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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
AFRICA
205
million).
8
In an even more blunt comparison, South Africa’s almost
50 private cardiac centres serving a population of 10 million
medical aid patients are in stark contrast to an indigent population
of a billion people living in sub-Saharan Africa, with access to half
this number of hospitals offering heart valve surgery.
Changing this appalling state of affairs will take huge
efforts on many levels. Pressure on governments will need to
be coordinated to have any effect. Activist groups such as
RHD Action will need to be broadly supported. International
awareness needs to increase dramatically and the readiness of
the medical device industry to become a partner and adjust
their price policy to indigent patients and not only to the
African private sector will be paramount. Advice from health
economists needs to be sought to provide cost-effective, evidence-
based interventions and present a high-level business model to
international agencies such as the World Heart Federation and
World Health Organisation.
Once these prerequisites are in place, training specialists
in a country that has exposure to RHD, rather than in North
America or Europe, will be crucial, with the goal firmly focused
on local capacity building. Critically important will be political
will and funding to drive a unified and integrated RHD agenda.
These key demands have been formulated in the Cape Town
Declaration. Much depends now on the support it gets to
implement them. One thing is undisputed: the time to act is now!
The authors acknowledge the immense contribution of Professor Bongani
Mayosi in the field of rheumatic heart disease and his passion and drive for
capacity building and action. He had agreed to write this editorial shortly before
his passing and we dedicate the ongoing work against RHD to his memory.
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