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Cardiovascular Journal of Africa • Volume 31, No 4 August 2020
S47
AFRICA
takes place and to a certain extent at corporate health events,
although screening at places of work has not officially been
instituted.
37
As part of the data collected for Uganda, a summary of the
strengths, threats, weaknesses and priorities follows.
Strengths
In 2014, the Uganda National NCD STEPS survey was
conducted because of an increase in the prevalence of NCD,
which were among the first 25 leading causes of DALYs.
9
These results led to the MoH introducing an annual National
Day of Physical Activity in July, through hosting various
activities such as stretching, dancing, netball and football,
among other games, to curb NCD.
29
Since 1979, the Agency
for Cooperation and Research in Development (ACORD)
has been working in Uganda with non-governmental and
grassroots organisations and communities to obtain social
justice and sustainable development. ACORD assisted
Uganda in developing the 2016–2020 Strategic Plan, which
includes implementing NCD policies, of which CVD was
one of the highest at 9%.
30
The United States Agency for International Development
(USAID) began the USAID Applying Science to Strengthen
and Improve Systems (ASSIST) project to improve and
strengthen health systems and social services in USAID-
assisted countries.
38
In March 2016, they met in Dar es
Salaam, Tanzania, with several representatives from these
countries to discuss and share various ideas. Among the
challenges in implementing strategies, policies or other
mechanisms, stakeholder engagement, lack of understanding
of key concepts, political will and champions, and sharing
successes, were some of the topics discussed. Delegates
agreed that a lack of general understanding of ‘quality policy
and strategy’ and ‘governance of quality’ could pose a barrier
to stakeholder engagement regarding policy formulation and
implementation, as mentioned by a Ugandan representative.
Along with a few other countries, such as Tanzania, Uganda
shared positive experiences they had achieved through
implementing quality improvement methodologies within
their health systems at public facilities. Although NCD
and CVD were not mentioned per se, one could assume
that implementing any quality improvement process at the
primary healthcare level would cover most services.
38
In a study to develop sustainable acute and chronic
cardiovascular care, a human-centred approach was used
involving patient and provider input. Several positive
outcomes emanated from this approach, such as the
establishment of four integrated regional centres of excellence
in RHD care with a national RHD registry.
Threats
Researchers who analysed data from the 2014 WHO STEPS
survey found a high prevalence of hypertension in Uganda,
with only 7.7% of persons aware of their condition. This
high burden of undiagnosed and uncontrolled high BP placed
them at high risk of CVD and other related NCD.
39
In a more
recent study, hypertension is still a threat, with more than
one in four adults having raised BP, resulting in cases of
stroke, heart attack and heart failure as a cause of increased
death rates.
15
Uganda’s three-year alcohol consumption is the
highest of all theAfrican countries under surveillance, at more
than 12%, which possibly contributes to the hypertension
burden.
4
Healthcare facilities were insufficiently equipped
and services lacked integrated care.
15
In a systematic review analysing epidemiological data
on RHD prevalence and health systems in Uganda and
Tanzania, the researchers found recurring complications,
such as pulmonary hypertension and AF, along with the high
RHD burden.
40
However, the identification of various barriers
and facilitators provides an opportunity for implementing
strategies to address the gaps in their health systems.
40
Weaknesses
Hypertension, affecting more than 25% of the adult
population, is the most reported NCD in Uganda. The very
low awareness and control of hypertension are an indication
of the absence of a well-defined policy framework for
preventing and managing this condition.
19
According to Dr
Okello (pers commun), hypertension causes a lot of mortality
directly and through complications, but unfortunately, most
of the data are hospital-based.
In the report emanating from the ASSIST project meeting
under the topic, political will and champions, quality
improvement requires dedicated commitment through
strategies and policy at all levels of the health system.
38
Therefore, with regard to the quality of care, it was suggested
that Uganda could make use of more champions at a national
and sub-national level.
38
Regardless of the launch of an NCD
prevention and control programme in 2008, some NCD
services were established at different levels of care, which
were fragmented within the MoH.
35
Uganda’s exceptionally high RHD prevalence is based on
a prospective cohort study done in Kampala.
7
Limitations
of this study, which could have influenced these results are
documented in the published article.
7
Therefore, these data
might not be representative of national data.
Priorities
To prevent disability and death and improve the quality
of life of persons at risk for developing NCD, preventing
CVD risk factors and providing effective and affordable
treatment should receive high priority.
15
Furthermore, the
health profiles of people with intermediate- and high-risk
factors for CVD need improvement at the community and
health facility level.
15
Funding for NCD, as in most African countries, remains
problematic and with the ever-growing epidemic, needs
to receive urgent attention. Almost all of Uganda’s NCD
funding comes from the World Diabetes Federation, which
is not sustainable. Attention should also be given to cost-
effectiveness and availability of resources when evaluating
integrated prevention and care models. According to
Schwartz
et al.
,
31
stronger governance and a robust civil
society are needed to ensure that policies are developed
and implemented. The co-operation and determination of
multiple sectors, including a supportive civil society, will
ensure a successful NCD agenda.
31
An urgent need for the