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AFRICA
Cardiovascular Journal of Africa • Volume 31, No 4 August 2020
S8
Stakeholder action
Non-governmental organisation (NGO) advocacy for CVD
policies and programmes in Mozambique are available on
CVD and cancer (AD, pers commun). However, there is
no active involvement of patient organisations in advocacy
for CVD/NCD prevention and management or advocacy
champions identified for RHD.
According to the Mozambique FCTC, unidentified NGOs
participated in developing and implementing a national
tobacco control plan that was approved by government in
2017.
25
Involvement of civil society in the development and
implementation of a national CVD prevention and control
plan is being implemented through the Non-Communicable
Diseases and Injury group.
34
However, that of civil society
in a national multi-sectoral co-ordination mechanism
for combating NCD/CVD is absent. Specific activities
by cardiology professional associations aimed at a 25%
reduction in premature CVD mortality by 2025 have been
implemented (AD, pers commun). Hypertension screening
at workplaces only takes place during May Measurement
Month activities (wellness days).
35,36
As part of the data collected for Mozambique, the following
strengths, weaknesses, threats and priorities are summarised.
Strengths
Non-communicable diseases were included in Mozambique’s
national health policy and through the national strategic
plan that was approved in 2008.
23,37
The aim of the Strategic
Plan for the Prevention and Control of NCD was to create
a positive environment whereby exposure to risk factors
would be reduced and access to care improved.
20
The MoH
developed diabetes and hypertension projects that could
be utilised in other NCD. Also, through the MoH and the
dedication of local champions, international support was
gained to improve diabetes care, which was incorporated into
its National Plan for NCD.
20
Several outcomes of this plan
have been:
• NCD focal points that were set up in all the provinces to
adjust the principles of the plan to each setting
• an alliance on NCD, which included departments from the
MoH, members of civil society, the media and the general
population was established
• an NCD unit that was created within the MoH
• an increase in the visibility of the diabetes association in
the community that was also strengthened
• consultations for diabetes and hypertension that were
established in 2006 and functioning at 12 health centres
in Maputo, two provincial health centres as well as 10
hospitals by 2009
• improved supply and availability of insulin, diagnostic
tools and trained healthcare workers, which have led to an
estimated increase in life expectancy.
A national surveillance system, the STEPS survey,
including CVD and their risk factors, is implemented every
10 years.
38
Mozambique is probably one of the few African
countries with two national representative surveys. Not only
has the prevalence of hypertension been reported but also
that of awareness, treatment and controlled hypertension.
11
In a study comparing PA levels and patterns among adults
across 22 African countries, Mozambique had the highest
prevalence at 96.2%, meeting the WHO recommendations,
with Ethiopia (85.7%) and Zambia (84.2%) trailing behind
but still at excellent levels.
39
Recommendations to improve and increase the role of the
Diabetes Association, and implement chronic disease law,
stating that people with diabetes and other chronic conditions
should receive an 80% subsidy on their medicines, were
suggested.
20
The Mozambique NCDI Poverty National Group, a
multi-sectoral platform that aggregates government leads,
researchers and clinical implementers, supports the expansion
of the NCDI national agenda by focusing on an equitable
approach for the entirety of the NCDI burden among the poor
and the young.
40
The aim is to provide technical support to the
government to deploy efforts in addressing neglected CVD,
such as RHD, cardiomyopathies and related infections such
as tuberculosis and schistosomiasis.
40
The NCDI recently
started a priority-setting exercise (including all NCD) to
define priority conditions and effective interventions.
There is also an ongoing open-heart surgery programme
at the main public hospital of Maputo.
41
Also, cardiac
catheterisation has been performed at Mozambique’s main
referral hospital since 2015.
Threats
Although life expectancy has improved slightly, NCD affect
the epidemiological profile of Mozambicans.
42
CVD are
the leading NCD cause of morbidity and mortality, with
hypertension as the primary risk factor, which increases
with age.
42
Another important cause of NCD and premature
death is diabetes, which is also responsible for an increased
risk of CVD.
42
In 2011, at the United Nations General
Assembly meeting, Mozambican President Armando
Guebuza indicated a steady increase in the incidence of
NCD, which mostly affected the workforce by placing an
extra burden on the economy.
37
In 2016, the prevalence of diabetes was 4.6%,
43
which
is higher than that reported by the IDF three years later for
Mozambique (3.3%) and Africa (3.9%).
15
Although low,
most people with diabetes are not aware of or on treatment
for the condition, which consequently creates barriers in
providing sufficient care.
19
Related risk factors adding to
increased CVD risk are overweight and obesity, along with
raised BP (31.4%) that was higher than the global prevalence
of 22.1%.
7
The GYTS, a nationally representative school-based
survey conducted in 2013, indicated 9.1% of adolescents
used tobacco.
8
Further findings showed that 19.1 and 37.4%
of these adolescents were exposed to tobacco smoke at home
and in confined public places, respectively.
8
In 2015, 22.8%
of adult men used tobacco (manufactured and hand-made
cigarettes), while 3.2% of women adopted the habit. For
smokeless tobacco, more women (4.6%) than men (1.1%)
made use of the practice.
7
Compared to neighbouring countries South Africa
(1.01%) and Tanzania (1.01%), Mozambique had a much