Plan d’action multisectoriel de prévention et de contrôle des maladies non transmissibles 2019-2023

Objectives

Burundi’s 2019–2023 National Multisectoral Plan for the Prevention and Control of Non-Communicable Diseases seeks a country free from avoidable morbidity and mortality from non-communicable diseases, in which affected people receive satisfactory treatment.[1][2]Its mission is to strengthen multisectoral collaboration and establish a concerted collective response that reduces non-communicable disease morbidity, mortality and disability by 2023.[1][3][4]The framework is aligned with the National Health Development Plan III and informed by the World Health Organization global action plan and surveillance framework.[5][6][7]

• Strengthen leadership, governance, co-ordination and advocacy for multisectoral action.[4][8]
• Prevent cardiovascular diseases, cancers, diabetes and chronic respiratory diseases by addressing tobacco use, harmful alcohol consumption, unhealthy diets, physical inactivity and underlying social and environmental determinants.[9][10][4]
• Strengthen primary-health-care management, early diagnosis, treatment, referral and palliative care, with access to essential medicines, basic technologies and defined care packages.[10][11][12]
• Improve surveillance, monitoring, evaluation and research on non-communicable diseases, risk factors, service responses and economic effects.[4][13]
• Achieve national targets, including reductions in premature mortality and major risk factors, no increase in diabetes and obesity, greater cardiovascular-risk treatment coverage, and improved availability and financial accessibility of essential medicines and technologies.[1][2][14]

Implementation

The plan uses a whole-of-government and whole-of-society model, combining population-level prevention with integrated, life-course health services.[15][3]It envisages action by public authorities, civil society, communities, private-sector organisations, development partners and health facilities, because many determinants and interventions lie outside the health sector.[16][3]Primary health care is the central delivery platform, with interventions to be incorporated into the minimum and complementary packages of activities throughout the country.[3]

• Establish a National Joint High-Level Committee, a National Technical Committee and a Scientific Support Committee, supported by provincial and communal co-ordination committees and decentralised programme focal points.[17][18]
• Assign the high-level committee responsibility for prioritising objectives, approving action plans, engaging stakeholders, promoting budgets and monitoring strategic implementation, while the technical committee follows delivery across facilities, ministries, civil-society organisations and communities.[18]
• Engage ministries responsible for health, education, finance, agriculture, commerce, justice, media, youth and sport, local administration and other relevant sectors, alongside Parliament, religious communities, non-governmental organisations and technical and financial partners.[16][19]
• Implement phased prevention, treatment and surveillance interventions in one rural and one urban pilot province, assess effectiveness and cost-effectiveness, and extend successful interventions nationally.[20]
• Apply fiscal, regulatory and communication measures to reduce tobacco, alcohol and sugary-drink consumption; promote healthy diets, breastfeeding, fruit and vegetable consumption and physical activity; and strengthen smoke-free environments.[8][21][22]
• Develop or adapt clinical guidelines and protocols; train providers and community health workers; equip facilities; subsidise essential medicines and technologies; and strengthen screening, diagnosis, treatment, referral and palliative care for priority conditions.[11][23][12]
• Support universal access through improved financial accessibility, national health insurance and consideration of compulsory solidarity-based coverage, although no detailed financing design or budget is specified in the supplied material.[24][25]
• Mobilise sustainable state and partner financing, including innovative sources and possible increased taxes on tobacco, alcohol and sugary drinks; the extracts do not provide monetary allocations or a quantified funding gap.[4][8][21]
• Monitor implementation through revised facility tools, indicators configured in the District Health Information Software 2 system, risk-factor indicators in the national health information system, population-based cancer registration, STEPS and Global Youth Tobacco Survey data, and multisectoral reviews.[11][26]
• Require partner focal points to submit six-monthly activity data to the national technical committee, produce consolidated six-monthly and annual reports for approval by the high-level committee, and conduct a final evaluation in 2023 using health information system data and a national final survey.[27]
• Improve mortality information by strengthening medical death certification, recording immediate and underlying causes and relevant conditions, and requiring certificates before burial.[13][28]

