Cardiovascular Journal of Africa: Vol 31 No 4 Supplement (July 2020)

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Cardiovascular Journal of Africa • Volume 31, No 4 August 2020 S51 AFRICA
per 10 000 people in 2010.4 A locally developed clinical tool
was adapted from the WHO Essential Non-Communicable
Disease tool (WHO PEN) to measure NCD management at
healthcare facilities.12 Locally relevant clinical guidelines
for CVD prevention (within the last five years) have also
been published.13 No guidelines for the treatment of tobacco
dependence are available or locally relevant (national
or sub-national) clinical guidelines for the detection and
management of AF. However, clinical guidelines have been
developed to manage pharyngitis, acute rheumatic fever
(ARF) and RHD.14 Zambia was one of the lower-middle-
income countries to participate in the REMEDY study that
reported a hospital-based registry for RHD and rheumatic
fever.15,16 However, there is no system to measure the quality
of care provided to people who have suffered acute cardiac
events. Regarding the detection and management of diabetes,
Zambia does have guidelines in place.17
Essential medicines and interventions
Angiotensin converting enzyme (ACE) inhibitors, aspirin,
β-blockers and metformin are included in the list for essential
medicines at primary care facilities in the public health
sector,4 while insulin was available in 42% of the health
centres.18 However, statins, warfarin and clopidogrel are not
available at healthcare centres. No data were available for
CVD risk stratification or TC measurement at the primary
healthcare level, and secondary prevention of ARF and RHD
in public-sector health facilities.
Secondary prevention and management
No data are available on high-risk patients with AF who
were being treated with oral anticoagulants, or those with
a history of CVD taking aspirin, statin and at least one
antihypertensive agent. In a study by Oelke et al.,19 it was
noted that of those participants who had ever been told they
had hypertension, 76.7% received medication. In another
study looking at hypertension management in rural clinics, of
the patient visits, 21.1% had an antihypertensive medication
prescribed.20
Part D: Cardiovascular disease governance
Zambia’s National Health Strategic Plan (NHSP) 2017–
2021 addresses NCD, which includes CVD as one of the top
10 causes of mortality over the five years, 2011 to 2015.21
Although an operational non-communicable diseases unit
in the ministry of health (MoH) is responsible for NCD,22
no budget has been dedicated to CVD.23 An RHD ongoing
control programme, BeatRHD Zambia, established in
2012, addresses and prioritises the problem in Zambia.14,24
Furthermore, a national surveillance system that includes
CVD and their risk factors has been implemented by
the MoH.7
Zambia has introduced a comprehensive national multi-
sectoral tobacco co-ordination and control plan through
the WHO framework convention on control (FCTC).25
Collaborative projects between the MoH and non-health
ministries for CVD interventions have been mentioned.26
However, government expenditure specifically allocated to
CVD healthcare is not known to have been part of
the WHO-CHOICE project, the benefits of CVD prevention
and control for population health and the economy have been
modelled.27,28
Assessment of policy response
No legislation exists that mandates health financing for CVD.
The Southern African Development Community adopted a
‘procurement co-operation’ strategy to procure essential
medicines at affordable prices, including those for CVD.29 The
MoH manages procurement through the procurement unit,
however, it could not be established how many and which of
these medicines were below the international benchmark of
affordable prices.29 No court orders protecting patients’ rights
and mandating improved CVD interventions, facilities,
health system procedures or resources are available.
Legislation banning smoking in indoor work and public
places has been introduced as has that protecting against
tobacco industry interference.25 However, tobacco advertising,
promotion and sponsorship, and clear visible warnings on
more than half the packaging have not been legalised.25
Policies ensuring equitable nationwide access to healthcare
professionals and facilities have been implemented.30
Although screening for CVD risk factors have been reported
in a few studies, there is no policy ensuring that of high-risk
CVD individuals. No sustainable funding for CVD so-called
‘sin’ taxes has been noted. Excise tax on unhealthy foods or
sugar-sweetened beverages was also not instituted,31 while
that on the final consumer price of tobacco was 25%,25 and
that of alcohol products reported being more than 10%.32
No legislation is available banning the marketing of
unhealthy foods to minors or mandating clear and visible
warnings on unhealthy foods. Although policy interventions
promoting a diet to reduce CVD risk have been mentioned,
appropriate programmes and policies have yet to be
developed to protect the most vulnerable peoples in the
country.33,34 Zambia does not have any policy interventions
that facilitate PA.
Stakeholder action
In 2017, advocacy for CVD policies and programmes by non-
governmental organisations such as the Diabetic Association
of Zambia and ZAHESFO were addressed.13 Involvement
of patient organisations in CVD/NCD prevention and
management advocacy has been reported along with that for
RHD by advocacy champions.35 Civil society involvement in
the development and implementation of a national tobacco
control plan was also reported.25 Similarly, civil society
involvement in the national multi-sectoral co-ordination
mechanism for NCD/CVD was mentioned in the Seventh
National Development Plan and National Assembly of
Zambia in 2017.36,37 Activities by cardiology professional
associations to reduce the burden of premature CVD by
25% in 2025 are in progress.13 Hypertension screening by
businesses at workplaces was suggested, and a repeated call
was made in 2019 to curb the high prevalence.38,39
The following strengths, weaknesses, threats and priorities
are summarised, as part of the data gathered for Zambia.