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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
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AFRICA
lifestyles. Sessions were held at primary healthcare centres
or in district community centres and were facilitated by staff
from UPCCD, the Nutrition Unit of the Health Ministry
and local healthcare centres. The sessions focused mainly on
skills needed for the adoption of a healthy lifestyle, including
demonstrations of healthy cooking. The need for adherence
to prescribed pharmacological agents such as anti-hyperten-
sive and oral hypoglycaemic agents was also emphasised.
•
A register for hypertension and diabetes mellitus was estab-
lished in 1997. Doctors of all health centres were requested to
update a summary form once a year, which was placed in the
inner page of the medical file of all patients with hypertension
and diabetes mellitus. The form prompted doctors to record
one value per year for all major risk factors, including blood
pressure, body mass index, total cholesterol, HDL choles-
terol, glucose levels, smoking, previous stroke and myocardial
infarction. Clerks who filled in the patients’ medical notes
then updated a health centre-based register with the informa-
tion recorded in the forms. Every year, all health centre regis-
ters are electronically compiled into a national register in the
Ministry of Health. Summary statistics and selected analysis
are fed back to health centres and other relevant offices for
information and action. For example, the lists of diabetic
patients are sent to ophthalmology departments to promote
screening and treatment of eye diseases.
Evaluation of the Seychelles primary health prevention
programme showed that (1) more than 90% of adults aged
35–65 years were aware of most of the main activities in the
prevention programme and a similar high proportion showed
good knowledge of CVD; (2) the prevalence of smoking
decreased significantly and this was linked to health education
and tax increases as a result of strong campaigns against
tobacco usage; (3) the active participation of a proportion
of the community and the active involvement of key persons
and sectors generated a broad coalition among the public,
authorities and other organisations that will be very useful in the
development of further healthcare interventions and relevant
policies; (4) although blood pressure and cholesterol levels
increased in the population, it is argued that the levels could
have been worse without this intervention programme, bearing in
mind the concomitant accelerated socio-economic development.
Lessons for other sub-Saharan African countries
from the Seychelles experience
There are many lessons for countries in sub-Saharan Africa to
learn from the Seychelles experience.
•
The programme was initiated by the government of Seychelles
through the health ministry. Other governments in the sub-
continent need to play more active roles in the control and
treatment of CVD, while not forgetting about communica-
ble diseases. Governments should realise that they can only
get support from other sectors such as private, parastatals,
academia and international organisations if they are first seen
to be committed.
•
The Seychelles programme was community based, with
healthcare brought to the population at their door steps. For
any CVD intervention programme to succeed in the sub-
continent, a community-orientated approach must be taken,
especially with rural areas where transportation is difficult and
the population struggles to seek medical help in urban and
semi-urban health facilities. Primary healthcare centres need
to be equipped with trained non-physician personnel and basic
tools such as blood pressure apparatus, glucometers, urinalysis
strips and point-of-care machines for cholesterol checks.
•
The programme succeeded in the Seychelles because it was
non-physician based, involving nurses and community health
workers, with physicians playing a supervisory role. For a
CVD prevention and treatment programme to be effective in
sub-Saharan Africa, nurses and healthcare workers, who can
reach people at their homes, must be properly trained and
empowered. This is also important in regions where there is a
lack of trained physicians.
•
The success of the Seychelles programme can be attributed to
good public education. Governments in sub-Saharan Africa
need to channel media activities to campaign on the preven-
tion of CVD if we want to curb the coming epidemic. This
should be easy in the sub-continent, since much of the media
is government owned.
•
The Seychelles has a comprehensive health insurance scheme
for the majority of the population, which ensured success of
the preventative measures. This type of programme would
be difficult in countries where patients pay out of pocket for
healthcare. For any such programme to succeed elsewhere,
governments would need to implement comprehensive health
insurance schemes.
•
There was a good referral system in the Seychelles.
Governments would need to develop such a system, flowing
from primary to secondary healthcare centres and then to
tertiary centres.
•
The Seychelles government was stimulated to embark on the
intervention programme as a result of data generated from
an epidemiological survey. For countries in sub-Saharan
Africa to make any headway regarding prevention of non-
communicable diseases, a non-communicable disease survey
is periodically needed in each country.
Suggested model for the prevention and treatment
of CVD and diabetes in sub-Saharan Africa
In view of the success stories in countries such as the Seychelles
and Rwanda, the following model may be useful for the
sub-continent, with a little modification to suit each country.
Firstly, it should be aimed at both the prevention of CVD and
diabetes mellitus, and at detecting and treating high-risk patients.
Secondly, it should be coordinated by the non-communicable
disease units of the ministries of health. Thirdly, it should be
community based and involve non-physician health workers
such as nurses, community health officers and allied staff, and
be coordinated by a physician. Fourthly, there should be an
emphasis on primary care in the rural areas.
Primary healthcare centres or clinics should be located near
where people live in the rural areas, with a larger comprehensive
health centre in the district headquarters, where physicians
can supervise the primary health centres. Such primary health
centres should be equipped with basic instruments such as
weight and height scales, blood pressure apparatus, glucometers,
urinalysis strips and strips for cholesterol measurement.
The comprehensive health centres should have an
electrocardiography machine. They should be attached to a