Monitoring & Evaluation

The plan establishes surveillance, monitoring and evaluation as one of five strategic action areas, alongside governance, prevention, care and research. It uses national indicators aligned with the World Health Organization non-communicable disease surveillance framework to assess progress towards five objectives and targets for 2023 and 2025.[2][4][7]

• Monitor inputs, processes, outputs and outcomes, including funds mobilised, human resources, facilities, coordination mechanisms, risk-factor change, mortality, disease prevalence, disability, health-system performance and quality of life.[7]
• Measure impact through indicators for premature mortality from the four main non-communicable diseases, harmful alcohol use, physical inactivity, salt intake, tobacco use, hypertension, diabetes, obesity, cardiovascular-risk treatment coverage, and the availability and financial accessibility of essential medicines and technologies.[1][2][7][14]
• Use the National Health Information System, facility data, population surveys, blood-pressure measurement, capillary blood-glucose testing, body-mass-index assessment, official reports and committee documentation as data sources.[7][14]
• Revise facility data-collection tools, configure non-communicable disease indicators in District Health Information Software 2, establish a population-based cancer registry, conduct STEPS and Global Youth Tobacco Survey surveys, and integrate risk-factor indicators into the national information system.[11][26]
• Strengthen mortality surveillance by improving medical death certification, recording immediate and underlying causes of death and relevant conditions, and requiring appropriate certification before burial.[16][13][28]
• Review implementation through semi-annual stakeholder meetings, quarterly coordination meetings, multisectoral assessment meetings, annual implementation reports and a final report in 2023.[17][11]
• Collect activity data through focal points in participating institutions; the National Technical Committee, identified as PNILMCNT, consolidates six-monthly reports for review and approval by CNCHN, while two six-monthly reports form an annual report for dissemination to national authorities and stakeholders.[27]
• Conduct a final 2023 evaluation using five annual reports, national health-information-system data and a countrywide final survey to assess implementation across levels and sectors, stakeholder involvement and effects on national targets.[27]

Illustrative 2025 targets include relative reductions of 15% in premature mortality and hypertension, 20% in tobacco use and 30% in salt consumption, with 40% coverage for chemoprophylaxis and counselling to prevent myocardial infarction and stroke and 60% availability and financial accessibility of essential medicines and basic technologies.[7][14]Several baselines, including those for harmful alcohol use, salt consumption and preventive chemoprophylaxis and counselling, require further research.[2]The plan assigns monitoring roles to national, technical, provincial and communal coordination structures, but the supplied extracts do not provide complete indicator definitions, baseline values, targets for all activities, or a fully specified evaluation methodology.[17][29][18]

Costing & Financing

The plan recognises that sustained non-communicable disease prevention and control require substantial, permanent and sustainably mobilised financing, but the supplied material does not provide a total implementation budget, activity-level cost estimates, quantified funding gap or detailed financing envelope.[4][20][17]

• Increase state-budget allocations for non-communicable disease control and integrate related activities into development partners’ programmes.[8][21][30]
• Mobilise additional domestic, partner, regional and international resources, including innovative financing mechanisms and technical and financial support.[3][17][29]
• Consider fiscal measures including increased taxes on tobacco, alcoholic drinks and sugar-sweetened beverages, with revenues potentially supporting health financing.[24][8][21][31][22]
• Improve affordability through subsidies for essential medicines and technologies, including antidiabetic, antihypertensive and selected respiratory medicines, and through compulsory universal health insurance or tax-supported health-system financing.[24][23][32]
• Mobilise funds after validation of the implementation plan, while the high-level national committee promotes adequate budget allocations, additional financing and appropriate use of available resources.[20][18]

Financial constraints were considered when setting national targets, including the target to improve the availability and financial accessibility of essential medicines and basic technologies.[6][10]The source cites global economic losses from non-communicable diseases of 7,000 billion US dollars over 15 years and notes that comparable countries could implement cost-effective measures with less than 4% of health expenditure.[33][34]It also presents intervention thresholds of up to 100 dollars per year of life and above 100 dollars per year of life, without assigning these values to a Burundi budget.[35]