On 13–15 June 2014, an East Africa NCD Stakeholder Meeting was held in Entebbe, Uganda. The meeting convened a wide range of representatives from governments, alliances, NGOs, academia and private sector committed to accelerating the response to non-communicable diseases (NCDs) in the East Africa Community countries of Burundi, Kenya, Rwanda, Tanzania including Zanzibar, and Uganda. It was organized as part of the East Africa NCD Alliance Initiative, which is led by the NCD alliances of Uganda, Tanzania, Zanzibar, Kenya, and Rwanda, in partnership with the Danish NCD Alliance, the global NCD Alliance, and three universities (University of Southern California Institute for Global Health, Office of Global Health, Department of Internal Medicine, Yale University and Center for Global Health, Aarhus University). The Initiative aims to promote regional cooperation between the East Africa NCD alliances by facilitating the sharing of good practices and expanding partnerships, and is funded by the DANIDA Civil Society Fund. The East Africa NCD Stakeholder Meeting provided an opportunity to present and discuss the new East Africa Civil Society Survey Report on NCDs, which was developed by the East African NCD alliances. The report provides a snapshot of the NCD response in the East Africa Community, from a civil society perspective. Progress was measured using the global NCD Alliance Benchmarking Tool, which focuses on implementation of priority NCD policy objectives. The report highlights gaps and good practices, and provides an evidence-based platform for further action. Discussion during the East Africa NCD Stakeholder Meeting underlined the increasing burden of NCDs in the East Africa Community, fueled by increasing vulnerability to the risk factors and the underlying social, economic and environmental determinants. In the East African Community, the linkages between NCDs, communicable diseases and maternal and newborn health are clear, as is the need for integrated approaches to prevention, diagnosis, treatment, care and education. These diseases are undermining sustainable human development in the region, and threatening achievement of the Millennium Development Goals (MDGs). The East Africa Civil Society Survey Report and the Stakeholder Meeting emphasized that despite the evidence and availability of cost-effective solutions, these diseases have not been prioritized on national, regional and global agendas. The Report underscores that while the region has made strong commitments for action and some progress has been achieved, there remain major challenges and gaps in implementation. For these reasons, the East Africa NCD Stakeholder Meeting developed and endorsed the East Africa NCD Civil Society Charter. This Charter aims to create a sense of urgency within the East Africa Community to accelerate progress at national and regional levels. It represents the shared priorities and views of NCD civil society in East Africa. We believe that urgent and decisive action is needed to improve the lives of people living with or at risk of NCDs in the East African Community. Action is not an option, it is an imperative. The Charter is targeted principally at governments, regional institutions and the global community. It has been developed to inform preparations for the forthcoming United Nations High-Level Review on NCDs in New York on 10–11 July 2014, as well as key regional bodies and institutions including the East Africa Community (EAC), the Africa Union (AU), and WHO Africa Regional Office.

The delegates of the East Africa NCD Stakeholder Meeting:

RECALLED:

·        The            Abuja        Declaration,                    committing                 African                    Union        countries to                    increase government funding for health to at least 15% and urging donor countries to scale up support (2001); ·        The            UN             Monterrey                    Consensus                  of                the                    International              Conference                    on Financing Development, committing developed countries to achieve the target of 0·7% of gross national income for ODA by 2015 (2002);
·        World        Health       Assembly Resolution                    WHA56,    Framework                    Convention on Tobacco Control (2003); ·        World        Health       Assembly WHA57.17,                    Global       Strategy   on               Diet,                    Physical Activity and Health (2004);
·        The            Paris,         Accra,        and                    Busan        Declarations               on                    Aid             Effectiveness,                    committing donor countries to align aid to developing country national priorities (2005, 2008, and 2011); ·        World        Health       Assembly Resolution                    WHA61.23                   on                    Prevention                 and Control of NCDs: Implementation of the Global Strategy, which urges Member States to strengthen national capacity and increase resources for the prevention and control of NCDs (2008);
·        The            Algiers      Declaration                 on                    Health       Research in                    Africa,       and            the                    Bamako Call to Action on Health Research (2008); ·        The            Ouagadougou           Declaration                    on               Primary    Health       Care                    and            Health Systems in Africa (2008);
·        The            Maputo    Declaration                 on                    Strengthening           of                    Laboratory                  Systems (2008); ·        The            Nairobi     Call             to                    Action       for              Health                    Promotion                  (2009);
·        The            Brazzaville                   Declaration                    on               NCD           Prevention                    and            Control     in                the WHO Africa Region (2011); ·        The            Moscow   Declaration                 from                    the             First           Global                    Ministerial                   Conference on Healthy Lifestyle and NCD Control (2011);
·        The            United      Nations    Political                    Declaration                 on               NCD                    Prevention                 and                    Control (2011); ·        The            WHO         Global       Action       Plan                    for              the             Prevention                    and            Control     of                NCDs 2013–2020 (2014);
·        The            East African                Community                    (EAC)         NCD           Strategy                    (2014).  

