Health‑System Preparedness for Non‑Communicable Diseases in East Africa: A Comparative Analysis of Kenya, Uganda, Rwanda and South Sudan

Background Non‑communicable diseases (NCDs) have become the leading cause of death worldwide, accounting for about 74% of the global disease burden. East African health systems are confronted with a ‘double burden’ as they continue to manage infectious diseases while facing a rising tide of chronic conditions such as cardiovascular disease and diabetes. Rapid urbanisation, demographic growth and constrained resources have intensified this challenge. Methods The study conducted a cross‑national comparative analysis of Kenya, Uganda, Rwanda and South Sudan to evaluate health‑system readiness for NCDs. Demographic and epidemiological trends from 2000‑2021 were assessed using data from WHO “Health at a Glance” country profiles and related datasets. Health‑system capacity was benchmarked using the WHO Health‑System Building Blocks (service delivery, workforce, information systems, access to medicines, financing and governance) and NCD Progress Monitor domains (governance, risk‑factor reduction, health‑system response and surveillance). Descriptive statistics were generated from aggregated data, and policy information was synthesised from documents and literature. Ethical approval was not required since only publicly available secondary data were used. Results All countries experienced population growth and increased life expectancy, but the pace varied. Rwanda achieved the largest improvement (about + 20.9 years), followed by Uganda (+ 17.2 years), Kenya (+ 12.4 years) and South Sudan (+ 7.1 years). In 2021, NCDs accounted for roughly half of deaths in Rwanda, 38% in Kenya and 37% in Uganda, whereas communicable diseases remained predominant in South Sudan. Kenya’s projected gains towards WHO “Triple‑Billion” targets are the highest (approximately 10.6 million more people enjoying better health, 4.6 million gaining essential services and 13.1 million receiving better emergency protection), while South Sudan is expected to make minimal progress. Policy analysis revealed that most countries have NCD strategies but struggle with implementation due to limited financing and workforce capacity; Kenya leads in policy development, Rwanda has integrated NCD care into primary care, whereas Uganda and South Sudan lag behind. Tobacco control laws are common, but comprehensive alcohol regulation exists only in Kenya and Rwanda, and none of the countries strongly regulate marketing of unhealthy foods. Health facilities often lack diagnostic equipment and trained personnel, and surveillance systems remain weak. Conclusions Health‑system preparedness for NCDs in East Africa is heterogeneous. Rwanda has advanced into an NCD‑dominant mortality profile, Kenya shows moderate progress, and Uganda and South Sudan remain at earlier stages of the epidemiological transition. Strengthening primary health care, enforcing risk‑factor legislation, investing in surveillance systems and securing sustainable financing are essential to address the growing burden of non‑communicable diseases and promote equitable health outcomes.