67 / 70
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 5, September/October 2019
AFRICA
309
No data were available for CVD risk stratification in primary
healthcare facilities, total cholesterol measurement at the primary
healthcare level, and secondary prevention of ARF and RHD in
public-sector health facilities.
4
Secondary prevention and management
The percentage of hypertensive persons receiving medical
treatment is 31.5%.
3
However, no data are available on high-risk
patients with AF who are being treated with oral anticoagulants.
The percentage of people with a history of CVD taking aspirin,
statins and at least one antihypertensive agent is also unknown.
Part D: Cardiovascular disease governance
A national strategy or plan that addresses CVD, and specifically
their risk factors, was developed by the national NCD directorate
and is functional.
6
However, no dedicated budget or unit is in
place to ensure its implementation. The FMOH also developed
a plan that addresses NCD and their risk factors and RHD
prevention and control as a priority, which is in use.
8
Sudan has
formulated a national tobacco control plan and multisectoral
co-ordination mechanism for tobacco control.
10
A national
surveillance system including CVD and their risk factors is in the
process of being implemented.
3,10
There are no collaborative projects between the Ministry
of Health and non-health ministries for CVD interventions,
and the percentage of total annual government expenditure on
cardiovascular healthcare is not known. The benefits of CVD
prevention and control for health and the economy of this
population have not been modelled.
Assessment of policy response
Legislation that mandates health financing for CVD/NCD has
been developed and implemented, along with that of essential
CVD medicines at affordable prices.
11
However, no judicial
orders protecting patients’ rights and mandating improved CVD
interventions, facilities, health-system procedures or resources
have been implemented.
Regarding tobacco control, legislation on the following has
been implemented:
•
banning of smoking in indoor workplaces, public transport,
indoor public places and other public places
•
clear and visible warnings on at least half of the principal
display areas of tobacco packs
•
banning all forms of tobacco advertising, promotion and
sponsorship
•
measures to protect tobacco control policies from tobacco
industry interference.
10
The percentage of the excise tax of the final consumer price
of tobacco products in Sudan is 230% and that of the final
consumer price of alcohol products is unknown.
12
The country does not have policies that ensure equitable
nationwide access to healthcare professionals and facilities or
screening of high-risk CVD individuals. No sustainable funding
is available for CVD from taxation of tobacco and or other ‘sin’
products.
As far as food legislation and that of physical activity is
concerned, no policy exists for the following:
•
taxes on unhealthy foods or sugar-sweetened beverages
•
banning the marketing of unhealthy foods to minors
•
mandating clear and visible warnings on foods that are high
in calories/sugar/saturated fats
•
interventions that promote a diet that reduces CVD risk
•
interventions that facilitate physical activity.
Alcohol is banned in Sudan therefore no other legislation or
policies need to be in effect.
Stakeholder action
Non-governmental organisation (NGO) advocacy has been
demonstrated for CVD policies and programmes, while the
Epidemiological Laboratory (EpiLab), a private, not-for-
profit NGO in Khartoum, was involved in the development
and implementation of a national tobacco-control plan.
13
Unfortunately, there is no known active involvement of patients’
organisations in the advocacy for CVD/NCD prevention and
management.
Advocacy champions and/or patient engagement for RHD
groups are also not available. Involvement of civil society in the
development and implementation of a national CVD prevention
and control plan and the national multisectoral co-ordination
mechanism for NCD/CVD is also lacking. Specific activities by
cardiology professional associations aimed at a 25% reduction in
premature CVD mortality by 2025 and hypertension screening
by businesses at workplaces have not yet been addressed.
As part of the data collected for Sudan, the following strengths,
threats, weaknesses and priorities are summarised.
Strengths
The NCD National Strategic Plan (NSP) 2010–2015 for Sudan
was developed by the national NCD directorate at the FMOH in
response to the NSP for the health sector (2003–2027), which is an
indication of a sound governmental commitment towards NCD.
6
Guidelines for the management of ARF and RHD are
available. A national surveillance system including CVD and
their risk factors is in the process of being implemented.
Sudan, through EpiLab, became a pioneer in developing
countries through its ground-breaking research demonstrating
the feasibility and sustainability of the development and
implementation of a national tobacco-control plan.
13
Legislation
regarding tobacco control is in place, as is an excise tax.
Legislation that mandates essential CVD medicines at affordable
prices has been implemented.
11
Threats
The percentage of deaths caused by CVD is very high (33%),
with Tunisia (51.5%) and Egypt (46.6%) having higher levels
compared to the other selected countries and global data
(31.8%). DALYs attributable to CVD ranked slightly lower than
that of the global data (Table 1). Deaths caused by hypertensive
heart disease are also higher compared to the global data, as is
raised blood pressure for men and women.
Overweight and obesity tend to be a problem in most African
countries, although Sudan has a lower prevalence (28 and
10%, respectively) compared to global data (38.9 and 13.1%,