Plan Stratégique – Lutte Contre les Maladies Non Transmissibles 2017–2020

Objectives

Senegal’s 2017–2020 integrated strategy for non-communicable diseases (NCDs) seeks to limit disease burden and premature mortality, contributing to the global target of a 25% reduction in premature NCD mortality by 2025 and the Sustainable Development Goal target of a one-third reduction by 2030.[1]Its vision is an emerging Senegal in which fewer people live with preventable NCDs or die prematurely from them.[2][3]

• Address cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, sickle-cell disease and haemophilia as priority conditions.[4][5]
• Reduce modifiable risks, notably unhealthy diets, insufficient physical activity, tobacco use and harmful alcohol consumption, while addressing obesity, hypertension, diabetes, air pollution, poor living conditions and artificial skin depigmentation.[6][1][7]
• Strengthen health-supporting environments, prevention, screening, early detection, treatment, palliative care, primary healthcare capacity and affordable access to essential medicines.[2][6]
• Improve health literacy and protective behaviour through targets for public knowledge of NCD risk factors and protective legislation, salt reduction, increased physical activity, lower perceived indoor-air-pollution exposure and improved perceived affordability of care.[7][8][9]
• Achieve quantified prevention targets, including maintaining adult obesity below 6.4%, diabetes below 2.1% and harmful alcohol use below 0.9%, while reducing insufficient physical activity by 6%, hypertension by 12.5%, smoking by 15% and artificial skin depigmentation by 10%.[1][8]
• Expand equitable care by targeting at least 90% protocol-compliant management for haemophilia and sickle-cell disease, cervical-cancer screening for at least half of women aged 30–49, human papillomavirus vaccination coverage above 90% among eligible girls, hepatitis B birth-dose coverage above 80%, and protocol-compliant asthma care.[7][8]
• Organise action around five strategic challenges: inter- and intra-sectoral collaboration, health-supporting environments, NCD care, monitoring and research, and sustainable financing.[7][10]

Implementation

The strategy adopts an integrated, multidimensional and decentralised approach combining cross-sectoral coordination, community engagement, public-private partnership, poverty reduction, improved living conditions, prevention and strengthened care throughout the health-system pyramid.[1][11]Government leadership is to be supported by a multisectoral platform chaired by the Prime Minister’s Office, with strategic follow-up, priority-setting and coordination across public institutions and partners.[10]

• Establish a multisectoral collaboration framework involving health, education, agriculture, finance, transport, planning, trade, customs, environment, local authorities, civil society, communities, non-governmental organisations, parliamentarians, development partners and the private sector.[2][6][10]
• Strengthen the Ministry of Health and Social Action’s Division for the Control of Non-Communicable Diseases through an organisational audit, stronger institutional positioning, adequate human and financial resources, technical bureaux, a scientific council and multisectoral coordination mechanisms.[12][13][14]
• Develop multisectoral policy, sectoral operational plans, actor mapping, regular coordination and advocacy meetings, and expert advisory arrangements covering prevention, care and strategic monitoring.[2][13][14]
• Promote supportive settings in schools, workplaces and disadvantaged communities through healthier food, physical activity, active transport, sports and leisure facilities, protected spaces, communication and regulatory or fiscal measures on tobacco, alcohol and sugary drinks.[15]
• Implement tobacco control under the 2014 anti-tobacco law through smoke-free environments, cessation support, warnings, advertising restrictions, taxation and coordination by national, regional and departmental tobacco-control bodies.[16][17]
• Integrate prevention and screening, including smoking cessation, weight management and physical-activity promotion, into routine care services and strengthen referral links between clinical, preventive and civil-society providers.[18][19]
• Decentralise diagnosis, treatment and emergency care by extending diabetes-hypertension centres, establishing hypertension services in health districts, strengthening regional oncology capacity, creating regional sickle-cell disease and haemophilia units, expanding dialysis services and improving chronic respiratory disease care.[20][5][21]
• Make standards, protocols, minimum care packages, essential medicines, technologies and equipment-maintenance arrangements available at all service levels, while building provider capacity and strengthening task-sharing and interprofessional collaboration.[19][20]
• Engage communities, patient associations, media, journalists, traditional-medicine practitioners, religious leaders and workplace networks in tailored communication, advocacy, screening, self-management support and structural change.[5][21][22][23]
• Consolidate monitoring through a unified results framework, NCD register and integration of core indicators into the District Health Information System 2 and/or continuous Demographic and Health Surveys, covering morbidity, mortality, risk factors, social determinants and vulnerable groups.[24][11]
• Conduct a national STEPwise approach to Surveillance survey, semi-annual monitoring meetings, qualitative process evaluation and final evaluation, while preparing the subsequent NCD strategic plan.[24]
• Support research and innovation through a shared agenda involving universities, research institutes, health services and communities, annual competitive research grants and the application of findings to programme design and adjustment.[25][11][21]
• Mobilise resources through a financing and resource-mobilisation plan, restructured funding arrangements, increased State allocations, private-sector and partner engagement, and parliamentary advocacy; the strategy seeks full financing and efficient use of resources, although no overall monetary budget is specified in the supplied material.[25][3][5]

