By Africa.com | Created at 2026-08-07 07:32:01 | Updated at 2026-08-07 11:36:14
4 hours ago
By Isaac Ntwiga, Programme Director, Partnership for Education of Health Professionals, Amref Health Africa
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.
NCDs accounted for 37% of all deaths in the WHO African Region by 2019, up from 24% 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.
Over the past decade, African countries have demonstrated that integrated chronic care is both feasible and effective. The WHO Package of Essential Non-communicable Disease Interventions (WHO PEN) provided a practical framework for managing common chronic conditions through primary health care. Building on this foundation, the PEN-Plus strategy extended care for severe chronic diseases, including type 1 diabetes, sickle cell disease and rheumatic heart disease, to first-level referral hospitals serving rural populations.
Countries like Rwanda, Malawi and Liberia have shown that integrated NCD services can improve access to care without creating parallel systems. Rwanda has successfully scaled PEN-Plus nationally, while Kenya and Zambia have adopted national implementation plans. Across the WHO African Region, nearly half of Member States are now developing operational plans to integrate NCD care into routine service delivery.
These are no longer isolated pilot projects. They represent a growing recognition that chronic disease management belongs where most people first seek care, within strong, community-centred primary health care systems.
If the evidence already exists, why has integration not progressed faster? The answer lies less in medicine than in politics and financing.
Many countries have adopted ambitious NCD strategies, yet too many frontline facilities still lack basic diagnostic equipment, reliable medicine supplies, trained health workers and effective referral systems. A national policy does not automatically place a glucometer on a clinic shelf or guarantee that insulin will be available when a patient needs it.
Financing poses an even greater challenge. At precisely the moment Africa’s need for lifelong chronic care is accelerating, global health financing is becoming more uncertain. Although NCDs account for nearly three-quarters of deaths worldwide, they continue to receive only a tiny fraction of development assistance for health, around one to two per cent. Meanwhile, projections suggest official development assistance for health could decline significantly by up to 46% by end of 2026, with African systems bearing the sharpest burden.
Africa cannot build lifelong care on short-term funding cycles. Sustainable chronic disease management requires predictable domestic investment, stronger public financing and health systems designed for continuity, not emergency response alone.
Patients Do Not Live in Vertical Programmes
The most important lesson emerging from Dar es Salaam was perhaps the simplest: Patients do not experience diseases in silos.
A person living with HIV may also have hypertension. Someone receiving treatment for diabetes may also require mental health support or cervical cancer screening. Yet health systems frequently ask them to navigate separate clinics, separate appointments and separate funding streams.
Integrated care begins by recognising that people, not diseases, should be the organising principle of health systems.
Ironically, some of Africa’s strongest foundations for integration were built through investments in communicable diseases. Laboratory networks, supply chains, digital information systems, differentiated service delivery models and community health programmes established through HIV and tuberculosis responses are now supporting hypertension, diabetes and other chronic conditions across several countries.
This should not be viewed as evidence that disease-specific investments were misguided. Rather, it demonstrates that vertical programmes can create horizontal capacity, provided governments deliberately connect these systems instead of allowing them to remain fragmented.
The same applies to the health workforce. Across Africa, nurses, clinical officers and community health workers are increasingly screening, diagnosing and managing common NCDs closer to where people live. Task-sharing is no longer simply a response to workforce shortages, but one of the continent’s greatest opportunities to expand equitable access to lifelong care.
Integrated Care Is the Future of Health Security
Too often, discussions about NCD integration are framed solely as a chronic disease issue. That misses the bigger picture.
The next health emergency, whether driven by climate change, conflict or another pandemic, will not arrive separately from existing health challenges. Countries with fragmented health systems will struggle to respond to multiple crises simultaneously. Those with integrated primary health care systems will be far more resilient.
Investing in integrated chronic care is therefore not simply about reducing deaths from hypertension or diabetes. It is an investment in universal health coverage, stronger primary health care, pandemic preparedness and long-term health security.
In an era of constrained resources, integration is no longer a luxury, but one of the smartest investments governments can make.
Governments must increase domestic investment in primary health care, including innovative financing mechanisms such as health taxes on tobacco, alcohol and sugar-sweetened beverages that can both improve population health and generate sustainable resources for health systems.
PEN-Plus should increasingly become part of routine service delivery rather than another vertical initiative. Every investment in health workers, medicines, diagnostics, digital systems and community health should strengthen integrated chronic care instead of creating new parallel structures.
Most importantly, community health workers must be recognised as professional members of the health workforce across Africa, properly trained, adequately supported and fairly compensated. They will be indispensable in ensuring that integrated care reaches the communities most often left behind.
