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Non-communicable diseases, injuries, and mental ill-health in Africa: the role of the Africa CDC

The Africa Centres for Disease Control and Prevention (Africa CDC) was established in 2017, after the west Africa Ebola virus disease outbreak. Upon creation, the
role of Africa CDC was to mandate strengthening of the capacity of public health institutions in Africa to prevent, detect, and respond to disease threats, based on science, policy, and data-driven interventions and programmes, as envisaged by the Abuja Declaration. The inaugural strategic plan was focused on building health systems for emergency preparedness and response. However, from its inception, the organisation recognised the concomitant need to comprehensively strengthen systems to prevent and manage noncommunicable diseases (NCDs) and injuries, and to face the neglected issue of mental health disorders. The division dedicated to these issues was conceptualised, but operationalisation was deferred to a future date.

In September, 2020, in an important phase of the African continental response to the COVID-19 pandemic, Africa CDC began operationalising the institutional mechanisms to address the growing threat of NCDs, injuries, and mental health disorders. The development of a strategy to support health systems strengthening in African Union member states for NCD and injury prevention and control, and mental health promotion was prioritised. This process was catalysed by the COVID-19 increased risks of morbidity and mortality for groups living with these conditions and the need for stronger health systems to prevent and manage both communicable and non-communicable diseases during complex emergencies.

The urgency to scale up improvements in prevention and management of NCDs, injuries, and mental health disorders is growing in Africa; the proportion of years of life lost due to NCDs, injuries, and mental health disorders is predicted to triple between 1980 and 2040.2 Africa has the highest rate of road-traffic injuries compared to other WHO regions. An estimated 85% of premature adult deaths due to NCDs occur in low-income and middle-income countries. In an estimated 90% of countries, including many African Union states, people have a higher risk of dying prematurely from NCDs than from communicable, maternal, perinatal, and nutritional conditions combined. The pandemic has magnified this issue and had a negative effect on mental health,5 which reasserts the duality of health equity and security. In a world increasingly beset by scarce resources and increasing costs of living, the focus on the pandemic has further shifted health spending and attention away from chronic diseases in many countries, which were already grappling with failing health systems. This shift results in a potential sharp increase in morbidity and mortality due to NCDs, injuries, and mental health disorders on the horizon, following waves of COVID-19.

In its first action, Africa CDC defined its strategic role in the management and prevention of NCDs, injuries, and mental health disorders through an extensive evidence-based process using consultation, research, and partnerships, advocating for a strong focus on multisectoral and upstream prevention. As an institution driven by its member states, priority areas were explicitly shaped to align with the states’ needs, implementation gaps, and national NCD plans.
Africa CDC elicited views of global partners, African Union departments (including those outside health), continental academics and practitioners, people living with NCDs, injuries, and mental health disorders, and civil society.

A three-phased approach involving desk-based evidence reviews, member state consultation (including a continent-wide survey), and wider engagement with continent-based academics, experts, and civil society progressively refined and consolidated priority areas from an initial long list. Africa CDC used an adapted version of the WHO essential public health functions as a framework,10 which allowed for a comprehensive public health approach to prevention and care. This process was undertaken with the UK Health Security Agency, the London School of Hygiene & Tropical Medicine, and CBM Global Disability Inclusion, which shows a dedication to collaboration, partnership, and advancing global public health.

The final six Africa CDC strategic priorities form a broad framework to focus activities across the continent. The organisation champions: (1) enhancing member
states’ capacity to develop, integrate, and implement policies to prevent, protect, and manage NCDs, injuries, and mental health disorders; (2) political advocacy;
(3) strengthening multisectoral action; (4) a trained, strong, and stable workforce; (5) sustainable continental funding mechanisms for implementation, activities,
and research on NCDs, injuries, and mental health disorders; and (6) access to essential technologies, medicines, and diagnostics. These priorities align with the African Union’s New Public Health Order.

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