Nigeria stands at a critical crossroads poised to become a double-burden country where non-communicable diseases (NCDs) threaten to surpass communicable diseases, with NCDs claiming 565 lives per 100,000 Nigerians, and 447,800 lives globally, disproportionately affecting low- and middle-income countries.
The recent NCD policy launch hosted by the Federal Ministry of Health and Social Welfare in collaboration with other national and regional partners saw the introduction of several key policies aimed at addressing the burden of NCDs in Nigeria.
Themed 'Revitalizing NCDs Prevention and Control in Nigeria -- Strengthening Multi-Sectoral Collaboration,' it resulted in the unveiling of policies designed at strengthening the fight against NCDs, focusing on enhancing multi-sectoral collaboration. The policies included the national policy for the prevention and control of NCDs, the national NCD task-shifting and task-sharing (NTSTS) policy, and the national guideline for the prevention and management of hypertension, all of which had been approved by the 64th National Council on Health (NCH).
Nanlop Ogbureke, the Executive Director of Resolve to Save Lives, urged increased funding for NCDs during the policy launch. She pointed out that infectious diseases have historically received more attention, leaving NCDs in the dark. Limited investment has hindered efforts to prevent and control NCDs in the country, making collaboration essential. She further explained that "NCDs have impacted healthcare costs, decreased quality of life, driven patients into poverty, and reduced mortality and productivity. We are committed to pushing this forward and shifting from policy to action."
Tackling modifiable risk factors is key to NCD prevention and control
NCDs such as hypertension, diabetes, cardiovascular diseases, and cancer are primarily driven by modifiable risk factors like the consumption of tobacco, alcohol, sugar-sweetened beverages (SSBs), and high salt intake, however, a general lack of awareness adds to how people's daily habits contribute to long-term health complications.
One of such is tobacco use which is particularly a risk factor for nearly all NCDs, contributing to the high prevalence of diseases like lung cancer and heart disease. Despite control efforts, tobacco remains a significant health threat in Nigeria.
In 2015, Nigeria implemented the National Tobacco Control Act (NTCA), which adopted the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), setting the stage for stricter tobacco regulations with violators facing fines of N50,000 to N100,000 or even imprisonment for 10 years or more. Still, about 10.4% of Nigerians smoke.
Nigeria is also the fourth largest consumer of sugar-sweetened beverages (SSBs) globally, which has fueled the rising incidence of type 2 diabetes and NCDs. In 2021, the Federal Government of Nigeria introduced a SSB tax. It is embedded in the Finance Act of 2021, which levies a ₦10 tax on each litre of non-alcoholic and sugar sweetened carbonated drinks.
Hypertension is also the foremost killer among NCDs in Nigeria. The inadequate supply chain for antihypertensive medications worsens the issue and makes effective management challenging. Incorporating NCD treatment, including hypertension, into the National Health Insurance Act (NHIA) and increasing coverage is critical to reducing the financial burden on patients and improving treatment accessibility.
Scaling up universal health coverage for non-communicable diseases
In many African countries, the implementation of NCD policies has stalled. While progress has been made in some areas, it is often offset by a decline in implementation. To effectively prevent NCDs and their impacts, policy adoption and implementation need to be significantly accelerated.
A significant part of the government's strategy is to combat NCDs by integrating NCD services into the broader framework of Universal Health Coverage (UHC). This integration aims to provide equitable access to prevention, early diagnosis, treatment, and rehabilitation services for all citizens, particularly underserved populations like those in rural and hard-to-reach areas, women and girls, by ensuring that primary healthcare (PHC) facilities are equipped to offer essential NCD services. Stakeholders also emphasised the need to revamp the entire healthcare system, which is in tandem with conversations at the Third High-level Meeting of the General Assembly on the Prevention and Control of NCDs.
During the launch, Dr Megan Adediran, the executive director of Hemophilia Foundation of Nigeria (HFN), noted that "while many NCDs are linked to lifestyle choices or dietary factors like sugar intake, others are rooted in genetics that individuals are born with. She stated that care for blood disorders, such as hemophilia and sickle cell anemia, needs to be urgently scaled up."
For example, the HFN has identified 859 hemophilia patients, only 3% of the expected number based on the global prevalence rate of 1 in 10,000 births. "The underdiagnosis in Nigeria exposes a critical shortfall in healthcare awareness and services for individuals with bleeding disorders, indicating a need for improved diagnosis and care." Women with Von Willebrand disease face an 80% risk of bleeding complications after delivery, Dr Adediran added.
In a country where maternal mortality rates are alarmingly high, with postpartum hemorrhage (PPH) being a leading cause of maternal deaths, it is crucial to consider underlying conditions like bleeding disorders when managing and diagnosing PPH. This broader understanding and recognition of blood disorders are essential for improving care for individuals living with lifelong conditions across Nigeria.
Incorporating NCD management into the PHC system is another vital step towards implementing the policies and addressing the NCD burden. Interventions such as newborn screening for sickle cell anemia, bleeding disorders and critical medications such as hydroxyurea should be accessible at PHC facilities, but this would require training of PHC workers and a functional supply chain system.
Critical factors to consider for policy implementation
To combat the growing impact of NCDs in Nigeria, a comprehensive and multi-faceted approach is crucial, involving enhanced stakeholder engagement, government support, and multisectoral collaboration. The NCD Alliance has been vital in coordinating efforts, mobilizing resources and implementing effective strategies to reduce NCD prevalence and improve health outcomes.
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Therefore, stakeholders at the launch recommended:
· A comprehensive national NCD prevention policy to be fully integrated into broader public health and development strategies.
· Improved funding for NCD control efforts, especially in underserved and rural areas.
· Increasing the tax on SBBS and earmarking the funds for health.
· Greater investment in public health infrastructure, human resources, and community outreach to support early detection and management of NCDs.
· Public and private sector collaboration to promote healthy environments and reduce exposure to NCD risk factors.
· Accelerated action to close the gap in access to essential medicines and technologies for NCD care.
· Increasing public awareness of NCDs, including modifiable and genetic risk factors to improve NCD prevention and control.
To effectively track the success of the NCD policy, key performance indicators will include monitoring healthcare centers offering NCD services, especially in rural and underserved areas, as well as tracking early detection rates and medication availability.
By adopting this comprehensive framework, Nigeria can ensure equitable outcomes in its fight against NCDs, ultimately reducing the economic burden on households, where up to 24% of food expenditure is spent on NCD care.
