The diabetes impact in Africa: addressing disparities to drive change

Africa is grappling with a pressing health challenge – diabetes. The region is set to register the highest increase in the number of people with diabetes of all regions. With approximately 24 million adults affected and significant disparities in care, a 129% increase to 783 million is expected by 2045. From prevalence and resource access to policy frameworks and healthcare infrastructure, diabetes care delivery in the region is confronted with myriad complexities. However, by implementing successful initiatives and decisive recommendations that address underlying obstacles, we can improve diabetes care and prevention to improve health outcomes for millions in the region.

Diabetes prevalence and incidence, drivers of the diabetes epidemic

According to the latest estimates released by the International Diabetes Federation (IDF) in 2021, approximately 24 million adults aged 20-79 are living with diabetes in the region. More than half (13 million) are undiagnosed. Furthermore, an estimated 52 million adults have impaired glucose tolerance, which places them at high risk of developing type 2 diabetes.

The same factors that have contributed to the diabetes surge in China and India are contributing to the rise in type 2 diabetes in Africa.  These include lifestyle and dietary changes, urbanisation and socioeconomic influences, all compounded by an ageing population, decreasing levels of physical activity and an increasing prevalence of people with overweight and obesity. In addition, challenges with early diagnosis and access to care further exacerbate the diabetes burden in the region. Often people do not know or do not notice the symptoms of diabetes until they are hospitalised or diagnosed with a diabetes-related complication.

Disparities in the prevalence and incidence of diabetes exist across countries in Africa. While some countries may have higher prevalence rates due to socioeconomic and demographic factors, others may struggle with accurate data collection and reporting, leading to underestimation of the impact of diabetes.

Furthermore, unequal access to diabetes medications and technologies negatively impacts diabetes care. In some countries, challenges in procuring essential diabetes medicines and technologies lead to inadequate management and care for people with diabetes.

Access to insulin

One recurring issue is the availability of insulin, an essential treatment for people with type 1 diabetes and many with type 2 diabetes and other forms of the condition. Rising prices and the shortage of insulin and diabetes supplies in some countries have hindered access for people with diabetes. Consequently, many young people with type 1 diabetes go without their diabetes treatment to make ends meet. Advocacy efforts in the region call on governments to ensure the availability of insulin in public hospitals so people with diabetes do not have to pay out-of-pocket for their diabetes treatment.

Successful initiatives in sub-Saharan Africa

Another factor impacting diabetes awareness and early diagnosis is the scattered availability of diabetes education and awareness programmes across Africa. While some countries may have well-established initiatives to promote diabetes education and awareness, others may lack comprehensive programmes, leading to limited public knowledge about diabetes prevention and management.

Several successful diabetes management programmes were implemented in sub-Saharan Africa, showcasing innovative approaches to improve the quality of care for people with diabetes. These programmes, which reflect the collaborative efforts of healthcare professionals, organisations and communities, demonstrate the potential to address the unique challenges associated with diabetes in the region.

In Tanzania, the Tanzanian Diabetes Association (TDA), together with the Ministry of Health, has established 44 specialised clinics for diabetes care throughout the country. These clinics are structured similarly to the Tanzanian health system and are run by district, regional and referral hospitals. The Ministry of Health provides staff, and international partners support through training and education.

In response to the increasing need for diabetes-trained healthcare professionals in the region, IDF and Sanofi Global Health Unit, in partnership with Ministries of Health, national diabetes associations and scientific societies, have rolled out a programme that provides online training for healthcare professionals in countries across Africa and face-to-face training in Chad, Malawi, Togo and Uganda.

The IDF network in Africa

The IDF network of 32 diabetes associations across 27 countries in Africa plays an important role in addressing the challenges posed by diabetes in the region. Their work highlights the importance of tailored, community-focused initiatives, interdisciplinary collaboration, and integrating diabetes care into the broader health system to tackle diabetes in the region effectively. From cities to remote villages, they organise awareness campaigns, conduct medical training to provide healthcare professionals with the latest knowledge and engage in policy advocacy to shape diabetes care at the highest levels. Support programmes are at the heart of their actions, offering help to people with diabetes, their families and carers.

Financial protection schemes and insurance plans

Variations in economic development and healthcare infrastructure influence a country’s capacity to allocate resources for diabetes management, resulting in disparate care and services. The three health priorities that underpin public health needs in Africa are malaria, tuberculosis, and HIV/AIDS. As a result, limited funding and resource allocation are available for diabetes care, further exacerbating healthcare gaps.

While existing financial protection schemes cover less than 10% of the population in sub-Saharan Africa, innovative programmes such as health equity funds for people experiencing poverty in Cambodia and universal health coverage scale-up initiatives in Kenya, Turkey, Mexico, Thailand, and China have shown initial successes in providing financial protection for people with diabetes. These initiatives stress the importance of comprehensive healthcare and the need for similar programmes.

Differences in policy and regulatory frameworks for diabetes care also contribute to African regional disparities. Some countries may have robust policies and regulations to prioritise diabetes as a public health issue. In contrast, others may lack comprehensive frameworks, affecting the quality and accessibility of diabetes care services.

The Global Diabetes Compact and The Diabetes Blueprint for Africa

Addressing diabetes care disparities in Africa demands strategic interventions. These include ensuring equitable access to medicines and technologies, strengthening education programmes, fostering collaborations for policy development, and increasing investments in healthcare infrastructure. These efforts are crucial for improving diabetes management across the region.

Launched in 2021 to mark the 100^th anniversary of the discovery of insulin, the World Health Organization’s Global Diabetes Compact is an initiative that seeks to reduce the risk of diabetes and ensure that all people diagnosed with the condition have access to equitable, comprehensive, affordable and quality treatment and care. The Compact focuses on increasing political will and resources, strengthening health systems, improving access to affordable medicine and technologies, and empowering people with diabetes.  The work undertaken as part of the Compact will also support the prevention of type 2 diabetes by addressing risk factors such as obesity, unhealthy diet and physical inactivity.

The Diabetes Blueprint is a strategy to implement the Global Diabetes Compact in Africa, targeting the region’s needs and particularities. It addresses challenges such as myths and misconceptions about diabetes, fragile primary healthcare systems, and insufficient capacity and training of healthcare workers. The aim is to strengthen diabetes prevention and management.

While the inconsistencies in diabetes care are consequential, they are not overwhelming. Collaborations and partnerships between national diabetes associations, local health authorities and international organisations can help strengthen diabetes care. By advocating for policies prioritising diabetes as a public health issue and allocating resources for diabetes management, we can significantly improve the quality and accessibility of diabetes care, ultimately reducing the burden of diabetes and its associated complications in the African region.