Plan Opérationnel de Lutte contre les Maladies Cardio-vasculaires et Métaboliques 2017–2019

Objectives

Senegal’s 2017–2019 Operational Plan for Combating Cardiovascular and Metabolic Diseases aims to reduce premature morbidity, mortality and social impacts through prevention, early detection, appropriate care and long-term support. It addresses hypertension, diabetes and dyslipidaemia as the core package, while incorporating secondary prevention of obesity and severe hypercholesterolaemia.[1][2]The plan is aligned with the Integrated Plan for Non-Communicable Disease Control, the World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020, the Plan Sénégal Emergent and the National Health Development Plan 2009–2018.[3][4]

• Increase by 50% the proportion of at-risk people who know their cardiovascular and metabolic clinical and biological status by December 2019.[5]
• Double the proportion of people in the package who receive care and/or treatment, and double the proportion of treated patients whose clinical and biological parameters are controlled.[5]
• Strengthen screening in health facilities and communities, including routine and targeted campaign-based screening, referral and counter-referral, and communication to increase demand for early testing and treatment.[6][7]
• Establish a coherent continuum of quality care across all health-system levels, supported by policies, standards, protocols, trained personnel, essential medicines and diagnostic technologies.[8]
• Improve medical, psychosocial and therapeutic follow-up through patient education, community support, home visits, appointment reminders and patient-association involvement.[9][10][11]
• Improve affordability by assessing treatment-pathway costs, expanding mutual health-insurance enrolment and advocating inclusion of the package in Universal Health Coverage.[9][12]
• Establish a monitoring and evaluation system to collect, analyse and use data on screening, care coverage, treatment control and implementation performance.[5][13]

Implementation

The plan uses a phased, integrated delivery model led by the Ministry of Health and Social Action, combining a pilot in Dakar Ouest with subsequent expansion across 46 districts in all 14 regions.[14][15]It seeks to link community action, primary care, referral hospitals, supply systems, health insurance, communication and routine performance management, while using pilot learning to refine national standards and scale-up arrangements.[6][16]

• Implement a decentralised 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 public hospitals provide national referral.[8]
• Develop, validate, disseminate and supervise use of national policies, standards and protocols for counselling, screening, management and referral, including treatment algorithms for hypertension and diabetes.[17][18]
• Build workforce capacity through training-of-trainers, cascade training, post-training supervision and specialist development for providers, laboratory personnel, community actors, medicine-store managers and data managers.[19][20][21]
• Deliver screening through health facilities, community mobilisation, outreach activities and information centres, supported by registers, screening forms, glucometers, test strips and defined patient pathways.[7][22]
• Strengthen medicine and technology availability by integrating cardiovascular and metabolic products into quantification, supply monitoring and innovative procurement strategies, while addressing recurrent stock-outs.[23][24]
• Use communication plans, posters, picture boxes, video materials, health-facility sessions and community discussions to promote healthy behaviours, screening, early treatment and treatment adherence.[16][25]
• Engage community health workers, civil-society organisations, patient associations, non-governmental organisations, local authorities, private providers and technical and financial partners in delivery, follow-up and advocacy.[9][26]
• Govern through the Division for the Control of Non-Communicable Diseases, under the Directorate for Disease Control, supported by a National Coordinating Committee for the Control of Non-Communicable Diseases and disease-specific subcommittees.[27]The executive division prepares annual action plans and reports, while regional and district teams coordinate implementation, supervision and reporting.[26]
• Monitor performance through indicators at process, output, outcome and impact levels, with annual targets and quarterly process targets.[28]Integrate relevant indicators into District Health Information System 2, develop electronic medical records and data-collection tools, conduct semi-annual reviews, and prepare annual reports.[29][21]
• Conduct continuous monitoring by the non-communicable disease division and strategic review by the national coordinating committee, with six-monthly presentation of implementation reports and performance results.[28]Conduct a mid-term evaluation in December 2018 and a final evaluation covering results, clinical outcomes and complications.[30]

Monitoring & Evaluation

The plan establishes a results-based monitoring and evaluation system for the cardiovascular and metabolic disease package, addressing previously weak monitoring, under-diagnosis and incomplete routine data. It combines a performance framework, service registers, electronic records, District Health Information System 2 integration, supervision, reviews, audits and programme evaluations.[31][29][28]