Monitoring & Evaluation

The 2017–2020 strategy proposes an integrated monitoring, evaluation, research and innovation framework to track non-communicable disease burden, mortality, risk factors, social determinants, vulnerable groups and implementation results.[24][3]It aligns monitoring with quantified targets for behavioural and metabolic risks, screening, vaccination, protocol-based care, health literacy, perceived pollution exposure and affordability of care.[1][7]

• Establish a single results-monitoring framework and unified non-communicable disease register that capture risk-factor information and progress towards the nine voluntary global targets.[24][11]
• Integrate core indicators into District Health Information System 2 (DHIS2) and/or continuous Demographic and Health Surveys with dedicated modules.[24]
• Conduct a national STEPwise approach to Surveillance survey and use periodic prevalence, risk-factor and socio-anthropological studies to guide prevention, care and strategic adaptation.[26][24][21]
• Hold semi-annual monitoring meetings, undertake a qualitative process evaluation and complete a final evaluation of the plan, followed by preparation of a second non-communicable disease strategic plan.[24]
• Strengthen routine reporting by addressing DHIS2 limitations, including the absence of a unique patient identifier, incomplete follow-up of chronic conditions, and incomplete inclusion of level-three public facilities and private providers.[27]
• Use existing surveillance assets, including the national STEPS survey, hospital cancer registry, cancer registry, service-readiness surveys and air-quality monitoring infrastructure.[28][29][30][4]

Existing evidence illustrates the intended measurement domains: non-communicable diseases were estimated to cause 34% of all deaths, the probability of dying from the four major conditions between ages 30 and 70 was estimated at 17%, and non-communicable diseases accounted for 17% of potential years of life lost in 2013.[31][32]Service-readiness monitoring includes availability of protocols, trained staff, diagnostic tests, medicines, specialised services and treatment uptake.[29][33][34]

Accountability is to be supported by a multisectoral platform chaired by the Prime Minister’s Office, a scientific council of disease focal points, coordination committees, regular meetings and follow-up of organisational audit recommendations.[12][10][13][21]Civil-society and patient participation is also intended to strengthen strategic decision-making and programme learning.[27]The source does not provide complete indicator definitions, baselines, reporting responsibilities, data-quality procedures or sanctions for non-performance.[1][7][21]

Costing & Financing

The plan identifies sustainable financing and efficient resource use as a core strategic challenge, seeking full financing of the 2017–2020 strategy through adapted Ministry of Health and Social Action financing instruments, increased State support, private-sector and partner engagement, and a resource-mobilisation plan.[35][25][3]

• Increase State budget support for non-communicable disease prevention, screening and care, and restructure existing financing agreements around strategic intervention areas.[25][3]
• Simplify fund-allocation processes and convene a national forum with private-sector actors and technical and financial partners to mobilise complementary funding.[25][3]
• Conduct semi-annual visits to private-sector and partner representatives to follow up resource mobilisation and monitor potential budget reallocation to the plan.[3]
• Advocate for allocation of at least 15% of the Fund for Scientific and Technological Research to non-communicable disease control for three consecutive years, alongside annual competitive research grants.[25]
• Use fiscal measures, including tobacco, alcohol and sugary-drink taxation and healthy-food subsidies, to support healthier environments.[15]

Financial protection is a central concern because long-term non-communicable disease treatment can increase household expenditure, reduce family income and compound poverty.[36]Diabetes treatment reportedly consumed 25% of household income among the poorest households in some African countries.[37]Direct and indirect costs for the six priority non-communicable diseases in Senegal, including productivity losses and premature mortality, remain poorly estimated.[36][38]

A 1997 estimate placed direct stroke-management costs at Fann University Hospital in Dakar at 32,614,442 West African CFA francs, or 56,232 United States dollars, averaging 78,426 West African CFA francs, or 135 United States dollars, per patient.[38]The documented cost components included hospitalisation, neuroradiology, personnel, medicines and other products.[38]

Public support measures include subsidised insulin, free dialysis, selected free or subsidised cancer treatments, and partner-supported home oxygen therapy, although the extracts provide no monetary valuations for these arrangements.[28][29][33][34]The source does not specify an overall plan budget, detailed activity costing, financing shares, confirmed funding commitments, funding-gap amount or economic assumptions.[1][25][5]