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AFRICA
Cardiovascular Journal of Africa • Volume 31, No 4 August 2020
S32
plan was discussed at a United Nations General Assembly
meeting, where the minister of health of Rwanda indicated
the importance of co-ordination.
35
The need for civil society’s
involvement in a national multi-sectoral co-ordination
mechanism for combating NCD and reducing their risk
factors was iterated in 2015.
32
Civil society organisations
are regularly part of an informal consultative MoH/Rwanda
Biomedical Centre Technical Working Group on NCD.
32
However, the draft concept and composition document for
a high-level co-ordination mechanism has been prepared but
not yet submitted for approval by the government. No data are
available on specific activities aimed at a 25% reduction in
premature CVDmortality by 2025 by cardiology professional
associations. A hypertension survey among adults working at
a tertiary institution in Rwanda showed it is possible to reach
employees at their workplace. However, there is no indication
of hypertension screening by businesses at workplaces.
36
As part of the data gathered for Rwanda, the following
strengths, weaknesses, threats and priorities are summarised.
Strengths
The National NCD Strategic Plan 2014–2019 emanated from
the National NCD policy 2013, the Rwandan Health Sector
Strategic Plan 2013–2018 and the Rwandan Economic
Development and Poverty Reduction Strategy II (EDPRS)
2013–2018.
19
The main objective of the national strategic
plan was to develop a robust monitoring and evaluation
system to track the NCD burden of disease in the country.
19
The integration of NCD monitoring tools in the national
health information system and electronic medical record, and
the implementation of the Bloomberg Philanthropies-funded
Verbal Autopsy Program are expected to improve morbidity
and mortality data collection.
37
Moreover, Rwanda has
successfully implemented an integrated and decentralised
chronic care model for most common NCD and CVD at the
district hospital and primary healthcare levels.
38
TheRwandaBiomedicalCentre is the implementingentity
for NCD prevention and control activities in terms of the
policy. The NCD division, on the other hand, is responsible
for the day-to-day implementation of interventions.
17
The
management, monitoring and evaluation of implemented
activities are under the supervision of existing organs and
structures in the national health system. The focus of this
policy includes CVD, and its goal is to alleviate the burden
of NCD and their risk factors along with protecting the
Rwandan population from related premature morbidity and
mortality.
17
In 2015, a team of recognised experts developed national
NCD guidelines according to international standards.
12
A
national surveillance system, the STEP survey, including
CVD and their risk factors, has also been implemented.
8
For a country that underwent the worst genocide in 1994,
Rwanda has made tremendous progress regarding financial
access and risk protection by strengthening pre-payment
mechanisms, which include community-based health
insurance and other health insurance schemes, also covering
NCD.
39
Rwanda is one of a few African countries that has
developed a sports policy.
29
Probably this was a way in
achieving post-conflict reconciliation and supporting the role
that sport plays in the health and well-being of communities
to reduce CVD risk.
40
Rwanda is benefiting from multilateral initiatives for
national NCD capacity building such as the Smoke-free
City project, and the Verbal Autopsy programme.
22,37
Also,
the United Nations-anchored multilateral defeat-NCD
partnership kicked off recently, as well as the establishment of
regional NCD training, specialised care and research-driven
centres of excellence through the East African community.
34,41
Threats
In Rwanda, mortality data became available from hospital
registries to demonstrate that NCD are an important cause
of death and place a heavy burden on the country, along with
prevention and control services, which are limited.
17
In 2016,
NCD were estimated to account for 44% of all deaths, of
which 14% included CVD.
16
Tobacco use among adolescent men in 2018 was about
13%, which is slightly lower than the global consumption
of 18.2% for this group.
4
In 2012, 19% of adult men used
tobacco, while 7% of women adopted the habit. The recorded
average (three-year) alcohol consumption per capita was
7 litres pure alcohol, which is more than most of the other
African countries under investigation.
4
Because of population ageing, there has been an increase
in the incidence of NCD.
42
The prevalence of hypertension,
a leading cause of CVD, is high in Rwanda.
7
Other risk
factors are diabetes, obesity, salt intake, smoking, lack of
exercise and a low intake of fruit, vegetables and unsaturated
fats.
19
The age-standardised estimate for raised BP in 2015
was 26.7%, which is higher than the global level (22.1%)
but slightly lower than that for Africa (27.4%), whereas the
prevalence among 15–64-year-olds was about 16% in 2013.
4,8
The prevalence of obesity was more predominant in urban
areas (10.2%) and in Kigali city (7.7%), with 14.3% of the
adult population, 15–64 years old, being overweight.
Compared to neighbouring countries Uganda (0.96%) and
Tanzania (1.01%), Rwanda had a slightly higher prevalence
of RHD, although low at 1.02%. Total RHD mortality rate
was also higher than these countries (0.17 vs 0.14% for both
countries), and that of hypertensive heart disease (1.82 vs
1.13% for Uganda and 1.43% for Tanzania).
10
Weaknesses
Although all 10 essential CVD drugs are available, these
are only at the district hospital level (public sector) and not
always at primary healthcare centres.
43
A national tobacco control plan and guidelines to treat
tobacco dependence are lacking, and sustainable funding
for CVD from taxation of tobacco or other ‘sin’ products
does not exist. However, there is a national multi-sectoral
co-ordination mechanism for tobacco control.
9
Primary healthcare facilities generally do not provide TC
measurements, and CVD risk stratification at this level is also
not prioritised. Rwanda, along with Cameroon, Mozambique,
Namibia and Sudan, has not yet introduced a policy regarding
the taxation of unhealthy foods or sugar-sweetened beverages
to combat obesity and other related NCD.
44