• Define process, output, outcome and impact indicators with annual targets and quarterly process targets, covering screening, treatment coverage, control of clinical and biological parameters, medicine availability, trained personnel and patient support.[28][32][33]
• Track outcome targets to increase awareness and effective management of hypertension from 7% to 14% and diabetes from 14% to 28%, while setting a 28% target for effective management of elevated cholesterol where the baseline was undetermined.[32][33]
• Monitor controlled treatment outcomes, including targets to increase controlled treated hypertension from 3% to 6%, controlled treated diabetes from 11% to 22%, and controlled treated high cholesterol from 3% to 6%.[34][35]
• Integrate indicators into District Health Information System 2, develop data-collection protocols and tools, establish patient registers and computerised medical records, and train regional, district, hospital and other data managers.[29][12][21]
• Conduct retrospective collection of hospital data, including from public and private hospitals, and audit data quality at district and hospital levels.[36][30]
• Undertake central-to-regional, regional-to-district and district-to-health-post supervision, with six-monthly supervision, semi-annual data and activity reviews, annual planning and annual programme reporting.[13][36][30]
• Use activity-level verification sources including workshop, training, supervision, advocacy and audit reports; screening forms and registers; invoices and delivery notes; policy drafts; and reports from information centres and therapeutic-education sessions.[17][37][20][10]
• Assess the pilot phase for feasibility, relevance, good practice and lessons to guide scale-up, then undertake a mid-term evaluation in December 2018 and a final evaluation of results, clinical outcomes and complications.[16][30]
• Assign continuous operational monitoring to the Division for the Control of Non-Communicable Diseases and strategic monitoring to the National Coordinating Committee for the Control of Non-Communicable Diseases, which receives six-monthly implementation reports and validates recommendations and adjustments.[28]
• Require regional and district teams to coordinate, supervise and report health information upwards, while hospitals contribute data to district and regional reports; the executive division prepares an annual activity report for committee approval.[26]

Surveillance evidence is constrained by incomplete reporting and uneven availability of national indicators. The source identifies that District Health Information System 2 previously lacked a cardiovascular and metabolic disease screening indicator, mortality reporting excluded many hospital and private-sector deaths, and a large proportion of adults had never had blood pressure measured.[23][38][39]The plan therefore specifies data-system strengthening, although some excerpts do not provide full indicator definitions, reporting frequencies or accountability procedures for every activity.[5][6]

Costing & Financing

The 2017–2019 operational plan has a stated total budget of 2,909,047,684 West African CFA francs, equivalent to an annual investment of 969,682,560 West African CFA francs.[14]It is supported by a budgeted action plan, while the pilot phase receives support from the Novartis Foundation.[15][28]

• Mobilise resources through the plan because partner support for non-communicable diseases is limited, including advocacy with development partners, local authorities, non-governmental organisations and the private sector.[14][26]
• Advocate for free screening of the cardiovascular and metabolic disease package financed through the Ministry of Health and Social Action budget, although no amount is specified for this proposal.[16]
• Improve affordability by assessing patients’ treatment-pathway costs, including tests, medicines, transport and diet, and by considering health mutuals, cooperative arrangements and inclusion of the package in Universal Health Coverage.[40][29][9]
• Develop a specific health-insurance package for diabetes and hypertension, including pilot and extension enrolment of informal-sector patients in health mutuals.[11][12]
• Maintain the Government of Senegal’s annual insulin subsidy of 250,000,000 West African CFA francs, reported since 2002, while recognising that it covers the needs of 20% of people with type 1 diabetes.[41]
• Recognise financial barriers to screening, as diabetes screening is not free and costs from 2,000 West African CFA francs in the public sector to 10,000 West African CFA francs in the private sector.[39]
• Fund implementation inputs including staffing, training, consultants, workshops, logistics, supervision, data systems, screening supplies, medicines, communication materials and therapeutic-education tools.[17][42][24]

Although the plan identifies resource needs and several funding mechanisms, most excerpts do not provide activity-level allocations, committed funding-source breakdowns, quantified funding gaps or economic assumptions.[14][36][15]Broader health-financing evidence indicates substantial household payment and relatively limited public-sector resources, but this is not a cardiovascular-specific financing plan.[43]