Plan stratégique intégré de lutte contre les maladies non transmissibles 2016-2020

Objectives

Burkina Faso’s Integrated Strategic Plan for Non-Communicable Disease Control for 2016–2020 aims to promote action against non-communicable diseases (NCDs) and reduce associated morbidity, disability and premature mortality through an integrated response to prevention, surveillance and care.[1][2]It addresses cardiovascular diseases, cancers, diabetes, chronic respiratory diseases, mental-health conditions, sickle-cell disease and other relevant chronic conditions, while prioritising tobacco use, harmful alcohol consumption, unhealthy diet and physical inactivity.[3][1]

• Strengthen leadership, governance, coordination, intersectoral collaboration, partnerships and the visibility of the National Non-Communicable Disease Programme.[4][5]
• Improve the availability, quality and financial accessibility of prevention, screening, diagnosis, treatment, follow-up, palliative care, rehabilitation and disability support across the health system.[2][6][7]
• Develop human resources through specialist recruitment, training, continuing education, clinical guidance and protocols, including a minimum package of primary-care NCD services based on the World Health Organization Package of Essential Noncommunicable Disease Interventions.[8][4][9]
• Promote health and prevent disease through behaviour-change communication, risk-factor control, enforcement of tobacco, alcohol and psychoactive-substance regulations, physical activity and improved access to healthy food.[10][11]
• Strengthen infrastructure, equipment, maintenance, logistics, medicines, reagents and consumables needed for NCD care.[12][10][13]
• Improve health-information management, surveillance, research and use of evidence on NCDs and their risk factors.[14][12]
• Increase resources for NCD care and reduce financial barriers through State financing, partner support, subsidies, mutual health organisations, private insurance and universal health insurance.[2][15][16]

Implementation

The plan applies a multisectoral, health-system-based delivery model, integrating NCD prevention and care within primary, district, regional and university-hospital services while building specialised capacity and working with other ministries, local authorities, civil society, private providers, traditional practitioners and technical and financial partners.[17][18][19]Implementation is led by the National Non-Communicable Disease Programme, known as PNMNT, alongside central Ministry of Health directorates, regional health directorates, hospitals and health districts.[16]

• Establish a high-level multisectoral consultation framework, designate NCD focal points in relevant sectors and create thematic working groups to integrate NCD considerations across policies and support implementation and evaluation.[20][21][22]
• Prepare annual integrated multisectoral action plans, disseminate the strategy among health-sector and non-health-sector actors, and convene periodic coordination and advocacy meetings with government sectors, partners, non-governmental organisations and associations.[19][23][20]
• Strengthen service delivery through primary-care integration, referral and counter-referral, specialist services, telemedicine, therapeutic education, national care protocols and targeted screening.[5][24]
• Build workforce capacity by training health workers, specialists, community-based health workers, traditional practitioners, civil-society actors, teachers and media professionals.[25][26][27][28]
• Improve prevention through communication plans, school awareness activities, public and media engagement, regulatory dissemination, vaccination measures, food-quality collaboration and advocacy for facilities supporting physical activity.[25][11][29]
• Upgrade care capacity through facility rehabilitation or construction, equipment procurement, preventive and corrective maintenance contracts, strengthened logistics and improved availability of essential NCD medicines, reagents and consumables.[25][15][30][31]
• Improve information systems by integrating NCD indicators into national data-collection tools, conducting data-validation workshops, disseminating STEPS survey findings, developing hospital cancer registries and commissioning thematic studies and literature reviews.[32][33][34]
• Mobilise financing through advocacy to decision-makers and partners, tobacco and alcohol taxation, bilateral and multilateral sources, private-sector and non-governmental contributions, and health-risk-sharing mechanisms.[16][35]

Monitoring and evaluation are to use operational plans and existing National Health Development Plan mechanisms, including monitoring committee sessions, joint visits with technical and financial partners, supervision, surveys, studies and periodic evaluations.[36]Annual and mid-term reviews are planned, with a mid-term evaluation at the end of 2018 and final evaluation at the end of 2020.[37]Monitoring includes indicators on coordination meetings, focal points, partnerships, training, referrals, service-package implementation, protocols, screening, infrastructure, equipment, supplies, data validation, research outputs and financing mobilisation.[5][24][38][32]

