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 provides a national framework to reduce morbidity, mortality and social impact from priority non-communicable conditions, particularly hypertension, diabetes and severe hypercholesterolaemia. It is aligned with the World Health Organization Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013–2020, the Plan Sénégal Émergent and the National Health Development Plan 2009–2018.[1][2][3]The plan concentrates on intermediate risk factors and secondary prevention of obesity and severe hypercholesterolaemia, while the wider integrated non-communicable disease plan addresses primary prevention of behavioural risks.[4]

• Increase by 50% by December 2019 the proportion of at-risk people who know their blood-glucose, blood-pressure, weight and lipid status.[5][3]
• Double the proportion of people with the cardiovascular and metabolic disease package who receive care or treatment, and double the proportion of treated patients whose clinical and biological parameters are controlled.[5][3]
• Strengthen screening in facilities and communities, responding to substantial gaps in awareness and detection of hypertension, diabetes and raised cholesterol.[5][6]
• Promote demand for screening, healthy behaviours, early treatment and long-term treatment adherence through communication and community mobilisation.[7][8]
• Integrate a quality care package throughout the health-system pyramid, improve access to essential medicines and technologies, and provide therapeutic education, psychosocial support and economic-access measures.[3][9]
• Establish a monitoring and evaluation system for the cardiovascular and metabolic disease package.[5][10]

The strategic rationale reflects a growing cardiometabolic burden. The 2015 STEPwise approach to non-communicable disease risk-factor surveillance survey recorded raised blood pressure among 29.8% of adults aged 18–69 years, raised cholesterol among 20%, and impaired fasting glucose or treated hyperglycaemia among 3.4%.[11]The plan also recognises major service weaknesses, including inconsistent screening and care guidance, limited community involvement, insufficient institutional capacity and coordination, and medicine stock-outs at health centres and posts.[5][4]

Implementation

Implementation uses an integrated, decentralised and phased model, combining a feasibility pilot in Dakar Ouest with subsequent expansion of effective interventions and training across Senegal’s regions and districts.[12][7][13]The Ministry of Health and Social Action leads through its Division for Non-Communicable Diseases within the Directorate for Disease Control, supported by a National Coordination Committee for Non-Communicable Diseases that provides multidisciplinary and multisectoral oversight.[14][15]

• Deliver screening routinely in health facilities and through targeted community campaigns, with referral and counter-referral to appropriate services and advocacy to make screening free during the pilot phase.[16][7]
• Organise care as a continuum in which communities support screening and follow-up, health posts provide basic care, health centres manage referred cases and complications, regional hospitals provide regional referral, and level-three public establishments provide national referral.[16][8]
• Develop and distribute national policies, standards, procedures, registers and patient-management tools for screening, counselling and care; 5,000 copies of the policy, standards and protocols document are planned for reproduction.[17][18]
• Build workforce capacity through cascade training of regional trainers, district providers, laboratory staff, community actors and private-sector personnel. Targets include 150 regional trainers, 1,150 district-level providers and 92 providers trained in preventive and curative podiatric care.[19][20]
• Strengthen medicine availability by integrating essential cardiovascular and metabolic products into quantification, supply monitoring and procurement strategies, improving communication with prescribers, and training medicine-store managers in 46 districts.[9][21]
• Support adherence through therapeutic education, educational tools, patient associations, home visits, telephone and text-message reminders, and links with mutual health-insurance schemes.[22][23][24]

Operational responsibility rests with the Division for Non-Communicable Diseases, which is expected to prepare annual work plans covering screening, care standards, training, communication, research and reporting.[25]Regional teams coordinate, implement and monitor activities and transmit health information centrally; district teams plan and supervise services and community actors; hospitals contribute to implementation and reporting.[15]Stakeholders include central and decentralised health authorities, hospitals, laboratories, the National Pharmacy Agency, professional and civil-society organisations, local authorities, development partners, non-governmental organisations and private-sector actors.[26][15]The Novartis Foundation supports the Dakar Ouest pilot, initially focused on hypertension screening.[7][13]

Monitoring is results-based, using process, output, outcome and impact indicators with annual targets and quarterly process targets.[13]The system is intended to link with District Health Information System 2, supported by revised logical frameworks, registers, electronic medical records, data-collection tools and training for data actors.[10][27]Annual work planning, twice-yearly supervision and reviews, annual programme reports, a December 2018 mid-term evaluation and a final evaluation provide the main accountability cycle.[12][28][14]Reports and indicator performance are to be presented to the National Coordination Committee every six months for validation of adjustments and follow-up of recommendations.[13]

