Plan Opérationnel De Lutte Contre Les Maladies Cardio-Vasculaires Et Métaboliques 2017–2019

Objectives

Senegal’s 2017–2019 Operational Plan for Cardiovascular and Metabolic Diseases aims to reduce morbidity, mortality and the social burden associated with hypertension, diabetes and dyslipidaemia, complementing the wider Integrated Plan for Non-Communicable Disease Control.[1][2][3]It aligns with Sustainable Development Goal 3.4, the Plan Sénégal Emergent and the National Health Development Plan, and seeks a rational, integrated health-system response to a growing burden of cardiovascular and metabolic conditions.[4][2]

• Reduce morbidity and mortality from cardiovascular and metabolic diseases by December 2019.[5][3]
• Increase by 50% the proportion of at-risk people who know their clinical and biological cardiovascular-metabolic status.[6][3]
• Double the proportion of affected people receiving care or treatment and double the proportion of treated patients whose clinical and biological parameters are controlled.[6][3]
• Strengthen screening and demand for screening in health facilities and communities, covering blood pressure, blood glucose, cholesterol, overweight and obesity.[3][7]
• Improve quality, continuity and economic accessibility of care, including access to essential medicines, technologies, patient education, psychosocial support and health-insurance coverage.[8][9]
• Establish a system for collecting, monitoring and analysing cardiovascular and metabolic disease data.[3][10]

The plan prioritises secondary prevention by controlling intermediate risk factors, particularly hypertension, diabetes and severe hypercholesterolaemia, while primary prevention of behavioural risks remains under the integrated non-communicable disease strategy.[11]Its action areas span screening, behaviour-change communication, decentralised diagnosis and treatment, medicine availability, long-term adherence, community support, workforce development, research, and monitoring and evaluation.[12][13]

These priorities respond to substantial gaps in detection and management, including a high proportion of adults with unknown glycaemic status and adults who have never had their blood pressure measured, alongside limited availability of guidance, trained providers and essential medicines at lower levels of care.[14][15][16][17]

Implementation

Implementation uses a phased model, beginning with preparatory studies and a pilot of the integrated cardiovascular and metabolic disease package in Dakar Ouest, supported through collaboration with the Novartis Foundation, before extension of effective interventions and training nationally.[18][19][20]The Division for Non-Communicable Disease Control within the Ministry of Health and Social Action has technical and operational responsibility, working under oversight from the national coordinating mechanism for non-communicable diseases.[21][13]

• Deliver a continuous care pathway in which communities support screening and follow-up, health posts provide basic care, health centres manage referrals and complications, regional hospitals provide regional referral, and level-three hospitals provide national referral.[22]
• Develop and disseminate policies, standards, protocols, registers and patient-management tools for screening, care, referral and counter-referral.[10][23]
• Build provider capacity through national training of trainers, regional and district cascade training, community-actor training and post-training supervision.[7][24][25]
• Organise facility-based and outreach screening, establish multidisciplinary screening teams and patient pathways, and create information centres outside hospitals and health facilities.[26][27]
• Implement communication and social-mobilisation activities using tested materials, community discussions, counselling, opinion leaders, associations, non-governmental organisations and peer educators.[22][28][29]
• Improve medicines access by integrating relevant products into quantification, supply-security and monitoring systems, revising medicine lists, engaging prescribers and training district medicine-store personnel.[30][31]
• Strengthen specialist and support staffing through mapping, recruitment of cardiologists, therapeutic educators and dietitians, and specialist training scholarships.[32][33]

Community participation is integral to delivery. Community health workers, civil-society organisations, patient associations and non-governmental organisations are expected to contribute to education, counselling, home visits, surveillance, referral and adherence support.[12][8]Patient-support interventions include therapeutic education, weekly education sessions, appointment reminders by SMS and telephone, and expansion of regional patient-association networks.[34][35][36]

Governance combines central coordination with decentralised implementation. Regional and district management teams coordinate, implement and monitor activities, supervise providers and community actors, and transmit information to the central level; hospitals contribute throughout implementation and report data through district and regional channels.[37]Local authorities, technical and financial partners, the private sector and non-governmental organisations contribute implementation and support.[37][13]

