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Cardiovascular Journal of Africa • Volume 31, No 4 August 2020
S37
AFRICA
American College of Cardiology guidelines.
12,13
No national
guidelines for the treatment of tobacco dependence have
been adopted,
6
although guidelines for the detection and
management of AF are available.
14
Locally relevant clinical guidelines for the management
of pharyngitis, acute rheumatic fever and RHD have been
incorporated into the Standard Treatment Guidelines (STG)
and National Essential Medicine List (NEMLIT).
14
No data
were found regarding clinical registers of people with a
history of rheumatic fever and RHD or a system to measure
the quality of care provided to people who have suffered
acute cardiac events.
Guidelines for managing diabetes in Tanzania were also
incorporated into the STG and NEMLIT in 2017.
14
In 2012,
Mayige
et al.
15
called for an urgent need to strengthen diabetes
services through the National Diabetes Project that would
also benefit other NCD in the country. These researchers also
suggested the need for secondary prevention measures for
those at high risk of developing NCD, including CVD.
15
Essential medicines and interventions
Angiotensin converting enzyme (ACE) inhibitors, aspirin,
β-blockers, metformin and insulin are included in the list of
essential medicines at primary care facilities in the public
health sector.
14
However, statins, warfarin and clopidogrel,
although listed, are not available at healthcare centres.
14
The measurement of TC is generally available at the
primary healthcare level. However, CVD risk stratification
or the provision of secondary prevention of rheumatic fever
and RHD is not available in public health facilities.
9
Secondary prevention and management
No information is available regarding the percentage of
patients with AF on treatment or those with a history of CVD
receiving medication. In an article by Edwards
et al.
, 10% of
patients with hypertension were receiving medical treatment.
16
Part D: Cardiovascular disease governance
A national strategy or plan addressing CVD, and specifically
their risk factors, has been developed.
17
Although there is no
dedicated budget, a unit in the national ministry of health
(MoH) is responsible for its implementation.
9
A national
strategy and action plan that addresses NCD, including
CVD and their risk factors, has been formulated,
17,18
but not
for RHD prevention and control as a priority. A national
surveillance system, including CVD and their risk factors,
has been employed.
19,20
Unfortunately no national tobacco control plan exists, but
there is a multi-sectoral co-ordination mechanism for tobacco
control.
6
While no data on collaborative projects between
the MoH and non-health ministries for CVD interventions
are available, more than 100 stakeholders from government
and other organisations participated in a collaborative multi-
sectoral initiative leading to the launch of a national NCD
programme.
20
The percentage of the total annual government
expenditure on cardiovascular healthcare is not yet known. In
an article published in 2017, the economic and health benefits
of CVD prevention were shown to have been modelled.
21
Assessment of policy response
No legislation mandating health financing for CVD/NCD
has been developed or implemented. However, a policy
exists that suggests all medicines in the National Essential
Medicines List have generic names as these are available at
affordable prices.
22
Furthermore, 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 is
functional:
• banning of smoking in indoor workplaces, public transport,
indoor public places and other public places
6
• clear and visible warnings on at least half of the principal
display areas of tobacco packs
23
• banning all forms of tobacco advertising, promotion and
sponsorship.
21
In contrast, measures to protect tobacco control policies
from tobacco industry interference are absent.
6
No data are
available on policies that ensure equitable nationwide access to
healthcare professionals and facilities, screening of individuals
at high risk of CVD or sustainable funding for CVD.
According to the WHO Global Health Observatory, taxes
on unhealthy foods or sugar-sweetened beverages have
existed since 2019, though the percentage of the excise tax is
unknown.
9
The percentage of excise tax of the final consumer
price of tobacco products is 36.7% and well below the WHO
recommendation of 70%, while that of the final consumer
price of alcohol products was 30% for beer.
24,25
Legislation mandating clear and visible warnings on foods
that are high in calories, sugar or saturated fats are in place
but not for banning the marketing of unhealthy foods to
minors.
17
Policy interventions that promote a diet to reduce
CVD risk or that facilitate PA have also not been realised.
Stakeholder action
Non-governmental organisation advocacy for CVD policies
and programmes has been adopted,
26
as has the involvement
of the Tanzania Tobacco Control Forum (TTCF) in the
development and implementation of a national tobacco
control plan.
6
Civil society involvement in the development
and implementation of a national CVD prevention and
control plan and the national multi-sectoral co-ordination
mechanism for NCD/CVD have been established.
27
However,
no active involvement of patients’ organisations in the
advocacy for CVD/NCD prevention and management or
group engagement for RHD exists.
No data are available on specific activities aimed at
a 25% reduction in premature CVD mortality by 2025 by
cardiology professional associations. However, in a pilot
study, hypertension screening by businesses at workplaces
was recommended to be feasible.
28
As part of the data collected for Tanzania, the following
strengths, weaknesses, threats and priorities are summarised.
Strengths
The Strategic Plan and Action Plan for the Prevention and
Control of NCD in Tanzania 2016–2020, was developed in