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VOLUME 15 NUMBER 2 • NOVEMBER 2018
PASCAR ROADMAP
SA JOURNAL OF DIABETES & VASCULAR DISEASE
organisations should pay attention to this report and work
together for a reduction in hypertension prevalence.
2. Allocate appropriate funding and resources for the early
detection, efficient treatment and control of hypertension.
• The costs of priority interventions for NCDs, including
hypertension, have been shown to be small and countries
are receiving global funds.
• No new global funding is needed to implement the 10
actions for controlling hypertension.
• Comprehensive implementation to control hypertension and
reduce salt intake is affordable in all countries.
• The current increasing burden of uncontrolled hypertension
is a barrier to the development of all African nations.
• Funding to support civil society and health organisations
will contribute to developing and implementing appropriate
health policies to control hypertension.
• Funding is needed to support dissemination of best practices
to detect, manage and control NCDs within Africa.
– Increase healthcare budgets in Africa to align with the
WHO global action plan of 2013–2020, which has already
been adopted by all SSA countries.
– Realign existing funding with the emerging hypertension
threat that SSA populations are experiencing.
– Dedicate a clear percentage of the health budget to
hypertension policy.
– Use existing resources more efficiently.
– Develop innovative funding mechanisms, including
additional alcohol and tobacco taxes.
– National cardiac and hypertension societies should
monitor the hypertension/NCD-related budget every two
years and advocate otherwise for improvement.
3. Create or adopt simple and practical clinical evidence-based
hypertension management guidelines.
• The role of simple and practical guidelines is crucial for
managing NCDs at large, and hypertension specifically.
• In 2015, only 25%of SSA countries had developed or adopted
clinical guidelines for managing hypertension (Fig. 4).
• New scientific knowledge guides implementation and
efficiency in developing guidelines according to the best
actual practices.
– PASCAR will develop and regularly update continental
guidelines with a simple care algorithm (Fig. 2) for
detecting, treating and controlling hypertension. National
cardiac societies are called upon to adopt or adapt to the
country’s circumstances where appropriate.
– Alternatively, the WHO HEARTS technical package for
CVD management in primary healthcare overtakes
WHO PEN12 and provides a comprehensive CVD control
approach,
23
with the possibility of integrating hypertension
as a risk factor.
– PASCAR has defined and will regularly update the
minimum standards (Table 3) to control hypertension,
which need to be achieved by each SSA country. Countries
are called upon to adopt and implement these.
4. Annually monitor and report the detection, treatment and
control rates of hypertension, with a clear target of improvement
by 2025, using the WHO STEPwise surveillance in all countries.
• The success of all NCD interventions, including hypertension
policy, will depend on how specific, measurable, achievable,
realistic and time-bound the objectives are.
• A framework for national and continental monitoring,
reporting and accountability will ensure that the returns
on investments in hypertension and other NCDs meet the
expectations of all partners.
– The WHO STEPwise approach to NCD risk-factor
surveillance should be strengthened in all African
countries to report on detecting, treating and controlling
hypertension annually.
– BP to be measured at all relevant clinical encounters.
– Regular representative population surveys are effective in
monitoring trends of key risk factors and the uptake of
priority interventions, such as the WHO STEPS approach
to monitor NCD risk factors.
– National cardiac and/or hypertension societies should
measure the level of coverage for some sentinel sites
(communities, industries, primary healthcare centres, etc.)
and report to PASCAR.
– National cardiac and/or hypertension societies should
take responsibility for reporting progress in hypertension
control, mobilising resources, developing policy and
identifying best practices.
– The monitoring and reporting team in sentinel sites will
ensure that people know their BP, hypertensives receive
appropriate treatment, BP is controlled and they remain
on treatment.
5. Integrate hypertension detection, treatment and control
within existing health services, such as vertical programmes
(e.g. HIV, TB).
• What the medical community learned from the large-scale
management of TB and HIV/AIDS should be successful in
managing hypertension.
– The government, private sector, academia and community
organisations should work together to align plans for
detecting, treating and controlling hypertension with
other ongoing programmes.
– Emphasis should be placed on (1) standardised treatment
protocols, (2) identification and availability of affordable
and effective drugs, and (3) service delivery, as with TB
and HIV programmes.
6. Promote a task-sharing approach with adequately trained
community health workers (shift-paradigm).
• SSA carries 11% of the world population, 25% of the
global burden of disease, with only 3% of the world’s health
labour force, and has a global health expenditure of less
than 1%.
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• These health-worker shortages are a major barrier to
controlling hypertension in Africa.
• Clear evidence exists that health staff without formal
professional training can be adequately trained to effectively
detect people with severe hypertension.
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• Using trained community health workers (CHW) to detect
hypertension would free health professionals in Africa to
treat and control the condition.
• Well-trained nurses, general and family physicians can
adequately manage uncomplicated hypertension, freeing
specialists for more severe cases.
– Design a course to train CHW in detecting hyper-
tension, providing information and educating the
community.
– Train 250 000 CHW to detect hypertension by 2025.