Why Dakar?

Why is hypertension such a problem?

Dakar metropolitan is home to 3.5 million people: around a fifth of Senegal’s entire population.1 Cardiovascular disease is one of the leading causes of mortality, resulting in around 10% of deaths in Senegal2 and around 29.8% of the population suffers from hypertension.3

The control rate of hypertension is just 8% in Senegal,3 compared to 66% in Canada and 53% in the USA.4

Senegal spends 4.7% of total GDP expenditure on health5 and poverty rates remain high in Senegal, affecting 46.7% of the population.6 Patients often face barriers to accessing and following treatment, for example affordability and the patient’s capacity to pay for the care they need.

The Novartis Foundation selected the city of Dakar for the Better Hearts Better Cities initiative not only because of its high unmet need in hypertension, but also due to its enabling environment, including adequate health infrastructure, strong local implementing partners and political will of the local government to actively collaborate.

People living in cities increasingly lead lifestyles characterized by unhealthy diet, reduced physical activity, stress, excessive alcohol and tobacco consumption: all risk factors for the development of non-communicable diseases (NCDs).

In Dakar, there remains a low awareness around these risk factors. The population consumes a diet high in salt and is increasingly exposed to fast food options. 67% of adults consume less than the recommended daily intake of 5 portions of fruits and vegetables3 and around 29% of the population are overweight or obese (BMI ≥ 25).7 In addition, 66% of adults do not regularly practice intensive exercise.3

Why is a multidisciplinary, multisector approach needed?

The factors contributing to the challenge of hypertension in Dakar are systemic and cannot be tackled by one organization alone. Better Hearts Better Cities aims to work with partners beyond healthcare providers – such as digital and telecommunication organizations, food suppliers, employers, insurance funds, social enterprises and civil societies – in collaboration with the local government to improve hypertension control.

Dakar

A Novartis Foundation initiative to improve cardiovascular health in low-income urban communities by improving the control of hypertension as a key risk factor for cardiovascular disease.

By improving the prevention, detection, treatment, management and care of high blood pressure (hypertension) through a multidisciplinary, multisector approach with long-term sustainability.

What is Better Hearts Better Cities?

How does it work?

What’s the overall aim?

How will Better Hearts Better Cities be managed?

Which local partners are involved in Better Hearts Better Cities in Dakar?

What’s going to happen?

Better Hearts Better Cities has the ambitious aim of improving the control rate of hypertension in Dakar.

For more information please contact info@novartisfoundation.org or follow us on Twitter @NovartisFDN

Steering and operations committees have been set up to ensure an integrated multisector approach to interventions for Better Hearts Better Cities. The steering committee provides strategic direction for the local interventions. The operations committee coordinates the implementation of Better Hearts Better Cities interventions with dedicated multistakeholder working groups.

The Ministere de la Santé et de l’Action Sociale (MSAS) will play a leadership role in this collaboration for Better Hearts and Better Cities with the support of local implementation partners IntraHealth and PATH.

IntraHealth International is a global health organization with over 35 years of experience in improving the performance of health workers around the world and strengthening the systems in which they work. IntraHealth’s support of Better Hearts Better Cities will focus on the assessment of existing primary health networks and how best to strengthen capabilities of physicians and community health workers.

PATH is an international nonprofit organization that aims to accelerate innovation across five platforms: vaccines, drugs, diagnostics, devices, and system and service innovations. PATH’s work with Better Hearts Better Cities will consist of providing technical support, translating guidelines into an algorithm of care for hypertension, and working with employers to build wellness programs for NCDs.

In 2017, Better Hearts Better Cities plans to implement a number of steps focused on tackling hypertension in Dakar - in line with the national operational plan for cardio-metabolic diseases that was recently developed by the Senegal Ministry of Health (2017). The 5 key areas are:

Strengthening Primary Care: leveraging Dakar’s existing primary care infrastructure to strengthen hypertension prevention and care via training schemes, developing a care algorithm, and engaging with community-based leaders and health workers.

Health Literacy: improving awareness and health literacy of hypertension through civil society engagement and working with existing patient association groups to reinforce education programs.

Surveillance: setting-up a registry and baseline for intervention, integrating key indicators into the national surveillance system, and collaborating with the Centers for Disease Control and Prevention (CDC) to monitor the program’s effectiveness.

Access and Affordability: working with key stakeholders, such as the Pharmacie Nationale d’Approvisionnement (PNA), to identify ways to improve the supply of essential medicines for hypertension.

Workplace Programs: working with key employers to align on existing practices on wellness programs for NCDs and identify opportunities for partnerships and scalability across the city.

Interventions will be prototyped in the Dakar Ouest District and rolled-out across the remaining city districts in 2018 and beyond.

1. Agence National de la Statistique et de la Démographie. 2017. Available at: http://www.ansd.sn/2. WHO. NCD Country Profile 2014. Senegal. Available at: http://www.who.int/nmh/countries/sen_en.pdf 3. WHO STEPS survey, Senegal 2015. Available at: http://www.who.int/chp/steps/Senegal_2015_STEPS_FS.pdf?ua=14. Joffres M, Falaschetti E, Gillespie C, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality:

a cross-sectional study. BMJ Open 2013;3:e003423. doi: 10.1136/bmjopen-2013-0034235. WHO. Country Cooperation Strategy at a Glance. Senegal. 2016.6. World Bank. Senegal Overview. Available at: http://www.worldbank.org/en/country/senegal/overview 7. Macia E., et al, ‘Hypertension and Obesity in Dakar, Senegal’, PLoS ONE, 2016.

Dakar