RECOGNIZED:

•                 That           the             global        burden     of                    NCDs         (namely   cancer,     cardiovascular                    disease, chronic respiratory disease, diabetes, and mental and neurological disorders), constitutes a global health and development emergency of the 21st century, undermining social and economic development and affecting all levels of society— national, community, family and individual; •                 NCDs         disproportionately  impact      on                    low-           and            middle-income                    countries (LMICs) and represent a significant challenge for sub Saharan Africa; this is compounded by road traffic injuries. Of the 36               million       NCD                    deaths      every        year,          80%            occur                    in                LMICs.      While        the NCD epidemic is increasing worldwide, the largest relative increase in NCD deaths globally in the next decade is expected to occur in Africa, where NCDs will become the leading cause of death by 2030. The burden from cancer alone is expected to more than double between 2008 and 2030;
•                 The            major        burden     of                NCDs                    in                East            Africa        includes                    cardiovascular           diseases (in particular hypertension and rheumatic heart disease), diabetes, cancers, chronic respiratory diseases, haemoglobinopathies (in particular sickle cell disease), mental disorders, violence and injuries, road traffic accidents, disability, oral and eye diseases; •                 NCDs         and            NCD-related                    mortality  occur         at                younger   ages                    in                sub Saharan Africa than in other regions, impacting on economic productivity, and disrupting social and cultural set ups. Two thirds of life-years lost and disability-adjusted life years (DALYs) due to NCDs and injuries in sub-Saharan Africa are in individuals younger than 40 years of age;
 

•                 The            double      burden     of                    communicable          and            non-communicable          diseases in the East African Community and the associated disabilities and premature deaths increase pressure on existing vulnerable health systems and national economies. NCDs impede economic growth by impacting on labor productivity, resulting in foregone national income, and entrenching household poverty. The cost of inaction far outweighs the cost of action;

