48 / 57
women.
9
In 2019, the prevalence of age-adjusted diabetes in
adults 20–79 years was 2.5%, which is much lower than the
global estimate of 9.3% or that for Africa (3.9%) (Table 1).
13
Part C: Clinical practice and guidelines
Health system capacity
Uganda had an average of 1.7 physicians and 12.4 nurses
per 10 000 of the population in 2017 and 2018, respectively,
with five hospital beds per 10 000 people in 2010.
4
Locally relevant clinical tools to assess CVD risk along
with clinical CVD prevention guidelines are available
through Uganda’s health system capacity.
14,15
Clinical
guidelines for the management of AF, pharyngitis, acute
rheumatic fever (ARF) and RHD are also locally available.
16
The Mulago Hospital in Kampala was included in the
REMEDY study, a prospective, international, multi-centre,
hospital-based registry for RHD and rheumatic fever.
17
However, guidelines for treating tobacco dependence have
not been fully developed. As in most African countries, no
system is available to measure the quality of care provided
to people who have suffered acute cardiac events. Uganda is
one of the African countries with guidelines for diabetes.
14,18
Essential medicines and interventions
According to the WHO Global Health Observatory, five of
the eight essential medicines were available at primary care
facilities in the public health sector.
4
In Uganda’s clinical
guidelines, incorporating the Essential Medicines List
released in 2016, six of these were available at different
healthcare levels. These are angiotensin converting enzyme
(ACE) inhibitors, aspirin, β-blockers, warfarin, metformin
and insulin.
16
Statins and clopidogrel are not available at the
primary healthcare level.
16
No data are available for CVD
risk stratification or 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
Patients at high risk of AF, who were on treatment with oral
anticoagulants, amounted to 10%. Those with a history of
CVD taking aspirin, statin and at least one antihypertensive
agent accounted for 0.05% (EO, pers commun). In a study
by Musinguzi and Nuwaha in 2013, the percentage of
hypertensive persons receiving medical treatment was
51.65%.
19
Of these, more men (62.2%) than women (48.7%)
were receiving treatment.
Part D Cardiovascular disease governance
A national strategic plan has been implemented to address
CVD and NCD and their specific risk factors.
20
There is a
dedicated budget within the NCD department
4
in the MoH
in the process of being set up.
20
Although RHD prevention
and control has not been prioritised in a national strategy
or plan, the Uganda RHD advisory committee has been
in discussions with the MoH.
21
National surveillance
systems that include CVD and their risk factors are
part of the NCD programme of the MoH.
9,20
A national
tobacco control plan has partially been developed, but
no national multi-sectoral co-ordination mechanism for
tobacco control exists.
22
Collaborative projects between the
MoH and non-health ministries, for example the Uganda
Bureau of Statistics, for CVD interventions have been
established.
20
The percentage of total annual government
expenditure on cardiovascular healthcare is unknown.
However, the benefits of chronic care, which incorporate
CVD prevention and control for population health and the
economy have been modelled.
23,24
Assessment of policy response
No legislation mandating health financing for CVD exists,
nor do court orders protecting patients’ rights and those
mandating improved CVD interventions, facilities, health
system procedures or resources. Although limited, essential
medicines are provided free of charge in the public sector in
Uganda.
25
National legislation banning smoking in indoor
public and workplaces, public transport, and other public
places was published in the Gazette as was that mandating
clear and visible warnings on tobacco packs.
26
Legislation
banning all forms of tobacco advertising, promotion and
sponsorship, and measures to protect tobacco control
policies from tobacco industry interference also came into
effect in 2015.
26
No other legislation or policies regarding
CVD are available.
Taxes on unhealthy foods or sugar-sweetened beverages
have been instituted, and the excise tax has been set at
200%,
4
while that of the final consumer price of tobacco
products is 31%.
27
The percentage of excise tax of the final
consumer price of alcohol products is 60%.
28
No legislation
exists regarding banning the marketing of unhealthy foods
to minors, or foods high in calories, sugar or saturated fats.
Policy interventions promoting a diet that reduces CVD risk
have also not been instituted. In July 2018, the MoH launched
the first National Day of Physical Activity that would become
an annual event.
29
Stakeholder action
Non-governmental organisations’ advocacy for CVD
policies and programmes are available, as is civil society’s
involvement in the development and implementation of a
national tobacco control plan.
30
Civil society’s involvement
in the development and implementation of a national CVD
prevention and control plan has also been documented.
31,32
Initiatives to engage with patient organisations in the
advocacy for CVD/NCD prevention and management, along
with advocacy champions or patient engagement groups
for RHD have been mentioned,
33
such as the Uganda RHD
patient-support group, hypertension patient group, and the
diabetes patients’ group.
34
According to Dr Ann Akiteng,
35
multi-sectoral
collaboration and partnerships for NCD/CVD are not well
developed in Uganda but should receive attention. Specific
activities by cardiology professional associations aimed at
25% reduction in premature CVDmortality rate by 2025 have
been addressed by the Uganda Heart Association through the
Uganda Heart Institute and annual activities such as World
Heart Day celebrations.
36
Similarly, hypertension screening
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