Hypertension & NCDs Program

Executive Summary

The Hypertension & Non-Communicable Diseases (NCDs) Program is a comprehensive, multi-sectoral initiative designed to address the growing burden of hypertension and other NCDs in Kenya. Launched in 2025, this flagship program represents UWRA's commitment to tackling one of the most significant public health challenges of the twenty-first century. Non-communicable diseases, including cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers, are responsible for approximately 50% of all deaths in Kenya, with hypertension being a major contributor to cardiovascular morbidity and mortality. The program recognizes that NCDs are not merely medical conditions but are also driven by social, economic, behavioral, and environmental factors, including poor diet, physical inactivity, tobacco use, harmful alcohol consumption, and air pollution.

The program is grounded in a thorough appreciation of the complex interplay between risk factors, health systems, and community contexts. It adopts a life-course approach to NCD prevention and control, recognizing that interventions must address risk factors across the lifespan, from childhood through adulthood and into older age. The program also recognizes the importance of strengthening health systems to provide comprehensive NCD prevention, screening, diagnosis, treatment, and care services, particularly at the primary care level. Furthermore, the program is guided by the principles of equity and inclusion, recognizing that NCDs disproportionately affect marginalized and vulnerable populations, including those living in poverty, women, and people with disabilities.

Working across four counties in Kenya, the program combines community-based screening and health promotion with health systems strengthening, capacity building, and policy engagement. It is implemented in close partnership with county health departments, community-based organizations, academic institutions, and international partners. The program is designed to be scalable and replicable, with a robust monitoring and evaluation framework that enables continuous learning and adaptation. By reducing the burden of hypertension and NCDs, the program aims to improve health outcomes, reduce health inequalities, and contribute to Kenya's progress toward universal health coverage and the Sustainable Development Goals.

Background & Rationale

Non-communicable diseases (NCDs) have become the leading cause of death and disability worldwide, and their burden is rising rapidly in Kenya and across Africa. According to the World Health Organization, NCDs account for approximately 50% of all deaths in Kenya, with cardiovascular diseases — particularly hypertension-related conditions — being the leading cause. The prevalence of hypertension among adults in Kenya is estimated to be around 25-30%, with many cases remaining undiagnosed, untreated, or inadequately controlled. This high prevalence is driven by multiple factors, including the nutrition transition (increased consumption of processed and high-sodium foods), sedentary lifestyles, tobacco use, harmful alcohol consumption, and limited access to quality health care.

The consequences of uncontrolled hypertension and NCDs are profound: they lead to premature mortality, disability, reduced quality of life, and substantial economic costs for individuals, families, and health systems. Hypertension is a major risk factor for heart attacks, strokes, kidney failure, and other serious health conditions. The burden of NCDs is not only a health issue but also a development issue, as it undermines productivity, increases health care costs, and perpetuates poverty. The socioeconomic impact is particularly severe for the poorest and most vulnerable populations, who often lack access to preventive services and quality care.

Despite the existence of effective interventions to prevent and control NCDs, including lifestyle modification, screening, and medication, their coverage and quality remain inadequate in Kenya. There is a need to scale up evidence-based interventions, strengthen health systems, and address the social and commercial determinants of NCDs. The Hypertension & NCDs Program is designed to contribute to these goals by implementing a comprehensive package of high-impact interventions that are tailored to local contexts, integrated with existing health services, and responsive to the needs and priorities of communities.

Program Objectives

The program is guided by a set of clear, measurable objectives that address the multiple determinants of hypertension and NCDs.

Program Components

The program is organized around five interconnected components that address the multiple determinants of hypertension and NCDs.

Component 1: Community-Based NCD Screening and Health Promotion

This component focuses on increasing access to NCD screening and promoting healthy behaviors at the community level. It includes the establishment of community-based screening sites where trained community health workers conduct blood pressure measurements, blood glucose testing, body mass index (BMI) assessments, and other relevant screenings. The component also includes targeted health promotion activities, including community education sessions on NCD risk factors and prevention, cooking demonstrations on healthy eating, and promotion of physical activity. The interventions are designed to be culturally appropriate, gender-sensitive, and accessible to diverse audiences, including people with disabilities and those living in remote areas. Social and behavior change communication (SBCC) strategies are employed to address the underlying social, cultural, and behavioral determinants of NCD risk.

Component 2: Health System Strengthening for NCD Management

This component focuses on strengthening the capacity of health systems to provide quality NCD prevention, screening, diagnosis, treatment, and care services. It includes the training of health workers on NCD management, including hypertension and diabetes care, cardiovascular risk assessment, and the use of standard treatment guidelines. The component also supports the integration of NCD services into primary care, including the establishment of NCD clinics at health facilities, the provision of essential medicines and supplies, and the strengthening of referral systems between the community and facilities. Additionally, it supports the development and implementation of NCD care protocols and the use of electronic health records for NCD surveillance and management.

Component 3: NCD Risk Factor Reduction and Health Promotion

This component focuses on reducing the prevalence of key NCD risk factors through multi-sectoral interventions that address the social and commercial determinants of health. It includes the implementation of tobacco control interventions, including smoking cessation support and advocacy for tobacco control policies; the promotion of healthy diets, including reducing sodium intake, increasing fruit and vegetable consumption, and reducing consumption of processed foods; the promotion of physical activity through community-based programs and the creation of enabling environments; and the reduction of harmful alcohol consumption through brief interventions and policy advocacy. The component also includes workplace health promotion and school-based NCD prevention programs.

