of Kenyans have ever been screened for hypertension blood pressure and also maybe when we go to a health facility is not readily offered or there are other challenges in terms of when I go there I have gone for malaria treatment or for antinatal care we routinely then assessed for blood pressure for blood sugar is even more dire the steps have been done in Kenya 80% of people had never been assessed for blood sugar so for you to know you are even at risk you need to be screened for it and even this Covid period has shown a lot of us that we may be having underlying conditions and we don't know you may be pre-diabetic or you may be having diabetes and you don't know because nobody has ever measured your sugar levels and that's another area of concern the other issue is cholesterol when it comes to cardiovascular diseases some of us have never really had our cholesterol checked one is health seeking we also talk about behavior change that we can get you information but how do you translate that information into action that's where our challenge is how do you translate the information I give you when I tell you you really do need to know your sugar levels do you know exactly what sugar levels are do you know where to go and when you go there and the service is readily available and once you are given that information do you have an instrument to help you deal with that information so today if I am told I am hypertensive this is what you need to do to ensure that you manage the condition appropriately so there are many issues around knowing acting and sustaining an action that helps you manage the condition in a protective manner that if I have hypertension is not a death sentence if I am told I have diabetes I can live healthy with diabetes we have a lot of people including my friend who has lived with diabetes because he understands the condition and he knows how to manage it so again this information we give must be information that is accompanied by support towards how to manage the condition like your grandmother she has the support system she has the family that understands this condition so even the caregivers know exactly what the triggers are and know what to do if then they need to seek care for her alright now other than the calls that you have mentioned will you be looking into this particular week what you feel that needs to be filling what actions other than what the government should be doing what else do you think will be of concern during this particular period of time during this week we really are working with our groups of people living with NCDs they have social media platforms there is a call to action act now a lot of us are affected if not infected a lot of us have people we live with who have NCDs we know somebody who has an NCD a lot of our young people are living with type 1 diabetes cancer is a big big challenge in this country so we need those voices out there whether it's on Twitter on Facebook on Instagram on WhatsApp so you can actually be part of the movement for change you remember we are talking about accountability we are talking about progress we are expressing our not only our challenges but also our successes we have people who have lived with NCDs for a long time and they have found a way to manage so we are counting on the voices of all of us people living with NCDs people affected with NCDs people who have an interest in NCDs to talk about NCDs so the entire week the NCD Alliance of Kenya has activities every single week that are geared towards enlightening people about the plight of NCDs the plight of the patients the people living with NCDs had a call to action that basically was looking at the limited access to treatment especially during this time of COVID-19 and calling on reduction in taxes removal of taxes on some of the essential medicine essential equipment calling on county governments to invest in prevention to invest in care for NCDs in their counties and so we can build on this momentum to begin to ask ourselves are we doing the best we can to support people with NCDs are we doing the best we can to prevent NCDs because the trends have been moving the upward we really do need if there's a curve we need to flatten is the curve of NCDs and to bring it down not just flatten it but basically ensure that we have less people exposed to the risks of NCDs than we have been than has been in the past when we really didn't pay attention to NCDs in this country as you wind up following the investment of funds we have held and we have had threats to from withdraw donors to our country if that happens how do you think the NCDs department and the persons with NCDs will be impacted I think it's a very it's very sad to be in this context currently with the the disease outcomes the outcomes from a lot of our conditions being as they are even just accessing healthcare you had medical doctors think talking about access to PPEs and the working conditions and some of them talking about having not been paid I think this is happening at the wrong time and as I said since the expose you have seen a lot of defiance I think among Kenyans some people are saying if it was there if it was there that money would not have been eaten so we have had a lot of statements to that effect but all I want to say it's you and I who are exposing ourselves the fact that Covid is here so I think it's important for all of us to know whatever is happening has not taken away Covid that's where we need to begin that even if funds were imbezzled and the government has assured us they are trying to find out who did this we have not done away with Covid the infection is still here so as even donors threaten to withdraw funds we cannot abrogate our individual responsibilities and decide that because money was taken we can live life the way we want to live so coming back to the question that you raised in terms of donors pulling away a lot of our health sector funding is donor driven USAID funds a lot of our HIV and AIDS activities TB malaria activities a lot of the other donors support direct support to healthcare so threatening to stop funding will be cutting a code, a baby's code unfortunately because a lot of the funding in this country I used to have the figures at some point was as high as 80% of expenditures in some of these areas of work that were funded by development partners so that threat should be taken very seriously I know people within the HIV and AIDS area of work have talked about how this can be will definitely affect them very directly we've already seen an effect of access to essential medicine within this COVID period that threat carries itself carries a lot of comes with a lot of fear for people who benefit directly from this support for facilities that are supported for programs that preventive programs that are supported by donors that threat should be taken very seriously we cannot be casual about it we cannot be dismissive about it we need to take it very seriously finally stigmatization has become issue over time and during COVID-19 patients of COVID-19 have been stigmatized as well as other conditions in the past but now with the NCDs are there reported cases of stigmatization and what is being done about it okay so COVID-19 unfortunately for a lot of us social scientists we really do wonder why we reached where we reached with stigma but I think it's the way in which we addressed we confronted COVID-19 in the beginning where it was a disease out there it was brought by travelers it was a disease in Nairobi it's a disease for people with underlying condition and the way we then buried the first people who passed on due to COVID-19 basically build the stigma around it sure I think NCDs have not been stigmatized in the past really diabetes has been treated with a lot of I think sympathy cancer patients have over time received a lot of care and support and even you when you hear somebody has cancer you basically are like what can we do to help so that stigma in my view has not been there in the past sickle cell again maybe misunderstanding, myths and conceptions regarding why we have these conditions but not stigma I think the stigma is now being pointed towards these conditions when people say oh if you have it you have an underlying condition then you are at risk so the call has been let's not stigmatize further stigmatize people who are dealing with a chronic condition let us embrace everybody the stigma around COVID-19 is misplaced because we've been told by the experts 90% of us will get COVID-19 so if we are all going to get it I think we should know how to support one another and provide care and support for each one of us at this time alright in that same bread give us your camera give us your final recommendations and particularly this NCDs week during this NCDs week we want to call upon each one of us to do something go on your twitter handle go on your Instagram Facebook all your social media platforms and talk about NCDs encourage someone if you live with somebody with NCDs take time to visit them or send them support send them lovely note to say that we care for you we understand you yes this week is a week of action let us try the best we can do to talk about NCDs to demystify NCDs and for government officials for politicians for senators for members of parliament for MCS let us focus on NCD policies let us focus on policies that will allow our people to protect themselves from NCDs let us also rari around prevention especially enforcement of some of the provisions legal provisions that are in place so that we can continue to prevent ourselves from NCDs we can continue to provide care and support with NCDs and we can continue to care for those who are already infected thank you very much thank you so much doctori for finding time for us and trying to put things into perspectives and helping us to understand and baku metrast you have learned something and thank you so much for keeping us company we have come to the end of this morning's show she has been my guest doctor Mary Amuyunzi secretary NCD Alliance Kenya and my name is Ravahila see you again in the evening with the news good day