Executive summary
Noncommunicable diseases (NCDs), tuberculosis and pollution and climate-driven diseases together impose a rising, interconnected burden on Kenya’s health, economy and human capital, with air pollution alone shaving measurable months/years off life expectancy. Existing programmes (eCHIS, TB control, NCD screening, immunization) provide a base, but scaling tech-enabled, data-driven community solutions, climate-sensitive surveillance, clean-energy interventions and blended financing will be required to protect lives and stabilize food systems.
The problem — scale & how these conditions interact
A. Noncommunicable diseases (NCDs)
- Global and local burden: NCDs (cardiovascular disease, diabetes, cancer, chronic respiratory disease) are the dominant cause of adult mortality worldwide and rising in Kenya; premature NCD mortality is concentrated in low- and middle-income countries.
- Drivers: urbanization, sedentary lifestyles, unhealthy diets, tobacco and alcohol use, and exposure to ambient & household air pollution increase NCD incidence and severity.
B. Tuberculosis (TB)
- Persistent burden: Kenya remains among high-burden TB countries, recent WHO data show annual incidence in the hundreds of thousands and continued challenges with detection and co-infection (HIV/TB). TB control is undermined by poverty, overcrowding and weakened health systems.
C. Air pollution & climate-driven disease
- Life-years lost: Air pollution measurably shortens life expectancy, Kenya’s outdoor PM2.5 (particulate matter) levels are above WHO guidelines; globally, reducing PM2.5 to WHO levels adds years of life on average. In Kenya some regions would gain >1 year of life expectancy if WHO limits were met.
- Climate as multiplier: Climate change increases heat-related mortality, spreads vector borne diseases (malaria, dengue), worsens food insecurity and degrades water/sanitation, all feeding into infectious disease risk, malnutrition and poorer NCD outcomes.
D. Interaction effects
- Co-morbid burden: Air pollution increases cardiovascular and respiratory disease risk — raising vulnerability to TB and worsening outcomes for diabetics and hypertensives. Climate shocks (droughts/floods) interrupt care, worsen nutrition and increase infectious disease outbreaks, compounding NCD and TB control challenges.
What’s already in place (Kenya + global)
- eCHIS (digital Community Health Information System) — Kenya has rolled out eCHIS to digitize CHW screening, referral and surveillance; it is already used for screening millions for hypertension and diabetes and can be expanded for air-quality and TB contact tracing data.
- TB control programmes — National TB programmes supported by WHO/Global Fund use active case finding, HIV/TB integrated care and contact tracing, but detection gaps remain.
- NCD screening & referral — Primary care and community programmes increasingly screen for hypertension and diabetes but need scale and continuity of care to achieve population impact.
Global guidance & evidence base
- WHO guidance on climate & health — WHO has spelled out climate threats to health and adaptation priorities (surveillance, essential services, heat action plans).
- Air quality & health science — AQLI (Air Quality Life Index) and peer-reviewed literature quantify life expectancy losses from PM2.5 exposure and the health gains from meeting WHO guidelines.
Gaps & constraints
- Data fragmentation & weak surveillance — incomplete case detection (TB) and inconsistent NCD registries; limited local air-quality monitoring networks.
- Finance shortfalls & misaligned funding — climate/air quality receives a small fraction of health funding relative to burden; NCDs and environmental health are underfunded.
- Capacity at community level — CHWs are essential but need tools, training, digital workflows, and referral linkages to sustain chronic care and rapid response to climate shocks.
- Energy & infrastructure constraints — many health facilities lack reliable power or cold-chain for diagnostics/vaccines; household reliance on polluting cookstoves persists.
Recommended solutions (for Ministries, WHO, Govt, donors, local communities)
A. National policy & financing
- Make climate-health an explicit health sector priority: Integrate climate risk assessment into all national health planning; create a Health-Climate Unit within MoH that coordinates with environment and disaster agencies.
