**Author details**

*Public Health in Developing Countries - Challenges and Opportunities*

by all relevant sectors [121].

marketing by a burgeoning food industry.

**8. Conclusion**

have suggested that the groups most at risk of NCDs in the next decade will be the urban poor [118]. While NCD epidemiology in high income countries is largely driven by explosion of traditional risk factors in Rwanda, increasing evidence points to a greater contribution of malnutrition, infections, and toxic environments - all exacerbated by poverty [119]. Poverty also limits access to quality NCD care. Majority of the urban poor lack access to health insurance and therefore resort to out-of-pocket payments, consequently leading to catastrophic spending [120]. Research on social and economic implications of NCDs remain scarce in most SSA countries yet such information is important for prioritization of NCDs

The rapid urbanization in Africa continues to drive the NCD epidemic, increasing vulnerability of individuals, threatening development and sustainability of African cities. To mitigate this rising threat - effective evidence-informed multisectoral policies are needed to address prevention and control of NCD focusing on the major NCD risk factors. While several countries have developed national strategies for NCD prevention following the global WHO NCD prevention strategies, implementation of these policies is still inadequate. Thus there is need for governments to put more effort in strengthening implementation of these policies including allocation of financial and other resources to support implementation. NCD policies need to be integrated into urban planning to address air pollution as well as physical inactivity by designing and developing parks and recreational facilities including pedestrian and cycling tracks, zoning walk-ways where motorized vehicles are not allowed and providing incentives for the non-use of motorized vehicles. Fiscal policies and regulatory measures to restrict unhealthy food environment in urban areas of Africa are also needed to curtail the ever growing food

There is need to strengthen health care systems to make them more responsive to NCD prevention and control. This include building capacity of health workforce on prevention and control of NCDs, strengthening infrastructure, providing essential commodities and supplies and strengthen surveillance systems to be able to plan, monitor, and assess the effects of NCDs on population health and monitor the performance of interventions. A good balance of investment is required for the delivery and coordination of both curative and preventive and promotive services to avert the NCD disease burden. Countries need to explore various models of partnership with private sector partners aimed at scaling up their contributions to addressing

NCDs directly or indirectly through various multi-sectoral strategies.

There is need to strengthen primary prevention interventions at communitylevels. These interventions include early detection, active screening, case finding, referral and treatment and working with at-risk individuals to reduce high risk behavior. Expanding opportunities for early detection at the community and in primary health facilities could yield positive outcomes, especially through deliberate implementation of task shifting and task sharing models, involving community health workers (CHWs), while consistently mentoring and evaluating performance of such a model. Further community interventions include health education and promotion focusing on NCD risk factors including importance of reduced alcohol and tobacco consumption, physical activity and decreased consumption of highcalorie foods and highly processed foods while increasing consumption of fruits and vegetables. Some evidence exist on the potential positive results of such small-scale healthy food interventions utilizing platforms such as school feeding programs and

**42**

Kenneth Juma1 \*, Pamela A. Juma<sup>2</sup> , Constance Shumba<sup>3</sup> , Peter Otieno1 and Gershim Asiki1

1 African Population and Health Research Center, Nairobi, Kenya

2 London School of Economics and Political Science, London, UK

3 Aga Khan Foundation and Aga Khan University, SONAM-EA, Nairobi, Kenya

\*Address all correspondence to: kjuma@aphrc.org

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
