Cardiovascular Journal of Africa: Vol 31 No 2 (March/April 2020)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 2, March/April 2020

AFRICA

107

retrospective registry of hospitalised RHD patients with valvular

lesions.

International guidelines are followed regarding the

detection and management of AF and pharyngitis.

Cameroon

does have national guidelines on diabetes mellitus management

or treatment.

Essential medicines and interventions

The availability and affordability of essential CVD medicines

were investigated in a study by Jingi

et al

Availability was

higher in the urban informal sector, with 63.6% of these

medicines available. Aspirin was the most affordable medicine

and available at 70% of the study sites.

Metformin and insulin

are not generally available in the public health sector.

Warfarin,

clopidogrel, ACE inhibitors, beta-blockers and statins, which are

mostly unaffordable, were not available. No data were available

for CVD risk stratification in primary healthcare facilities, total

cholesterol measurement at the primary healthcare level, and

secondary prevention of ARF and RHD in public sector health

facilities.

Secondary prevention and management

Of the hypertensive persons, 11.5% is receiving medical

treatment,

while oral anticoagulants are prescribed in 34.2%

of high-risk patients with AF.

The percentage of people

with a history of CVD taking aspirin, statins and at least one

antihypertensive agent is unknown.

Part D: Cardiovascular disease governance

The National Integrated and Multi-sector Strategic Plan for

the Control of Chronic NCD (NIMSPC-CNCD) of 2011–2015

included CVD and risk factors, such as hypertension, diabetes,

tobacco use, unhealthy diets, physical inactivity and the harmful

use of alcohol.

Although a unit for NCD is in place in the

Ministry of Health,

no dedicated budget is available to ensure

implementation. Preventing and controlling RHD as a priority

in Cameroon was also included in the NIMSPC-CNCD, but this

plan was never published or distributed.

21,22

Ten-year NCD/CVD surveillance programmes have been

reported, based on the STEPS approach and others.

20,23,24

However, a more comprehensive surveillance system for

NCD was suggested.

Cameroon follows the World Health

Organization (WHO) best-buy policies regarding tobacco use

and has formulated a national tobacco control plan and multi-

sectoral co-ordination mechanism for tobacco control.

Developing the National Health Development Plan (NHDP)

2016–2020 was a collaborative project between the Ministry

of Health and non-health ministries, which included NCD,

of which CVD are prominent.

The health system is severely

underfunded with NCD not prioritised and therefore affecting

dedicated CVD funding, which has to rely on privately funded

donors and out-of-pocket payments.

Cameroon was part

of the WHO-CHOICE project, which incorporated a cost-

effectiveness modelling tool that gathers national data to be used

for developing the most effective interventions for leading causes

of disease burden. The model can be adjusted according to the

specific needs of the country and assist policymakers in planning

and prioritising services at a national level.

Assessment of policy response

Legislation that mandates health financing for CVD/NCD is

lacking, as is that of essential CVDmedicines at affordable prices.

Jingi

et al

noted aspirin was the most affordable CVD medicine

with 70% availability and suggested improving access to affordable

medicines through policy options, which include cost containment

and promoting generics. No judicial orders protecting patients’

rights and mandating improved CVD interventions, facilities,

health-system procedures or resources have been implemented,

although a few policies address individual interventions, such as

tobacco and alcohol use, and physical activity.

According to Cameroon’s Framework Convention on Tobacco

Control (FCTC) report, tobacco policy addressed the creation

of smoke-free zones, warnings on tobacco products, a ban on

advertising, and tax increases.

11,20

There were nomeasures to protect

tobacco control policies from tobacco industry interference.

The country does not have policies that ensure equitable

nationwide access to healthcare professionals and facilities or

screening of high-risk CVD individuals. However, the public

sector provides most of the healthcare, which is burdened by a

lack of funding.

Sustainable funding is also not available for

CVD from taxation of tobacco and/or other ‘sin’ products. There

are no taxes on unhealthy foods or sugar-sweetened beverages.

The percentage of the excise tax of the final consumer price of

tobacco products in Cameroon was 19%, while that of the final

consumer price of alcohol products was rated 25% in 2015.

11,20

No legislation exists on banning the marketing of unhealthy

foods to minors or mandating clear and visible warnings on

foods that are high in calories/sugar/saturated fats. Cameroon

developed a food and nutrition policy to improve food and

nutrition, as well as one that addressed physical inactivity

through mass media awareness.

Stakeholder action

In Cameroon, non-governmental organisation (NGO) advocacy

for CVD policies and programmes as such has not been

demonstrated. However, NGO involvement in NCD policies

has been reported, for example the multi-sectoral expert group

on tobacco.

Clinical Research Education, Networking and

Consultancy (CRENC) is the most active cardiovascular research

organisation in the country.

Its primary goal is to educate young

researchers, linking them and translating research findings into

practice to improve healthcare programmes and improve the

well-being of people.

The Cameroon Heart Foundation and the

Fondation Coeur et Vie also play an active role in Cameroon.

No involvement of patients’ organisations in the advocacy for

CVD/NCD prevention and management has been reported, and

no evidence was found regarding advocacy champions and/or

patient engagement for RHD groups.

Involvement of civil society organisations (CSO), such as

the National Multi-sectoral Committee for Tobacco Control,

in the development and implementation of a national tobacco

control plan was mentioned in the FCTC report.

Cameroon

contributed to the Mapping of NCD Civil Society Organisations

in Francophone sub-Saharan Africa, initiated by the NCD alliance

with a focus on NCD, more specifically diabetes and CVD.

CSO involvement in the national multi-sectoral co-ordination

mechanism for NCD/CVD was documented by Juma

et al.

30,32

An example is the Cameroon Civil Society NCD Alliance that