Monitoring & Evaluation

The plan establishes a structured monitoring, evaluation and accountability approach for non-communicable disease control during 2016–2020. It combines routine health-information improvements, activity and service-delivery indicators, data validation, periodic reviews, operational research, and formal mid-term and final evaluations.[39][16][36][37]

• Implement a monitoring and evaluation plan for the Integrated Strategic Plan, supported by annual integrated multisectoral action plans, semi-annual implementation follow-up, and activity reports.[20]
• Conduct annual reviews and a mid-term evaluation at the end of 2018 to assess implementation processes and results and allow plan adjustment, followed by a final evaluation at the end of 2020 examining medium-term results and impact.[37]
• Use National Health Development Plan monitoring mechanisms, including monitoring-committee sessions, joint visits with technical and financial partners, periodic evaluations, surveys, studies and supervision.[36]
• Assign the Directorate for Disease Control responsibility for operational planning, implementation coordination and monitoring, partnership coordination, and planning guidance for regional and district authorities; regional committees oversee implementation, while district management teams integrate activities into local plans and report indicators.[37]
• Monitor governance through coordination-meeting reports, the existence of a multisectoral consultation framework, sectoral focal points, identified partners, signed agreements and functioning thematic working groups.[16][5]
• Track service delivery through trained personnel, referrals and counter-referrals, facilities implementing the minimum non-communicable disease package, national protocols, telemedicine use, screening, self-management education, supportive care, equipment, maintenance contracts, vehicles, medicines and supply interruptions.[24][10][38]
• Strengthen information systems by incorporating non-communicable disease indicators into collection tools, holding a consensus workshop, conducting annual data-validation workshops in 13 regions, publishing database outputs and developing hospital cancer registries.[13][32][34]
• Measure effects against 2020 targets for fruit and vegetable consumption, physical activity, medically followed hypertension, detected and followed diabetes, and primary facilities providing the essential intervention package.[32]
• Assess impact through surveys of tobacco and harmful alcohol use, physical inactivity, obesity, hypertension, salt consumption, diabetes, access to essential medicines and technologies, premature mortality, combined risk factors, active trachoma and trachomatous trichiasis.[40]
• Track research through publications, thematic studies, literature reviews, reports, dissemination and restitution workshops, research projects and participation in scientific meetings.[35]

Costing & Financing

The plan identifies insufficient financing, high household costs of non-communicable disease care and constrained resource mobilisation as major implementation barriers. Its financing approach combines State budget allocations, partner support, health mutuals, private and universal health insurance, subsidies and potential innovative sources, including tobacco and alcohol taxation.[41][2][16][35]

• Allocate part of the disease-control budget line to non-communicable disease activities and use annual budget review and realignment to support operational plans.[40][23]
• Mobilise additional resources through advocacy with decision-makers, technical and financial partners, bilateral and multilateral sources, the private sector and non-governmental organisations.[19][16][35]
• Use a donors’ round table to address the funding gap and complete the estimated budget, although no overall plan budget or quantified gap is provided in the supplied material.[40][23]
• Promote financial risk-sharing through State subsidies, mutual health organisations, private insurance and universal health insurance.[15][16]
• Reduce financial barriers through free cervical-cancer screening and management of precancerous lesions, subsidies for selected services including dialysis and medical evacuations, and advocacy for affordable generic medicines and palliative-care medicines.[42][43][8]
• Recognise that cancer absorbs 60% of the State budget allocated to medical evacuations abroad, while haemodialysis is described as costly, unsubsidised and largely financed by families.[44][45]
• Budget mental-health plan operationalisation at 4,391,462,054 CFA francs over five years, while noting that available financing is insufficient.[46]
• Cost specific implementation activities, including information-system strengthening, medicines and consumables, training, communication, governance, supervision and evaluation, but leave the currency unspecified for many budget-table entries.[20][47][33][48]