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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
44
AFRICA
•
lack of financial and technical resources for programme
implementation
•
poor recording of CVD-related indicators in the health-
management information system with the resultant paucity
of planning data
•
low awareness and misconceptions about the burden and
consequences of CVD of the community, healthcare provid-
ers and political leaders
•
limited availability and affordability of high-quality, safe and
effective basic technologies and medicines for screening, diag-
nosis, treatment and monitoring of CVD
•
inadequate mix and capacity of the health workforce
•
inadequately staffed regional health bureaus
•
poor partnership between the public and private health
systems
•
poor or no regulation on khat, oils and fats, sugar, salt and
environmental pollution
•
non-existent multi-sectoral co-ordination mechanism for
prevention and control of CVD
•
inadequate resources for CVD (competing priorities of major
infectious diseases).
Priorities
According to the NSAP,
34
four priority areas guide the
implementation of NCD activities, which have also been
incorporated into the HSTP-II.
36
These are to:
•
strengthen the national response through policy, governance
and leadership
•
intensify health promotion and disease prevention, targeting
behavioural and environmental risk factors
•
develop comprehensive and integrated clinical interventions
for NCD and their risk factors, and CVD in particular
•
determine progress in the prevention and control of NCD
through monitoring, evaluation and research.
Comprehensive interventions or programmes are needed to
address unhealthy diets, physical inactivity, alcohol, obesity and
air pollution among adults and children, as has been done for
tobacco control.
41
Also, addressing the mentioned weaknesses
through specific actions and stakeholders in the fight against
NCD and CVD, such as RHD, HHD, heart failure and
atherosclerotic CVD, which are emerging and will probably flood
the country in a decade or so.
Total annual government expenditure should set a percentage
apart for cardiovascular healthcare,
and sustainable funding for
CVD (for example, from taxation of tobacco and or other ‘sin’
products).
Recommendations by the Ethiopia NCDI commission to
combat the NCD-related burden of disease include policy,
planning and oversight; finance; service integration; strategic
information, target setting, monitoring and evaluation; and
education and advocacy. By attending to these and to achieve a
25% reduction in CVD by 2025 (Table 2), prominence should be
given to:
•
improving and implementing the WHO’s best buys
•
strengthening the primary healthcare system
•
improving access to and affordability of essential drugs and
technology
•
strengthening community screening to commence drug ther-
apy early
•
increasing the health taskforce capacity.
This publication was reviewed by the PASCAR governing council and
approved by the president of the Society of Cardiac Professionals in Ethiopia.
References
1.
Mohamed AA, Fourie JM, Scholtz W,
et al
. Sudan Country Report:
PASCAR and WHF Cardiovascular Diseases Scorecard project.
Cardiovasc J Afr
2019;
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: 305–310.
2.
Dzudie A, Fourie JM, Scholtz W,
et al.
Cameroon Country Report:
PASCAR and WHF Cardiovascular Diseases Scorecard project.
Cardiovasc J Afr
2020;
31
(2): 103–110.
3.
PASCAR WHF. The World Heart Federation and Pan-African Society
of Cardiology Cardiovascular Disease Scorecard project for Africa.
Cardiovasc J Afr
2020;
31
(4)(Suppl): 1–56.
4.
World Bank. [Online] 2017.
https://data.worldbank.org/.5.
Ministry of Health.
Ethiopia Health Accounts, 2016/17.
Addis Ababa,
Ethiopia: Federal Democratic Republic of Ethiopia, September 2019.
6.
World Health Organization. The Global Health Observatory (GHO).
WHO.
[Online] 2020.
https://www.who.int/data/gho/.7.
Ali S, Misganaw A, Worku A,
et al
. The burden of cardiovascular
diseases in Ethiopia from 1990 to 2017: evidence from the Global
Table 2. Indicators for Ethiopia to reach a reduction in premature CVD and
related mortality by 2025
Indicators
Baseline
Target by 2025
Reduce overall premature mortality from
CVD
25% relative
reduction
Reduce prevalence of current tobacco use
in persons ≥ 15 years
5%
30% relative
reduction
Reduce harmful use of alcohol in persons
≥ 15 years
12.5% NCD STEPS in
2015*
10% relative
reduction
Reduce prevalence of current khat use in
persons ≥ 15 years
16% NCD STEPS in
2015*
20% relative
reduction
Reduce prevalence of insufficient PA in
persons ≥ 15 years
5.8% NCD STEPS in
2015*
10% relative
reduction
Reduce mean population salt intake to
< 5 g per day in persons ≥ 15 years
8.3 g NCD STEPS in
2015*
30% relative
reduction
Reduce insufficient fruit and vegetable
consumption in persons ≥ 15 years
97.6% STEPS in 2015* 25% relative
reduction
Reduce the percentage of people who are
obese or overweight
6.3% STEPS in 2015* 15% relative
reduction
Reduce the age-standardised prevalence
of raised TC among persons ≥ 18 years
5.6% STEPS in 2015* 10% relative
reduction
Reduce prevalence of raised BP in persons
≥ 15 years
16% STEPS in 2015* 25% relative
reduction
Reduction in the prevalence of ARF/
RHD in the 4–24-year-old age group
17/1 000 school children
and young adults**
25% relative
reduction
Increase treatment (pharmacological
and non-pharmacological) coverage for
patients with hypertension
Baseline 28% of diag-
nosed based on the NCDI
commission report**
50%
Increase the proportion of people with
hypertension with controlled BP
26% based on the NCDI
commission report**
60%
Halt increase in prevalence of raised
blood sugar in persons ≥ 15 years
3.2% STEPS in 2015* 0% increase
Increase the proportion of people with
diabetes with controlled blood glucose level
24% based on the NCDI
commission report**
60%
Increase treatment coverage for patients
with diabetes (pharmacological and non-
pharmacological)
3% STEPS 2015*
50%
Increase availability of basic technologies
and essential medicines (including gener-
ics) required to treat CVD in public and
private facilities
Availability based on the
SARA 2018 report
#
80%
Decrease household air pollution from
biomass fuel use
Baseline > 90% house-
holds use biomass fuel
< 60%
CVD, cardiovascular diseases; NCD, non-communicable diseases; STEPS, step-wise
survey; PA, physical activity; TC, total cholesterol; BP, blood pressure; ARF/RHD,
acute rheumatic fever/rheumatic heart disease.
*STEPS report;
12
**NCDI commission report;
49
#
SARA 2018 report.
25