Component 4: Patient Support and Adherence

This component focuses on supporting patients with NCDs to achieve optimal treatment outcomes. It includes the provision of patient education on NCD management, including medication adherence, lifestyle modification, and self-monitoring. The component also includes the establishment of patient support groups that provide peer support, information sharing, and mutual encouragement. Additionally, it includes the use of mobile health (mHealth) technologies to support patient follow-up, provide health education, and promote adherence to appointments and medications. The component recognizes the importance of addressing the social determinants of health that affect treatment adherence, including poverty, food insecurity, and lack of transport.

Component 5: Policy Engagement and Advocacy

This component focuses on generating and translating evidence to influence national and county-level NCD policies. It includes the production of policy briefs, evidence summaries, and technical reports on NCD prevention and control; the organization of policy dialogues and stakeholder workshops; and the provision of technical assistance to county and national governments. The component also works to strengthen the capacity of civil society organizations to advocate for effective NCD policies, including the implementation of the WHO Framework Convention on Tobacco Control, the reduction of salt and sugar in processed foods, and the promotion of healthy environments. The component also supports the development of multisectoral NCD prevention and control plans.

Target Populations

The program targets vulnerable populations in four counties in Kenya, selected based on the prevalence of NCD risk factors and the availability of health services. The primary beneficiaries include:

• Adults aged 30 years and above: This group is at highest risk for hypertension and other NCDs and is the primary target for screening and treatment.
• Women of reproductive age: Women are at risk for NCDs and often serve as gatekeepers for family health; the program supports their health and well-being.
• Youth and adolescents: Early intervention and health promotion among young people are critical for preventing NCDs later in life.
• Individuals with elevated risk factors: This includes people with obesity, tobacco use, harmful alcohol consumption, physical inactivity, and family history of NCDs.
• People living in informal settlements: Urban poor populations are at elevated risk for NCDs due to lifestyle factors and limited access to health services.
• People with disabilities: This group is often overlooked in NCD prevention and care and is particularly vulnerable.

Implementation Approach

The program is implemented through a multi-stakeholder, participatory approach that involves communities, county governments, and other partners at all stages. The following principles guide our implementation approach:

• Community Engagement: We work in close collaboration with communities to co-design and co-implement interventions, ensuring that they are relevant, acceptable, and sustainable.
• Integration: The program is integrated with existing health services, particularly primary care, to maximize efficiency and sustainability.
• Multi-Sectoral Collaboration: We work across sectors, including health, education, agriculture, and urban planning, to address the social and commercial determinants of NCDs.
• Evidence-Based: The program is grounded in the best available evidence and is continuously informed by monitoring and evaluation data.
• Systems Thinking: We adopt a systems approach that considers the complex interactions between risk factors, health systems, and communities.
• Equity and Inclusion: The program is designed to address inequalities and reach those who are most vulnerable to NCDs.

Partners

The program is implemented in partnership with a range of organizations and institutions that bring complementary expertise and resources.

• County Governments: The program works closely with county health departments to align with local priorities and systems.
• Ministry of Health: Collaboration supports national policy alignment and technical assistance.
• Community-Based Organizations: Local CBOs are engaged in community mobilization, outreach, and implementation of interventions.
• Academic Institutions: Partnerships with universities support research, monitoring and evaluation, and capacity strengthening.
• Civil Society Organizations: Engagement with CSOs supports advocacy and community mobilization on NCD issues.

Monitoring, Evaluation, and Learning

The program has a robust monitoring, evaluation, and learning (MEL) system that tracks progress toward objectives, assesses effectiveness, and generates evidence for program improvement. Key elements of the MEL system include:

• Baseline and Endline Surveys: Comprehensive household surveys measure changes in NCD risk factors, screening coverage, treatment outcomes, and related indicators.
• Routine Data Collection: Health management information systems (HMIS), program monitoring tools, and facility registers provide ongoing data on service coverage and quality.
• Qualitative Research: Focus group discussions, in-depth interviews, and participant observation explore experiences, barriers, and enablers related to NCD prevention and care.
• Clinical Audits: Regular audits of NCD care quality at health facilities assess adherence to treatment guidelines and identify areas for improvement.
• Dissemination: Findings are disseminated through reports, policy briefs, presentations, and publications.

Expected Outcomes

By the end of the program, we expect to achieve the following outcomes:

• Increased Screening Coverage: At least 60% of the target adult population in four counties will have been screened for hypertension and NCDs.
• Improved NCD Treatment Outcomes: At least 70% of diagnosed hypertensive patients will have controlled blood pressure, and similar improvements will be seen for other NCDs.
• Reduced NCD Risk Factors: The prevalence of tobacco use, harmful alcohol consumption, and physical inactivity will decline by at least 15% in target areas.
• Enhanced Health System Capacity: At least 80% of health facilities in target areas will provide quality NCD services, as measured by performance standards.
• Influenced Policy: At least three policy documents will incorporate evidence generated by the program.
• Empowered Communities: Target communities will demonstrate enhanced knowledge and practices related to NCD prevention and care.