A roadmap for kidney care in Africa: An analysis of International Society of Nephrology–Global Kidney Health Atlas Africa data describing current gaps and opportunities

Abstract

Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa reported zero co-payment for all modalities of kidney replacement therapy in the public sector. Policies on chronic kidney disease and non-communicable diseases were scarcely available across all African sub-regions. The ISN–GKHA African data highlight a stark difference in kidney care measures between North and sub-Saharan Africa and also suggest the need for a more cohesive approach to policy formulations that support and protect patients with kidney disease in the continent, especially from the excessive costs associated with care. Using the World Health Organization (WHO) Global Action Plan for noncommunicable diseases, this paper proposes an African roadmap for optimal kidney care. Keywords: CKD, kidney failure, dialysis, transplantation, cost, policy

Transporting Sodium-Glucose Cotransporter-2 Inhibitors to the African Continent: Challenges and Solutions

“…Rapid economic strides, however, bring newer healthcare concerns. 1 Once a continent portrayed as home to “dangerous” infections, Africa is now catching up with the rest of the world in terms of life-style associated noncommunicable diseases. The position paper by 13 senior leaders from the African Association of Nephrology in this issue of Kidney International Reports highlights the important concern of the increasing prevalence of chronic kidney disease (CKD) in Africa, driven by the triple burdens of rising noncommunicable diseases, infections and social determinants of health, superimposed on genetic predisposition in some regions.…”

“…3 The strength, quality, and financing of health systems varies across the continent, with most kidney services being covered by the health system in North Africa and most services being paid for out of pocket in many countries in Sub-Saharan Africa. 1 The challenges experienced in diagnosis and access to care for CKD vary with local contexts, being generally greater in Sub-Saharan Africa than in North Africa. Despite this diversity, the recommendations put forward in this position paper are largely generalizable across Africa and beyond and must urgently be implemented everywhere.…”