- Scale blended finance for air quality & health resilience: Mobilize blended finance (government seed, Green Climate Fund grants, Multilateral Development Bank-MDB concessional loans, private impact capital) to fund clean energy for health facilities, community cookstove subsidy programs, and air-quality monitoring networks.
- Invest in national air-quality monitoring & public alerts: Expand fixed monitors in cities and regional hubs and deploy low-cost sensors linked to a public AQI dashboard and early warning for vulnerable populations.
- Mainstream NCD & TB continuity funding: Allocating and protecting specific budgets to guarantee uninterrupted access to medicines for chronic diseases, and to strengthen proactive TB detection efforts in communities and digital CHW systems (e.g., eCHIS scale-up).
B. Health system & service delivery
- Scale community digital platforms (e.g., eCHIS + ICHH model): Expand CHW apps (screening, referral, adherence reminders) to capture NCD vitals, TB symptom screening/contact tracing, household air-quality readings, and nutrition metrics. Use these data to trigger referrals and micro-targeted interventions.
- Deploy community-level preventive packages: Package includes: NCD screening + lifestyle counselling, TB symptom screening + rapid referral, clean cookstove subsidy or PAYG clean-stove option, air-quality education and household monitors for the highest exposure homes.
- Strengthen TB detection with digital tools: Use CHW apps for symptom screening, digital chest X-ray triage (AI assist where available), SMS follow-up for test results, and home tracing for contacts. Ensure linkage to shorter TB regimens and social support.
- Heat early-warning & hospital preparedness: Develop heat-health action plans integrated with weather alerts and CHW reporting. Stockpile supplies for surge response after floods/droughts.
C. Community & technology (implementable by counties, NGOs, private sector)
- Integrated Community Health Hub (ICHH) — scale a CHW app + dashboard model: Use CHWs to screen for NCDs (BP, glucose), TB symptoms, nutrition and household PM2.5 via low-cost monitors. Automate referrals, medication reminders and teleconsultation links to clinics.
- Clean Energy & Respiratory Health Initiative (CERHI): Subsidized/financed smart clean cookstoves (PAYG or micro-loan) plus indoor air monitors. Partner with energy ministry for subsidies and carbon financing for scale.
- Digital Nutrition & Wellness Platform (DNWP) & lifestyle nudges: Mobile-first personalized nutrition/physical activity programme, gamified incentives, and tele-nutrition consults for chronic disease management (hypertension, diabetes). Link to local markets for healthy-food discounts.
- Digital Sexual Health & STI Management System (DSHS): Confidential chatbot-based STI risk assessment, anonymous partner notification, and QR referral for syndromic care — integrated with NASCOP (National AIDS and STI Control Programme) and youth outreach.
D. Environment & energy
- Promote clean household energy at scale: National subsidy + PAYG delivery model for clean cookstoves and LPG where feasible; incentivize local manufacturing of low-cost clean stoves.
- Green health facilities: Prioritize solar + battery for primary health centers to power diagnostics and cold chain; include air filtration in high-risk hospitals. Finance via blended grants + concessional loans.
Governance, partnerships & financing (WHO, donors, counties)
- Cross-sectoral coordinating body — a national Health-Environment Steering Group (MoH, Environment, Energy, Treasury, WHO, civil society) to operationalize the plan and unlock blended finance.
- Use existing mechanisms — leverage Global Fund (TB/HIV), Gavi (immunization resilience), Green Climate Fund (health resilience grants), MDBs (PPPs, MDB guarantees) for blended pipelines.
- Data governance & open dashboards — publish anonymized community health & air-quality data to mobilize civil society, researchers and investors.
Risks & mitigation
- Risk: insufficient funding → Mitigation: staged pilots + blended finance to demonstrate results and crowd in private capital.
- Risk: CHW burnout/data overload → Mitigation: simple UX (User Experience), real-time dashboards and task shifting; incentives for CHWs.
- Risk: basis risk in sensor data / cookstove adoption → Mitigation: combine objective monitoring with behavior change campaigns and subsidy models.
References
