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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
AFRICA
41
and awareness and advocacy of RHD are happening.
50
A national
surveillance system (the STEP survey) that includes risk factors
for CVD has also been undertaken and a report disseminated.
17
According to the WHO FCTC, civil society is mainly
responsible for advocacy for the development and enforcement
of tobacco-control laws.
19
The implementation or enforcement
of a national tobacco-control plan is the responsibility of
government entities such as the EFDA, and excise tax is
charged.
19
In February 2019, the Ethiopian parliament passed
a new law on tobacco products, which claims to be ‘one of the
strongest tobacco-control legislations in Africa.’
41
Among other
things, this new law will require work and public places to be
tobacco free.
41
Legislation mandating essential CVD medicines
at affordable prices has also been implemented.
38
In summary, the strengths of the NCD programme in general
and CVD in particular include:
•
evolving interest and commitment of the FMoH and regional
health bureaus on prevention and control of CVD
•
an NCD agenda (including CVD) incorporated within the
HSTP I and II
•
strategic and annual plans regularly being developed on NCD
(including CVD)
•
guidelines, training materials and client and provider educa-
tion materials developed on CVD
•
awareness-raising campaigns being conducted, though not in
a structured manner
•
NCD issues (including CVD) integrated into the health-
extension programme
•
NCD programme (including CVD) integrated into the
Ethiopian primary healthcare guideline
•
national STEPS on NCD risk factors and GATS conducted
and results launched
•
national NCDI commission produced a report on NCDI
situation and developed recommendations and cost-effective
CVD interventions
•
NCD investment case report produced by WHO and inter-
agency task force on NCD (including CVD).
Threats
In 2008 the FMoH, and in 2014 the WHO Regional Office,
showed that NCD such as CVD, diabetes mellitus and cancer
were contributors to the high level of mortality and morbidity.
33,55
Other increasing threatening risk factors are raised BP, unhealthy
diets, air pollution, high low-density lipoprotein cholesterol levels,
high fasting plasma glucose levels, overweight, physical inactivity
and tobacco use.
7,55
In 2017, CVD accounted for almost 11% of
the mortality rate,
9
while the diabetes prevalence among 15- to
69-year-old adults was 5.8% in 2015, which is higher than the 4.3%
recently reported for the country by the IDF.
13,18
The prevalence of
raised BP in Ethiopia for men and women is higher than that of the
global data (22.1%) and most of the other sub-Saharan countries
included in this project.
6
Although slightly lower compared to the
global figure (1.65%), deaths caused by HHD were 1.1% in 2017.
9
As mentioned, overweight and obesity, as in most African
countries, tend to be a problem, although these figures are lower
than the global data at 38.9 and 13.1%, respectively.
6
Less than
15% of the adult population is insufficiently physically active.
6
As per the NSAP/HSTP-II 2020–2025,
36
the following threats
have been identified by the core committee:
•
unregulated transnational (global) trade leading to imported
products and behaviours
•
proliferation of industrial/commercial food processing and
brewery
•
globalisation with resultant lifestyle changes (smoking, alco-
hol, physical inactivity, foods with added salt, sugar and
saturated or trans fats)
•
poor health-seeking behaviour among the public
•
economic gain by the government from the booming industry,
which predisposes to NCD risk factors (alcohol, khat, soft
drinks)
•
rapidly expanding urban centres and industries related to
urbanisation.
Weaknesses
In Ethiopia, no comprehensive, nationally representative study
had been done before the nationwide step-wise survey in 2014,
55
however, raised BP was found to be the most prevalent CVD
risk factor in a few urban and rural studies.
22
Data on NCD
and their risk factors were lacking, while there is also a lack
of comprehensive management at health facilities.
34
Although
the mean TC level among all STEPS participants, including
those on current medication for increased TC was 130.9 mg/dl
(> 7.2 mmol/l) in 2015,
17
country data for raised TC were not
available.
While the new tobacco law should make a difference
in protecting the public against its devastating effects, its
enforcement in main cities of the country is far from the
expected, except for the Tigrai region.
41
Although improved
taxation of tobacco-control products is being implemented,
Ethiopia is not yet making use of tax income to fund a national
plan for a tobacco-control and CVD programme.
56
Although the WHO supports countries such as Ethiopia in
developing health-finance policies, no policy exists specifically
for CVD.
55
Another weakness is the lack of sustainable funding
for CVD, and the triple burden of diseases is still consuming the
resources with little left for NCD. The little global funding for
NCD, with enormous out-of-pocket expenditures, is widening
the gap between the rich and poor. Furthermore, low awareness
of NCD could have catastrophic effects on the health and
economy of the country. Policies and legislation banning the
marketing of unhealthy foods to minors and mandating clear
and visible warnings on foods, similar to most countries, are not
yet endorsed, nor are those promoting diets and PA to reduce
CVD risk. There are also no policies for screening individuals at
high risk of CVD. However, new initiatives on PA by the prime
minister are underway, and the new HSTP (2020–2024/25) has
indicated CVD risk stratification.
36
Some of the CVD targets to be achieved by the year 2025 are
far from being realised. The prevalence of diabetes and obesity
has increased, and the availability of essential drugs is low.
57
Mainly, however, there is no adequate budget allocation for the
CVD programme.
In summary, the following weaknesses have been identified by
the core committee for the NSAP development:
•
poor prioritisation of the CVD programme at all levels of the
health system, especially in regions and woredas (districts)
•
inadequate high-level advocacy for political leaders on CVD
and risk factors