Africa: Africa Only Has Partial Visibility of its True NCD Burden, Says WHO Official

Non-communicable diseases (NCDs) are often described as Africa's "silent epidemic," but much of that silence reflects how little of the true burden is actually visible.

The burden of NCDs now accounts for a growing share of deaths across Africa, driven by rising risk factors such as unhealthy diets, physical inactivity, hypertension, obesity, diabetes, and air pollution. The World Health Organization (WHO) has warned that NCDs are among the biggest development challenges facing the continent, with the number of deaths steadily rising and health systems under increasing strain.

This is compounded by systemic weaknesses, including fragile supply chains and persistent health worker shortages. Initiatives such as PEN-Plus have trained thousands of mid-level providers in 20 countries to manage severe NCDs at district level, but retention remains a major challenge, with nearly half of Africa's health workers reportedly considering migration.

Without this, ICPPA 2026 will end up being just another paper commitment.

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Dr Joana Ansong, Technical Officer at WHO AFRO, said in an interview that Africa still has only partial visibility of its true NCD burden, with many severe conditions going undiagnosed and much of the data relying on estimates rather than direct measurement. She added that while efforts like PEN-Plus are expanding care, challenges around health worker retention and fragile medicine supply chains continue to limit progress.

A lot of severe NCD cases in Africa are never diagnosed at all; people live with undiagnosed type 1 diabetes or rheumatic heart disease until it's a crisis. How much of the burden is WHO AFRO actually able to measure right now, and how much is still a guess? Does the region know the true scale of what it's dealing with?

There is partial visibility into Africa's severe NCD burden, but large gaps remain due to weak surveillance systems, supply chain fragility, and health worker migration. NCDs cause 37% of all deaths in Africa; premature NCD mortality (ages 30-70) is around 20.8%, far above the global average. Most countries lack reliable cause-specific mortality data systems, meaning much of the severe NCD burden (e.g., undiagnosed type 1 diabetes, rheumatic heart disease) is extrapolated (modelled estimates) rather than directly measured. The region knows trends but not the true patient counts, especially in rural areas where diagnosis is rare

PEN-Plus depends on training mid-level providers at district hospitals to manage conditions that used to require a specialist in a capital city. But those same trained health workers are often the first to leave for better pay elsewhere. How is WHO AFRO addressing retention, not just training, and is that conversation happening with member states?

20 countries have adopted PEN-Plus protocols, with thousands of mid-level providers trained. Nearly 46% of African health workers report intentions to migrate, driven by inadequate remuneration and poor working conditions. It is critical to note that "training alone is not enough" and therefore the urgent need to link education, employment, and retention policies.  Retention of health workers is now an economic issue, and finance ministries need to consider workforce investment as part of economic development, and not just health spending.

For a child with type 1 diabetes, access often comes down to whether insulin is actually in stock and affordable at the nearest facility. What's the real state of medicine and diagnostic supply chains for severe NCDs across the region right now, and where are the worst gaps?

Across the African region, the supply chain for severe NCD medicines and diagnostics is still fragile and uneven, with access often determined by whether the nearest facility can reliably stock, store, and replenish essential products like insulin, test strips, and basic diagnostic equipment. The biggest gaps are not just "out of stock" events, but deeper system problems: weak forecasting, limited procurement capacity, poor cold-chain and storage, thin diagnostic coverage, and financing barriers that keep affordable medicines from reaching patients consistently.

Evidence across the region shows that severe chronic NCD care is constrained by gaps in availability, affordability, and health-system readiness, especially for conditions needing continuous treatment such as type 1 diabetes. A recent insulin market analysis notes that access in low- and middle-income countries is expanding too slowly, and that persistent barriers in sub-Saharan Africa include product fragmentation, diagnostic capacity limits, and weak system readiness. In practice, that means a child may be diagnosed late, started on treatment late, or have treatment interrupted because a facility cannot maintain stock or storage.

The worst gaps tend to cluster in low-resource settings, rural areas, and countries with weaker procurement and distribution systems, where essential medicines and diagnostics are least reliable. Insulin-dependent diabetes is especially vulnerable because it requires uninterrupted access to insulin plus glucose-monitoring supplies and temperature-controlled handling, which many facilities struggle to provide consistently. More broadly, NCD supply chains across the region often perform better for centrally managed, adult chronic medicines than for pediatric, device-dependent, or temperature-sensitive products.

As mentioned, several bottlenecks such as weak demand forecasting, fragmented procurement, insufficient financing, and limited warehousing and distribution infrastructure continue to recur.  For children with type 1 diabetes, the system's weak point is continuity: insulin without syringes, strips, refrigeration, or regular resupply is not enough. Delays are especially dangerous because interruptions in insulin access can quickly become life-threatening, and many settings still lack the diagnostic and monitoring capacity to support safe long-term care. So, the real state of the supply chain is not "no access anywhere," but rather highly unreliable access, with the most serious failures occurring where infrastructure, financing, and logistics are weakest.

PEN-Plus has 47 member states on paper, but rollout in a country dealing with conflict or displacement, like Sudan or eastern DR Congo, looks very different from rollout in a stable country. How does WHO AFRO think about reaching severe NCD patients in places where the health system itself is under strain?

PEN-Plus is being piloted in 20 countries, but rollout in places like Sudan or eastern DR Congo is slowed by insecurity and displacement. WHO AFRO’s approach for these settings has been adaptation through pilot facilities, mobile clinics, and NGO partnerships in fragile states, while stable countries move faster toward national scale-up. Additionally, we have started an integrated NCDs in emergency programme to improve preparedness in the fragile states to ensure continuity of health services during emergencies.

Domestic health budgets across the region are stretched thin, and severe NCD care is expensive to scale. Beyond the Helmsley-funded expansion, what's the actual case WHO AFRO is making to finance ministers to get severe NCDs into national budgets, not just donor-funded pilot programmes?

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WHO AFRO continues to make the case that severe NCD care is an economic investment, not just a health cost. The pitch to finance ministries is emphasizing that every $1 invested in the health workforce yields up to $10 in returns, and that untreated NCDs drain productivity. Again, the reality is that most programmes remain donor-dependent (Helmsley Trust, others), but WHO is pushing for domestic budget lines for NCDs.

Conferences produce declarations, but declarations don't treat patients. What is the one concrete thing that has to happen in the months right after ICPPA 2026 for this not to be just another set of commitments on paper?

Now that ICPPA 2026 has concluded,  what must happen?

Concrete step - Countries must translate declarations into funded national operational plans, with clear budget allocations, procurement schedules, and workforce retention strategies. In addition, we recommend countries come up with blended financing models for multiple innovative funding sources, including sin taxation, mobilization from the private sector, and other philanthropies for funding NCDs.

Without this, ICPPA 2026 will end up being just another paper commitment. WHO AFRO leaders stressed that integration of PEN-Plus into national health budgets is the single most urgent action.

The key message is that PEN-Plus is expanding, yet retention, financing, and conflict-zone rollout are still unresolved challenges. The months ahead, now that ICPPA 2026 has concluded, will be decisive for turning declarations into funded, staffed, and stocked services.