A Policy Analysis of Chronic Lung Diseases in Sub-Saharan Africa

Abstract

Background: Globally, 4 million people die prematurely from Chronic Lung Diseases (CLDs) like asthma and chronic obstructive pulmonary disease (COPD). In sub-Saharan Africa (SSA), the burden of CLDs is large and growing. However, the CLD policy landscape in SSA is not well understood, a gap this study seeks to fill.

Methods: We conducted interviews with health officials and practitioners in Uganda (n=10) and Kenya (n=14), which informed a desk review of CLD-relevant policies from five regional level (East Africa) entities and Ministries of Health in Kenya and Uganda. Results: We found no CLD-specific policies apart from Kenya’s 2011 Guidelines for Asthma Management. Generally, CLDs fell under the umbrella of NCDs. Policies do not name CLDs as a group, but they do refer to COPD and asthma. The main approach to CLD control in the two countries is prevention. Documentation of CLD-related financial investments was not available, though allocations for NCDs were smaller than that for infectious diseases. Interviews revealed insufficient resources to address CLDs.

Conclusion: We found a lack of CLD policy prioritization at East Africa Regional level and in Kenya, Uganda, although there is increasing attention on NCDs. The growing burden of CLDs and lack of commensurate policy attention calls for local evidence on CLDs’ disease burden, economic burden, as well as interventions to strengthen health system CLD management.

Note:

Funding Information: This research was funded by the National Institute for Health Research (NIHR) (IMPALA, grant reference 16/136/35) using UK aid from the UK Government to support global health research.

Declaration of Interests: The authors have no competing interests to report.

Ethical Approval Statement: All study participants provided oral and/or written informed consent and signed a post-interview confidentiality form (Annex 5) on the data usage. The studies were approved by the Liverpool School of Tropical Medicine Ethics Committee (LSTM REC) (Kenya: protocol 18-054; Uganda: protocol 18-037). Approval in Kenya was provided by Kenya Medical Research Institute Scientific and Ethics Review Unit (KEMRI/SERU/CRDR/037/3717), and the county government of Nairobi (August 14th, 2018); and in Uganda by The AIDS Support Organization (TASO IRB: TASOREC /030/18-UG-REC-009) and the Uganda National Council for Science and Technology (HS232ES).

Keywords: Chronic lung diseases, Asthma, chronic obstructive pulmonary disease, health policy, East Africa, sub Saharan Africa