•                 The            full              realization                   of                    human      rights         and            fundamental                    freedoms for all is an essential element in the response to NCDs, including in the areas of prevention, care, support and treatment, and that it reduces vulnerability to NCDs and prevents stigma and related discrimination against people living with or at risk of NCDs;
•                 Links          between communicable          and                    non-communicable diseases   require integrated interventions. Communicable diseases contribute to and exacerbate the NCD burden. For example, TB negatively affects diabetes outcomes; presence of HIV can increase risk of cardiovascular disease and some types of cancer. In fact, one third of cancers in Africa are related to infection, which is twice the global average; •                 Maternal nutrition  and            health                    during       pregnancy                   and                    health       and            nutrition in the first two years of life have a profound impact on the development of obesity, diabetes, CVD and other NCDs in adult life. Malnutrition in early childhood affects NCD outcomes. Stunting, for example, is associated with development of obesity later in life, and affects 40% of children in Africa. Children in East Africa exhibit “nutritional transition” with a significant proportion being underweight, while at the same time the proportion of overweight and obesity is increasing;
•                 NCDs         impact      disproportionately  on                    the             poor          and            most                    vulnerable groups, such as children, women, young mothers, and older people, both directly—these populations have higher NCD rates—and indirectly —women and children share the majority of unpaid labor towards care for an ill or disabled member of the household; •                 The            conditions                   in                which                    people      live             and            their                    lifestyles  influence their health and quality of life, and that poverty, uneven distribution of wealth, lack of education, urbanization and slum dwellings, and social and environmental determinants are among the contributing factors to the rising incidence and prevalence of NCDs in East Africa
•                 Protect     public        health       policies     from                    interference              by               vested                    interests of the alcohol, tobacco and food industries through comprehensive legislation and enforcement of national laws and policies; •                 Implement                 cost-effective            and                    affordable                   interventions             to                    reduce      exposure to the risk factors of NCDs, including policies, legislation and regulations that lead to healthy food options being more available and affordable, increasing physical activity and reducing obesity, and banning marketing of unhealthy products to children;
•                 Increase   national    ownership                  of                    the             NCD           response through                    greater allocation of domestic resources and health budgets, remaining cognizant of the Abuja Declaration target to allocate 15% of national budgets to health, and through traditional and voluntary innovative financing mechanisms; •                 Promote  access       to                affordable,                    safe,          effective  and            high-quality                    essential NCD medicines and technologies in working with the private sector, particularly pharmaceutical companies;
•                 Foster       collaborative              partnerships                    between government               and            civil                    society to fill gaps in the provision of prevention and treatment services, and actively engage communities and people living with NCDs in national efforts to prevent and control NCDs; •                 Support    operational                 research                    through    national    and            international                    collaborative platforms to inform, improve and document the development of best practices and approaches in improving health systems, provision and service delivery in a comprehensive, continuous and integrated way;
•                 Establish  clear          and            rigorous                    monitoring                  and            evaluation                    mechanisms at the country level to ensure accountability of progress in the NCD response.

 And the delegates of the East Africa NCD Stakeholder Meeting urge regional institutions and the global community to

: •               Prioritize  NCDs         in                regional                    health       and            development            plans                    and            strategies, including from the Africa Union, WHO Africa Regional Office, and the African Development Bank;
•                 Urge          the             East            Africa                    Community                Secretariat                  to                    fully           implement                  the             EAC NCD Strategy, and improve and standardize data collection on NCDs across the region; •                 Prioritize  and            integrate NCDs         into                    bilateral,  regional,  multilateral                 and global development agendas and planning instruments, including the post-2015 development agenda, Poverty Reduction Strategy Papers (PRSPs), and UN Development Assistance Frameworks (UNDAFs);
   
         Mobilize   additional                    predictable                    and            sustainable                 global                    resources for NCDs by integrating NCDs into existing global financing mechanisms, and complement national budgetary allocations of developing countries with Official Development Assistance (ODA) for NCDs, in line with the Paris, Accra, and Busan Declarations on Aid Effectiveness and in fulfilment of the commitments by many developed countries to achieve the target of 0.7% of gross national income for ODA by 2015;         Furthermore, the delegates of the East Africa NCD Stakeholder Meeting commit ourselves, as civil society, to the following actions in accelerating the NCD response in East Africa: •        Promote  the             capacity-building    of                NCD-related               NGOs,                    alliances   and networks at the national and regional levels, including through the establishment of a Civil Society Fund for NCDs to support NCD civil society in LMICs

 

 

•                 Lead          awareness-raising   activities,                    sensitizing                   communities              and                    the wider general public to NCD prevention and treatment; •                 Coordinate                 advocacy and                    lobbying   activities  at                national,                    regional    and global levels to maintain political leadership and action on NCDs, as well as resource mobilization;
•                 Provide    complementary        services    to                    governments             to                prevent    NCDs and support people affected, including training, and patient support and empowerment; •                 Promote  research, good          practice,   and                    monitor    progress  on               NCDs         in the East Africa Community.

. The East Africa NCD Civil Society Charter was endorsed and signed on 15 June 2014 in Entebbe, Uganda, by:

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