The operational plan is costed at 2,909,047,684 West African CFA francs for 2017–2019, equivalent to 969,682,560 West African CFA francs annually.[12]It is intended to support advocacy for additional resources in a context of limited partner support for non-communicable diseases.[12]A separate budget summary reports a total allocation of 3,016,188,584, but the supplied extract does not specify its currency or reconcile this figure with the stated operational-plan cost.[29]

Monitoring & Evaluation

The plan establishes a results-based monitoring and evaluation system for the cardiovascular and metabolic disease package, addressing previously weak routine monitoring and fragmented epidemiological information. It combines service data, screening and care registers, DHIS2 integration, supervision, periodic reviews and mid-term and final evaluations.[5][10][13]

• Establish a monitoring and evaluation system by December 2019, supported by a revised logical framework, indicators, a monitoring and evaluation plan, registers, electronic medical records and training in data collection.[5][10]
• Track outcome objectives to increase by 50% the proportion of at-risk people who know their clinical and biological status, double care or treatment coverage, and double control among treated patients by December 2019.[3]
• Monitor awareness of hypertension, diabetes and raised cholesterol, with 2015 baseline awareness levels of 32%, 28% and 4% respectively and targets of 48%, 42% and 8%.[6]
• Measure activity and output indicators including providers and community actors trained, screening tests supplied, functional screening teams, people screened, communication materials distributed, information centres established and therapeutic-education sessions delivered.[26][30][31][32][33]
• Link indicators to the District Health Information System 2 and routine information systems, while developing physical and electronic data-collection tools, patient registers and reporting templates.[10][27]
• Conduct retrospective data collection in public and private hospitals, annual data-audit missions and data-quality monitoring, with a target of 95% coherent, good-quality data across all 14 regions by 2019.[34][35]
• Undertake supervision twice yearly from central to regional, regional to district and district to health-post levels, alongside annual work planning and semi-annual reviews of screening and care data.[12][34][35]
• Prepare and validate annual implementation reports and present implementation reports and indicator performance to the National Coordination Committee for Non-Communicable Diseases every six months.[12][13]
• Conduct a mid-term evaluation in December 2018 to assess organisational arrangements, efficiency and implementation progress, followed by a final evaluation of available data, clinical outcomes and complications.[14]
• Use the performance framework as a contractual accountability mechanism between the Division for Non-Communicable Diseases and partners financing the operational plan.[13]

Evidence generation draws on the 2015 STEPwise approach to non-communicable disease risk-factor surveillance survey, hospital and specialist-service data, health-facility surveys and condition-specific studies.[36][37][38]Important baseline gaps include no routine indicator for cardiovascular and metabolic screening in the cited information system, no active community screening strategy at the time of assessment, and limited population evidence on risk-factor awareness.[2][39]

Costing & Financing

The 2017-2019 operational plan is costed in the source at 2,909,047,684 West African CFA francs, equivalent to an annual investment of 969,682,560 West African CFA francs.[12]A separate budget-summary extract reports a total programme allocation of 3,016,188,584, with no currency identified in that extract.[29]

• Allocate reported annual programme amounts of 260,383,064 for 2017, 1,325,100,242 for 2018 and 1,430,705,278 for 2019; the budget-summary extract does not identify the currency.[29]
• Use the budgeted action plan as an advocacy instrument to mobilise resources for service quality and safety, in a context of limited partner support for non-communicable diseases.[12]
• Seek Ministry of Health and Social Action budget financing to make cardiovascular and metabolic disease package screening free during the pilot phase.[7]
• Assess patient affordability through a prospective study of care-pathway costs, including assessments, medicines, transport and diet, and examine medical-insurance, cooperative and universal-health-coverage options.[9][40][24]
• Support pilot implementation through the Novartis Foundation and seek continuing technical and financial support from development partners, local authorities, civil society and the private sector.[41][15][13]
• Fund human-resource recruitment through the Ministry of Health and Social Action budget and partner support, including ten annual specialist-training scholarships costed at 1,500 euros per scholarship per year for four years.[42][43]
• Maintain the reported annual government insulin subsidy of 250,000,000 West African CFA francs since 2002, although it is reported to meet only 20% of the needs of people with type 1 diabetes.[44]

Resource requirements include medicines and technologies, screening supplies, training, supervision, communication materials, data systems, logistics, consultants and patient-support activities.[45][21][23][28]The supplied material identifies medicine stock-outs, inadequate human and financial resources, and reliance on partner financing as constraints, but generally does not specify financing shares, a comprehensive funding gap or economic assumptions.[2][4][46]