Measuring her blood sugar level every morning is an ingrained, if not always welcome, part of Elisaria Matau’s daily routine.
The 70-year-old retired Tanzanian businesswoman from Dar es Salaam has been living with type 2 diabetes for decades. Her late husband, a soldier, died of complications from diabetes, and she is one of six in her extended family with the chronic illness.
Her family’s health situation is not unusual. Government health sector reports show that non-communicable diseases (NCDs) such as diabetes are on the rise and now account for about 40% of Tanzania’s disease burden.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
The country has one of the world’s fastest-growing populations, and UN projections suggest it will be one of eight countries responsible for more than half the increase in global population by 2050.
People are also living longer – life expectancy is a predicted 66 for men and 71 for women by 2025 – and the UN expects the number of Tanzanians over 60 to more than double over the next three decades. Even at its current population, Tanzania is struggling to meet its health needs.
Older Tanzanians are disproportionately affected by NCDs, yet nearly 90% of people over 50 do not have health insurance and have little access to medical services. The state health insurance scheme can cost between £70 and £350 a year, and healthcare costs are prohibitive for many. Authorities estimate that more than three-quarters of people don’t visit hospitals until they are severely ill.
Matau lives alone in Kawe neighbourhood in the capital. She is one of few Tanzanians who can afford private healthcare, and visits a nearby clinic every few weeks. But Matau’s health insurance only covers a portion of her medical expenses; her children help pay the rest.
“It’s so difficult for them because they also have a family they are taking care of,” says Matau, sitting outside her home. She has had to change her diet because of her diabetes, which means spending more on food.
Victoria Matutu, 35, is shouldering a double burden. Diagnosed with type 1 diabetes two years ago, Matutu spends about £35 a month on insulin, and the same amount on clinic visits every two months. Her mother also has the condition, so Matutu has to help her with medical bills. She earns the equivalent of £140 a month, which is not enough to pay into the government’s scheme. “We’ve really had to dig into our pockets,” she says.
Mary Mayige, coordinator of the National Survey for Non-Communicable Diseases, says that conditions that once mainly affected the elderly now affect people in their 30s who are “the production engine of the country”.
Healthcare has always been thought about in terms of spending, she says. “It’s high time that countries begin to look at the situation as a threat to the economy and human capital development.”
She wants the government to widen its approach by making targeted investments and increasing social and economic incentives for healthier lifestyles.
Tanzania allocates less than 5% of its GDP to health, which is below the international threshold for provision of basic services. Donor funding contributes to about 60% of total public spending, but the health programmes it pays for are heavily skewed towards infectious diseases such as malaria and tuberculosis, despite data which suggests that cases of infectious diseases are falling, while NCDs are on the rise and account for nearly half of the country’s deaths.
The government’s healthcare strategy for 2021 to 2026 recognises the need to increase its focus on NCDs. “Government will stimulate preventive measures addressing lifestyle-related and mental health risk factors, as well as environmental factors,” says the strategy. “Where necessary, legislation and regulations will be put in place to reduce exposure to risk factors. There will be early detection of chronic diseases through screening and early treatment of non-communicable conditions of public health importance.”
“We need to reorient the health system to respond to the growing burden of NCDs,” says James Kiologwe, assistant director of NCDs at the Ministry of Health.
A universal health insurance scheme is due to launch next year, offering lower premiums to larger families and providing targeted support for elderly people or those with chronic diseases. But NCD experts say that much more needs to be done – or tailored solutions found – to tackle the country’s growing NCD burden.