Monitoring and evaluation arrangements include revision of the logical framework, development of indicators and a monitoring plan, integration of data collection with District Health Information Software 2, package-specific registers and electronic patient records.[38][10]Activities are planned annually through Annual Work Plans, with central-to-regional-to-district supervision, six-monthly reviews of screening and care data, annual programme reports, a mid-term evaluation in December 2018 and a final evaluation in 2020.[38][21][39]The performance framework uses process, output, outcome and impact indicators, with annual targets and quarterly process targets; six-monthly reports and corrective recommendations are submitted to the coordinating committee.[20][39]

The 2017–2019 operational plan is budgeted at 2,909,047,684 FCFA, with annual investment estimated at 969,682,560 FCFA.[18]Resource mobilisation is to be supported through a financing or contribution matrix recording government and partner commitments, identification of funding gaps, and annual partner round tables.[39]

Monitoring & Evaluation

The plan establishes a national monitoring and evaluation system for the cardiovascular and metabolic disease package, combining routine data collection, supervision, periodic review, reporting and programme evaluation.[38][10][20]It links package data to District Health Information Software 2, introduces registers and electronic patient records, and assigns implementation monitoring to the Division for Non-Communicable Disease Control and strategic oversight to the Coordinating Committee for Non-Communicable Disease Control.[38][10][20]

• Track outcome targets by December 2019, including a 50% increase in at-risk people who know their clinical and biological status and doubling treatment coverage and control among treated patients.[6][3]
• Monitor service delivery through screening registers, referral and counter-referral, patient follow-up, community surveillance, home visits and medicine-supply tracking.[6][12][8]
• Use process, output, outcome and impact indicators, with annual targets and quarterly process targets, within a performance framework and monitoring and evaluation manual.[20]
• Conduct annual work planning, six-monthly supervision and reviews, annual programme reporting, and data audits at district and hospital level.[38][40][41]
• Submit six-monthly implementation reports and indicator results to the Coordinating Committee, which validates corrective recommendations and follows up their implementation.[39]
• Complete a mid-term programme evaluation in December 2018 and a final evaluation in 2020 assessing data, clinical outcomes and complications.[21][39]

Priority indicators include screening uptake, awareness of hypertension and diabetes status, treatment coverage, clinical control, provider supervision, medicine availability and data quality.[42][43][31][44]Baseline evidence is fragmented and includes the 2015 STEPwise survey, hospital data and specialised-service cohorts; earlier health information systems lacked indicators for awareness activities and diabetes screening.[45][46][14][15]

Some extracts do not provide complete indicator definitions, reporting templates, accountability sanctions or evaluation methodologies, although the operational plan specifies supervision, reviews, reporting and committee oversight.[38][10][21][37]

Costing & Financing

The 2017–2019 operational plan is budgeted at 2,909,047,684 FCFA, with an annual investment stated as 969,682,560 FCFA.[18]The plan combines a budgeted action plan with a resource-mobilisation strategy and financing matrix intended to record government and partner commitments, monitor financing and identify funding gaps.[13][39]

• Mobilise resources through Ministry of Health and Social Action advocacy and annual round tables with technical and financial partners to review commitments, performance and financing needs.[39]
• Secure support from the Novartis Foundation for plan development and the Dakar Ouest hypertension pilot, while extending interventions and training nationally.[4][18][20]
• Improve economic access by advocating for free screening and inclusion of the cardiovascular and metabolic disease package in Universal Health Coverage.[19][8][47]
• Assess patient treatment-pathway costs, including consultations, medicines, transport and diet, and examine insurance, mutual and cooperative arrangements.[8][9][36]
• Address resource constraints affecting the Non-Communicable Diseases Division, medicines availability, laboratory access, training, logistics and human-resource expansion.[48][49][25][32]

Objective 2 has a stated total of 626,890,500 across unspecified cost columns, including 392,700,000 for human resources; the currency, funding sources, budget periods and financing gaps are not identified in that extract.[50][51]The State’s annual insulin subsidy is 250,000,000 FCFA, but it reportedly covers only 20% of the needs of people with type 1 diabetes.[52]Diabetes screening costs range from 2,000 FCFA in the public sector to 10,000 FCFA in the private sector.[15]

Many activity extracts identify required inputs, such as financial resources, logistics, training, consultants, medicines, technologies and data-management materials, without specifying unit costs or allocations.[53][24][28][54]Nutrition activities are reported to depend entirely on partners and to face insufficient financial resources.[55]