Table 3 Summary of the Kingdon framework’s three streams describing problem, policy and politics surrounding cardiovascular disease in Senegal and outcomes directly or indirectly attributed to the urban population health initiative (bold/italic)
Problem stream | Policy stream | Politics stream |
|---|---|---|
2015 STEPS survey  • Hypertension prevalence estimated at 29.8% in 18–69 year olds (ranging from 15.3% in people aged 18–29 years, to 64.2% in the 60–69 year old group)  • 46% of the hypertension patients are aware of their condition  • 17% of the hypertension patients report taking antihypertensive medicines, while only 8% achieve BP control  • Stroke considered the fifth major cause of death in Senegal 2015 National Agency of Statistics and Demography reports frequent shortages of anti-hypertensive medicines. E.g. enalapril available in only 3% of the health centres and health posts, thiazide diuretics in 1%, atenolol in 3% and amlodipine in 33% 2016 MOH establishes protocols for standardizing hypertension management, covering all levels of the health system 2018 WHO NCD report  • NCDs estimated to account for 42% of all deaths in Senegal, with 17% of the deaths attributed to CV disease in 2016 | 2014: Adoption of Tobacco Control Act  • By 2016, a comprehensive ban on all tobacco advertising, promotion and sponsorship was achieved  • As of 2019, Senegal was the only LMIC offering full smoking cessation support services 2016: National Guidelines for six priority NCDs 2017: National Operational Plan for Cardiovascular and Metabolic diseases 2017–2020 2017–18: NCD National guidelines translated into a single standard algorithm of care for managing hypertension in PHC services.  • Nurses of PHC centres and health posts now allowed to refer hypertension patients to 2nd or 3rd level of care (task shifting policy)  • Every adult ≥ 18 presenting in a health facility is being screened for high BP.  • National policy enabling community health workers to measure BP, refer patients for confirming hypertension diagnosis, and follow up for patients under treatment 2018: National Tobacco Control Strategic Plan 2018–2022 2018: National Health and Social Development Plan 2018–2028 2018: National essential drug list revised to allow prescription of antihypertensives such as amlodipin and captopril also at lower level health facilities (community health posts and health centres). | 1975: Belgium Development Cooperation starts supporting health sector in Senegal, focusing on the PHC and overall health system strengthening 1998: National Health and Development Plan 1998–2007 2008: National Health and Development Plan 2009–2018 2013: NCD Division created within MOH with a unit focusing on CV diseases 2014: ‘Emerging Senegal Plan’ 2014–2023 2016: Belgium Development Cooperation supports harmonization of guidelines for six priority NCDs 2017: National Operational Plan for Cardiovascular and Metabolic diseases 2017–2019 2018: Stakeholder workshop, chaired by the WHO local office, contributing to the strengthening of local guidelines and standard algorithms of care for hypertension 2018: National Health and Social Development Plan 2018–2028 2018/2019: World Hypertension Day celebrations in Dakar 2020: Government sets up a multisector committee to address NCDs |