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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
40
AFRICA
is comprehensive and integrated.
28,37
Although legislation
mandating essential CVD medicines at affordable prices have
been introduced, these medicines are available at 30 to 40% of
health centres in the primary healthcare level, with interruptions
being common.
25,38
Court orders protecting patients’ rights and
mandating improved CVD interventions, facilities, health-system
procedures or resources were also not available.
In February 2019, the strongest tobacco-control legislation in
Africa was passed in Ethiopia, covering at least four of the WHO
framework convention on tobacco control (FCTC) articles.
41,42
These are articles 8 (protection from exposure to tobacco smoke,
including banning smoking in indoor work and public places),
11 (packaging and labelling of tobacco products), 13 (tobacco
advertising, promotion and sponsorship) and 16 (sales to and
by minors).
41
Policies ensuring equitable nationwide access to healthcare
professionals and facilities have been implemented,
43
whereas
screening of high-risk CVD individuals has been suggested.
44
Currently, a CVD risk-prediction module is being developed, and
a CVD risk-prediction chart will soon be adopted (Gebremichael,
pers commun). No sustainable funding for CVD from so-called
‘sin’ taxes was noted. In 2008, the percentage of excise tax on
sugar-sweetened beverages was 30%, while that of the final
consumer price of tobacco and alcohol products was 75%.
45
Parliament recently endorsed a proclamation for increasing
excise taxes on alcohol and tobacco products [30%
ad valorem
plus US$0.25 (8 ETB) specific excise tax for cigarettes].
46,47
No legislation is available banning the marketing of unhealthy
foods to minors or mandating clear and visible warnings
on unhealthy foods.
22
However, policy interventions by the
Ethiopian Food and Drug Administration (EFDA) and MoH
(sugar, salt, trans fats and saturated fats) are under development
for promoting a diet to reduce CVD risk.
46
Stakeholder action
As part of the HSDP IV, initiatives were formulated to implement
an integrated approach for the prevention and control of NCD
through the advocacy of risk factors such as smoking, diet
and PA.
33
Advocacy for CVD policies and programmes by
non-governmental organisations was addressed by the NCD
Alliance, and particularly, the Consortium of Ethiopian NCD
Associations (CENDA).
48
More recently, Ethiopia established
the NCD and Injuries (NCDI) commission that was tasked with
reviewing the NCDI situation and produced a report in 2018.
49
This report forms the basis for the NCD initiatives and advocacy
campaigns in the country, which extensively contributes to curbing
these diseases.
49
Health professionals at six universities have been
working with the FMoH on raising awareness and training health
workers on RHD since 2016 through a project, Improving RHD
Care in Ethiopia.
50
Patient engagement groups for RHD are also
in progress, as indicated in a study by Yadeta
et al
.
30
In 2019, the WHO and the inter-agency task force on
NCD conducted an investment case study for NCD and risk
factors for NCD in Ethiopia, recommending that an effective
multi-sectoral co-ordination mechanism be developed involving
various partners.
49
Until now, the only involvement that has
been invested is in the national tobacco-control plan.
19
The
MoH is working with different professional societies such as
the Ethiopian Society of Cardiac Professionals on developing
guidelines, raising community awareness and training health
workers.
51
In a study on civil servants, hypertension screening by
businesses at workplaces was suggested, and a repeated call was
made in 2019 to curb the high prevalence.
52,53
The FMoH introduced an integrated management package
for diabetes and hypertension at health centres and hospitals
throughout the country.
54
Currently, about 691 health facilities
are implementing PACK [maintained by Population Services
International (PSI)-Ethiopia, with support from HHA (Healthy
Heart Africa), CUAMM (
Collegio Universitario Aspiranti
Medici Missionari
) with funding from the World Diabetes
Federation (WDF); and the Tropical Health and Education
Trust (UK-based, often DFID-funded NGO), with support
from Novartis and Vital Strategies/Resolve to Save Lives].
54
The country has adopted the South African PACK global
programme and developed the Ethiopian primary healthcare
guidelines, which is currently implemented in more than 500
health centres, with NCD care adequately addressed.
As part of the data gathered for Ethiopia, the following strengths,
weaknesses, threats and priorities are summarised.
Strengths
Through the HSDP IV and HSTP, Ethiopia has outlined
strategies to combat the growing incidence of NCD, of which
CVD ranks the highest.
33
An NCD unit was established to
co-ordinate national NCD prevention and control activities,
including the development of protocols for each of the main
NCD, such as CVD, diabetes, asthma and cancer, along with
identifying essential services for each of these.
34
To improve data usage at all levels of the healthcare system,
Ethiopia launched an information revolution strategy. The
FMoH has one autonomous regulatory body to enforce
regulations on harmful products such as tobacco, alcohol and an
unhealthy diet.
43
This body, the EFDA, is funded by the FMoH,
issues licenses and monitors all professionals and facilities in the
public and private sector.
43
The government has an NCD interest within the FMoH that
is included in the HSDP IV and HSTP I.
33,35
Community-based
health insurance coverage includes services for NCD prevention
and treatment for the rural people and informal sector, which
is relatively active although coverage and sustainability are still
uncertain.
34
The other scheme, social health insurance for the
formal sector, is pending because of refusal by this sector, while
disease surveillance systems at national and sub-national levels
strengthen NCD management.
34
Guidelines to reduce the incidence of CVD and other related
NCD, such as hypertension andRHD, have already been developed
and are being implemented.
22
National guidelines to treat tobacco
dependence are integrated within the national guidelines for
clinical and programmatic management of NCD, and training
manuals on healthy lifestyle counselling (including tobacco
cessation) have been developed for primary healthcare workers.
22
Ethiopia has developed and launched a national tobacco-control
strategic plan, although the smoking prevalence is relatively low.
19
Ethiopia, a LIC, also participated in the REMEDY study, a
prospective, international, multi-centre, hospital-based registry for
RHD.
20
Through the project, Improving RHD Care in Ethiopia,
with support from the Minneapolis Heart Foundation and other
donors, improved registration of cases, training of health workers