Mamka Anyona Rosemary, de Courten Maximilian
School of Global Health, University of Copenhagen, Copenhagen, Denmark.
Centre for Chronic Disease, College of Health & Biomedicine, Victoria University, Melbourne, Australia.
AIMS Public Health. 2014 Dec 2;1(4):256-274. doi: 10.3934/publichealth.2014.4.256. eCollection 2014.
Kenya is a developing country in sub-Saharan Africa, facing a triple disease burden, with an increase in non-communicable diseases (NCDs); uncontained infectious diseases; coupled with significant morbidity and mortality from environmental causes such as droughts and flooding. The limelight has been on infectious diseases, leaving few resources for NCDs. As NCDs start to gain attention, it is becoming apparent that essential information on their epidemiology and risk factor trends-key in evidence-based decision-making-is lacking. As a consequence, policies have long relied on information derived from unreliable data sources such as vital registries and facility-level data, and unrepresentative data from small-scale clinical and academic research. This study analyzed the health policy aspects of NCD risk factor surveillance in Kenya, describing barriers to the successful design and implementation of an NCD risk factor surveillance system, and suggests a strategy best suited for the Kenyan situation. A review of policy documents and publications was augmented by a field-study consisting of interviews of key informants identified as stakeholders. Findings were analyzed using the Walt and Gilson policy analysis triangle. Findings attest that no population baseline NCD burden or risk factor data was available, with a failed WHO STEPs survey in 2005, to be undertaken in 2013. Despite the continued mention of NCD surveillance and the highlighting of its importance in various policy documents, a related strategy is yet to be established. Hurdles ranged from a lack of political attention for NCDs and competing public interests, to the lack of an evidence-based decision making culture and the impact of aid dependency of health programs. Progress in recognition of NCDs was noted and the international community and civil society's contribution to these achievements documented. While a positive outlook on the future of NCD surveillance were encountered, it is noteworthy that overcoming policy and structural hurdles for continued success is imperative.
肯尼亚是撒哈拉以南非洲的一个发展中国家，面临着三重疾病负担，即非传染性疾病（NCDs）增加；传染病未得到控制；再加上干旱和洪水等环境因素导致的大量发病和死亡。人们一直将注意力集中在传染病上，留给非传染性疾病的资源很少。随着非传染性疾病开始受到关注，越来越明显的是，缺乏关于其流行病学和风险因素趋势的基本信息——这是循证决策的关键。因此，长期以来政策一直依赖于来自不可靠数据源（如人口动态登记处和机构层面数据）以及小规模临床和学术研究中缺乏代表性的数据。本研究分析了肯尼亚非传染性疾病风险因素监测的卫生政策方面，描述了成功设计和实施非传染性疾病风险因素监测系统的障碍，并提出了最适合肯尼亚情况的策略。通过对政策文件和出版物的回顾，并辅之以一项实地研究，该实地研究包括对被确定为利益相关者的关键信息提供者进行访谈。使用沃尔特和吉尔森政策分析三角对研究结果进行了分析。研究结果证明，没有可用的人群非传染性疾病负担或风险因素基线数据，2005年世界卫生组织的“逐步”调查失败，原定于2013年进行。尽管在各种政策文件中不断提及非传染性疾病监测并强调其重要性，但尚未制定相关战略。障碍包括对非传染性疾病缺乏政治关注和相互竞争的公共利益，缺乏循证决策文化以及卫生项目对援助的依赖影响。注意到在认识非传染性疾病方面取得的进展，并记录了国际社会和民间社会对这些成就的贡献。虽然对非传染性疾病监测的未来有积极的展望，但值得注意的是，克服政策和结构障碍以持续取得成功势在必行。
