NCDs now account for 37pc of African deaths, yet care remains broken

For decades, African health systems were built to fight infectious diseases, and rightly so. Those investments have saved millions of lives and transformed the fight against HIV, tuberculosis, and malaria. But the continent's disease burden has changed. Today, non-communicable diseases (NCDs) are no longer emerging threats waiting on the horizon; they are quietly becoming the defining challenge of African health systems.

Yet many patients still navigate a system designed for yesterday's realities. A woman living with type 1 diabetes in Samburu may travel hundreds of kilometres to receive insulin. A farmer in Tanzania's Lulanzi village, living with hypertension, may visit one clinic for HIV services, another for diabetes care, and yet another for heart disease. The problem is not simply the diseases they live with, but a health system that continues to organise care around programmes instead of people.

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NCDs accounted for 37 per cent of all deaths in the WHO African Region by 2019, up from 24 per cent in 2000, with many occurring prematurely among adults in their most productive years. The question, therefore, is no longer whether African countries should integrate NCD care into primary health care; it is whether they can afford not to.

That was the key message emerging from the Third International Conference on PEN-Plus in Africa, held recently in Dar es Salaam. The debate over whether NCDs belong in primary health care is largely over. What remains is a far more difficult challenge: whether governments and development partners have the political courage and financial commitment to build health systems that reflect Africa's new epidemiological reality.

Africa has already proven that integration works

For too long, NCD care in Africa was organised as a parallel service rather than an essential part of primary health care. Patients travelled long distances to referral hospitals for routine consultations. Screening happened through occasional campaigns instead of everyday clinic visits. Medicines and diagnostics were often unavailable outside urban centres, while financing remained fragmented and heavily dependent on donor-funded projects.

That model is no longer sustainable.