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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016
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AFRICA
•
identify key stakeholders for collaboration in eradication of
RHD.
The meeting was officially opened on 21 February by His
Excellency theAUCommissioner for Social Affairs, DrMustapha
Kaloko. Opening comments were provided by representatives
from the Government of the Federal Democratic Republic of
Ethiopia, the African Union Commission Department of Social
Affairs, the WHO Regional Office in Africa, and Novartis/
Sandoz Pharmaceuticals.
Three main activities comprised the meeting:
•
Formal presentations on successful ARF/RHD control
programmes in Africa and Oceania.
•
Breakout sessions on the minimal datasets that are needed,
key investments that will be required, and stakeholder partici-
pation that should be sought in order to develop ARF/RHD
programmes in African countries.
•
A group deliberation on the final set of expert recommenda-
tions and key principles to be enumerated in the communiqué.
At the close of the meeting, the principles of the communiqué,
reproduced in Table 2, were assented to, and the document was
sent by the AUC to the April 2015 Ministerial Conference on
Health, Population and Drug Control for consideration.
Recommendations
1. Establish prospective RHD registers. These would occur at
sentinel sites in AUmember states affected by ARF/RHD. The
major objective of these registers will be to monitor progress
towards RHD-related health outcomes, which include a 25%
reduction in premature mortality from RHD by the year 2025.
2. Ensure adequate supplies of benzathine penicillin G (BPG).
The WHO recognises BPG as an essential medication. In
order to achieve adequate coverage of primary and secondary
prevention measures for ARF/RHD, BPG must be readily
available at all primary care facilities in AU member states,
and training of providers on effective and safe use of BPG
should be part of supply-side efforts. BPG can also be used
for the treatment of other endemic diseases in Africa, such as
syphilis, yaws and sickle cell disease.
3. Guarantee universal access to reproductive health services for
women with RHD. RHD greatly increases a woman’s risk of
mortality and foetal demise during pregnancy. Reproductive
health services, including contraception, are currently under-
utilised among women with RHD in Africa and this contrib-
utes to the high maternal mortality rates on the continent.
Comprehensive care for RHD and other NCDs should include
access to reproductive health services for all women at risk.
4. Decentralise diagnostic services for ARF/RHD to district
hospitals. Primary healthcare services and district hospitals
need appropriate technical expertise in the diagnosis of ARF
and RHD. Key point-of-care technologies that should be
considered for provision at district and community levels
include ultrasound of the heart (echocardiography), antico-
agulation testing, and antigen tests for the rapid diagnosis of
group A streptococcal pharyngitis.
5. Establish cardiac surgery centres of excellence. Such facilities
could sustainably deliver state-of-the-art surgical care as well
as train the next generation of African cardiac specialists.
They could also be centres of research on endemic cardiovas-
cular diseases (including RHD).
6. Foster multi-sectoral and integrated national RHD control
programmes led by ministries responsible for health
.
These
programmes would oversee the implementation of national
RHD action plans and progress towards the ‘25-by-25’
targets.
7. Cultivate partnerships that can implement the actions above.
A partnership needs to be developed between the AU
commission, ministries responsible for health, international
agencies, governments, industry, academia, civil society and
other relevant stakeholder to monitor and evaluate progress
related to the implementation of the key actions and achieve-
ment of the outcome of 25% reduction in premature mortal-
ity from RHD by the year 2025.
In addition to these recommendations, important and specific
roles for international stakeholders (Table 3) were identified.
Finally, the communiqué requested the AU to mandate PASCAR
and other stakeholders to work with the AU commission to
develop a detailed implementation plan of the key actions. This
would include roles and responsibilities, timelines, estimates of
costs, and a communication framework for the roadmap.
Adoption and next steps
On 14 April 2015, the Addis Ababa communiqué was presented
to the African Union Specialised Technical Committee on
Health, Population and Drug Control (a platform of ministers
Table 1. Barriers to ARF/RHD eradication in Africa
1. Lack of RHD surveillance efforts at the local, regional and national level.
2. Variable supply and use of high-quality benzathine penicillin G.
3. Low use of reproductive health services among women with RHD.
4. Overly centralised diagnostic and treatment services for RHD.
5. Few facilities capable of providing cardiac surgery for advanced RHD.
6. Lack of national RHD prevention programmes.
7. Absence of multi-sectoral RHD initiatives.
Table 2.The Third All-Africa Workshop on ARF and RHD:
recommendations to the AU commission and member states
1. Establish prospective RHD registers at sentinel sites in affected member
states in order to monitor RHD-related health outcomes, including the
achievement of a 25% reduction in mortality from RHD by the year 2025.
2. Ensure adequate supplies of high-quality benzathine penicillin that can be
administered in the most effective manner, in order to achieve primary and
secondary prevention of RHD.
3. Guarantee universal access to reproductive health services for women with
RHD and other NCDs, in whom pregnancy carries specific and often fatal
risks, and for whom contraception can reduce maternal and foetal mortality.
4. Decentralise appropriate technical expertise to the primary and district levels
in order to improve the diagnosis of ARF (which is under-diagnosed in
Africa) and early detection, diagnosis, secondary prevention and treatment
of RHD using cross-cutting point-of-care technologies such as cardiac ultra-
sound, anticoagulation testing and rapid antigen tests for group A strepto-
coccal pharyngitis.
5. Establish centres of excellence for cardiac surgery, which will sustainably
deliver state-of-the-art surgical care, train the next generation of African
cardiac practitioners, and conduct research on endemic cardiovascular
diseases, including RHD.
6. Foster multi-sectoral and integrated national RHD control programmes led
by the Ministry of Health, which will oversee the implementation of nation-
al RHD action plans in order to achieve the goal of reducing mortality from
RHD and other NCDs by 25% by the year 2015.
7. Cultivate, through a strong communication framework, partnerships
between the AUC, ministries responsible for health, international agencies,
governments, industry, academia, civil society and other relevant stakehold-
ers, in order to ensure the implementation of the above actions, and the
connection of African RHD control measures with the emerging global
movement towards RHD control.