Non-communicable diseases (NCDs) such as heart disease, cancer, chronic respiratory disease and diabetes are the leading cause of premature death worldwide. People with hypertension (high blood pressure) and diabetes have a greater chance of suffering from heart disease, which accounts for more than 17,7 million deaths annually. To address the risk factors for hypertension and diabetes in South Africa, policies and programmes (population-level interventions) must focus on the underlying socio-economic, environmental, behavioural or cultural conditions in which people live and work.
This is according to a study* by researchers in the Department of Global Health in the Faculty of Medicine and Health Sciences at Stellenbosch University. The study was published recently in the peer-reviewed journal BMC Health Services Research. It forms part of a larger project ̶ Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) ̶ on population-level interventions to curb hypertension and diabetes in the country.
The researchers interviewed expert decision makers such as managers, directors and policymakers who participated in the planning and developing of policies, programmes or supportive environments for the prevention and management of these conditions. These decision-makers were from national and provincial government departments, agencies involved in NCD-related programmes, NGOs, the food industry and academic and research institutions.
As part of their study, the researchers used the World Health Organisation's Global Strategy for Diet, Physical Activity and Health as a framework, and focused on three broad categories – supportive policies, supportive programmes and supportive environments. Supportive policies are fiscal, legislative and regulatory measures that can target risk factors for hypertension and diabetes. Supportive programmes can be national, district or community-based programmes that reach people where they live, study or work. A supportive environment refers to activities that influence the creation of circumstances in which healthy choices are the easier option for people.
Speaking ahead of World Hypertension Day (17 May), the researchers say their study shows some of the key enablers and challenges for the planning and development of targeted population-level interventions to reduce the risk factors for hypertension and diabetes.
“The decision-makers we spoke to, emphasised stakeholder engagement and collaboration, contextualisation of policies and programmes, ongoing monitoring and evaluation and organic growth as key enablers for policy formation. They mentioned the value of partnerships between communities, industry, academia and relevant government departments.
“They also said it is important for policies to be responsive to the needs of the community, and that a public health approach should be used because striking a balance between the economic and nutritional needs of people who are at higher risk of hypertension and diabetes was essential to planning for interventions and creating supportive environments.
“Participants also highlighted the need for monitoring and evaluation of policies and programmes to capture, for example, positive change, information about consumer perspectives and further information to inform future policy formation. Another enabler was planning programmes that could organically grow from smaller initiatives that show positive results in evaluation."
According to the researchers, key challenges for the formulation of supportive policies and programmes, and to enable supportive environments, included the lack of time, resources and funding, lack of stakeholder consultation, regulations and competing priorities and ineffective monitoring and evaluation.
“The decision-makers indicated, for example, that a lack of time resulted in the National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2020–2025 (NCD Strategy) being developed without much stakeholder consultation. They pointed out that without consultation and buy-in from key stakeholders, especially communities, policy formulation processes are compromised, risking successful implementation and uptake from stakeholders.
“They also said competing interests between government and other sectors have a detrimental effect on policies and programmes aimed at reducing the risk factors for hypertension and diabetes. Competing priorities translated into unethical sponsorships such as industries supplying and promoting unhealthy diets through sponsorship of governmental events, sending conflicting messages to the public.
“According to them, competing interests, the lack of baseline data and electronic monitoring systems made it difficult to measure the impact of interventions and to refine and improve policies as exemplified in the Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013-17 and the Regulations Relating to the Reduction of Sodium in Certain Foodstuffs and Related Matters."
The researchers say the perceptions of the decision makers show that collaborative planning and engagement, funding, reliable evaluation data, as well as a careful assessment of the needs and circumstances of communities are essential to successfully plan and formulate policies and programmes to reduce the risk factors for hypertension and diabetes.
They add that the feasibility and sustainability of programmes can only be ensured when the resources are provided, and environments enabled to promote healthy lifestyles in communities.
- Source: Hendricks, L; Uwimana‑Nicol, J; & Young, T 2023. Decision makers perceptions and experiences of developing population‑level interventions targeting risk factors for hypertension and diabetes in South Africa: a qualitative study. BMC Health Services Research (2023) 23:146: doi.org/10.1186/s12913-023-09135-x
*This study was supported by the Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) project funded by the German Federal Ministry of Education and Research as part of the Research Networks for Health Innovation in Sub-Saharan Africa Funding Initiative. CEBHA+ is a nine-partner, six country consortium aimed to establish long-term capacity and infrastructure for evidence-based healthcare and public health in sub-Saharan Africa, to strengthen African research institutions, and to build competence in the understanding and rapid uptake of evidence in health system institutions.