Cardiovascular Journal of Africa: Vol 30 No 3 (May/June 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019 136 AFRICA
programmes classified as ‘major’) and lack of financial resources
(7/18 programmes).
Study limitations are reported elsewhere.14,15 However, there are
some additional considerations when interpreting the findings in
an African context. First, the majority of CR programmes (80%)
that were identified in the present study were based in South
Africa, limiting interpretation and generalisation of findings
in the broader African context. Second, CR programmes were
identified through published research and key informants.
However, in resource-constrained contexts such as Africa,
programmes likely do not have the time, resources or capacity
for research, and therefore we may have failed to identify some
programmes. Finally, one may challenge the appropriateness of
an exercise component as an inclusion criterion for this study
in the African context. Physical inactivity may play more of a
role in CVD in western countries. Instead, physical activity is
often a necessity in resource-constrained settings (e.g. farming
communities, walking as primary mode of transport), with other
risk factors such as smoking playing a more prominent role.21
Implications
Strategies that could be pursued to increase capacity include
advocacy for government reimbursement,22 greater exploitation
of alternative settings (e.g. community-based programmes),14
alternative delivery models (integration of NCD management
and prevention within communicable disease programmes),23,24
increasing the use of community healthcare workers to deliver
CR, and increasing the number of patients served per staff
member and per programme.
With regard to delivery, programmes would be wise to tailor
the specific components to the most prevalent risk factors in
their setting (e.g. harmful use of alcohol). Capacity to offer
tobacco-cessation interventions and return-to-work counselling
should be increased within programmes. Buy-in is needed across
the continuum of care to ensure patient referral.
Conclusion
This is first time that the availability and nature of CR services
delivered in Africa has been evaluated. Overall, there were 32
CR programmes identified in eight of 47 countries. Unmet
need for Africa, for IHD alone, was estimated at 1 383 858
more CR spots. These findings, particularly in the context of
the projected accelerated increase in incidence of NCDs in
Africa (Figs 1, 2),3 demonstrate CR capacity must be augmented
massively. Given the realities of the African context (e.g. lack of
trained healthcare professionals, limited resources, geographical
challenges, multi-faceted and complex burden of disease), how
to do this feasibly remains to be determined.
On behalf of the International Council of Cardiovascular Prevention and
Rehabilitation, through which this study was undertaken, the Global CR
Programme Survey Investigators are grateful to the World Heart Federation
who formally endorsed the study protocol. We also thank Ms Ella Pesah for
anonymously providing feedback to respondents and for data cleaning.
This project was supported by a research grant from York University’s
Faculty of Health. Prof Derman reports some financial activities that were
outside the submitted work. Dr Heine reports funding from the AXA
Research Fund.
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