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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
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AFRICA
–– All SSA countries should have adopted and should
follow the WHO global agenda of reducing NCDs by
2020.
–– When reporting to the Ministry of Health and the
WHO, stakeholders should report specifically on hyper-
tension.
–– National cardiac and hypertension societies should
monitor the prevalence, awareness and control rates of
hypertension and report to PASCAR.
–– Government, private sector, academia and community
organisations should pay attention to this report and
work together for a reduction in hypertension preva-
lence.
2. Allocate appropriate funding and resources for the early
detection, efficient treatment and control of hypertension.
•
The costs of priority interventions for NCDs, including
hypertension, have been shown to be small and countries
are receiving global funds.
•
No new global funding is needed to implement the 10
actions for controlling hypertension.
•
Comprehensive implementation to control hypertension
and reduce salt intake is affordable in all countries.
•
The current increasing burden of uncontrolled hyperten-
sion is a barrier to the development of all African nations.
•
Funding to support civil society and health organisations
will contribute to developing and implementing appropri-
ate health policies to control hypertension.
•
Funding is needed to support dissemination of best prac-
tices to detect, manage and control NCDs within Africa.
–– Increase healthcare budgets in Africa to align with
the WHO global action plan of 2013–2020, which has
already been adopted by all SSA countries.
–– Realign existing funding with the emerging hyperten-
sion threat that SSA populations are experiencing.
–– Dedicate a clear percentage of the health budget to
hypertension policy.
–– Use existing resources more efficiently.
–– Develop innovative funding mechanisms, including
additional alcohol and tobacco taxes.
–– National cardiac and hypertension societies should
monitor the hypertension/NCD-related budget every
two years and advocate otherwise for improvement.
3. Create or adopt simple and practical clinical evidence-based
hypertension management guidelines.
•
The role of simple and practical guidelines is crucial for
managing NCDs at large, and hypertension specifically.
•
In 2015, only 25% of SSA countries had developed or
adopted clinical guidelines for managing hypertension
(Fig. 4).
•
New scientific knowledge guides implementation and
efficiency in developing guidelines according to the best
actual practices.
–– PASCAR will develop and regularly update continen-
tal guidelines with a simple care algorithm (Fig. 2)
for detecting, treating and controlling hypertension.
National cardiac societies are called upon to adopt or
adapt to the country’s circumstances where appropriate.
–– Alternatively, the WHO HEARTS technical package
for CVD management in primary healthcare overtakes
WHO PEN
12
and provides a comprehensive CVD
control approach,
23
with the possibility of integrating
hypertension as a risk factor.
–– PASCAR has defined and will regularly update the mini-
mum standards (Table 3) to control hypertension, which
need to be achieved by each SSA country. Countries are
called upon to adopt and implement these.
4. Annually monitor and report the detection, treatment and
control rates of hypertension, with a clear target of improve-
ment by 2025, using the WHO STEPwise surveillance in all
countries.
•
The success of all NCD interventions, including hyper-
tension policy, will depend on how specific, measurable,
achievable, realistic and time-bound the objectives are.
•
A framework for national and continental monitoring,
reporting and accountability will ensure that the returns
on investments in hypertension and other NCDs meet the
expectations of all partners.
–– The WHO STEPwise approach to NCD risk-factor
surveillance should be strengthened in all African coun-
tries to report on detecting, treating and controlling
hypertension annually.
–– BP to be measured at all relevant clinical encounters.
–– Regular representative population surveys are effective
in monitoring trends of key risk factors and the uptake
of priority interventions, such as the WHO STEPS
approach to monitor NCD risk factors.
–– National cardiac and/or hypertension societies should
measure the level of coverage for some sentinel sites
(communities, industries, primary healthcare centres,
etc.) and report to PASCAR.
–– National cardiac and/or hypertension societies should
take responsibility for reporting progress in hyperten-
sion control, mobilising resources, developing policy
and identifying best practices.
–– The monitoring and reporting team in sentinel sites will
ensure that people know their BP, hypertensives receive
appropriate treatment, BP is controlled and they remain
on treatment.
5. Integrate hypertension detection, treatment and control
within existing health services, such as vertical programmes
(e.g. HIV, TB).
•
What the medical community learned from the large-scale
management of TB and HIV/AIDS should be successful in
managing hypertension.
–– The government, private sector, academia and commu-
nity organisations should work together to align plans
for detecting, treating and controlling hypertension
with other ongoing programmes.
–– Emphasis should be placed on (1) standardised treat-
ment protocols, (2) identification and availability of
affordable and effective drugs, and (3) service delivery,
as with TB and HIV programmes.
6. Promote a task-sharing approach with adequately trained
community health workers (shift-paradigm).
•
SSA carries 11% of the world population, 25% of the
global burden of disease, with only 3% of the world’s
health labour force, and has a global health expenditure
of less than 1%.
24
•
These health-worker shortages are a major barrier to
controlling hypertension in Africa.