Healthy Heart Africa
Investing for the Future
What is the Healthy Heart Africa Programme?
AstraZeneca has over a century of experience in treating cardiovascular diseases and an extensive portfolio of anti-hypertensives. AstraZeneca’s Healthy Heart Africa (HHA) is an innovative programme committed to tackling hypertension and the increasing burden of cardiovascular disease (CVD) across Africa.
Partnering with local and global partners, HHA aims to improve access to hypertension care and was established with the ambition to be sustainable. To help achieve this, AstraZeneca provide branded medicines at a significant discount, but one that enables us to implement a no-profit/no-loss business model.
HHA aspires to reach 10 million people with elevated blood pressure across Africa by 2025, by:
- Increasing awareness and educating around lifestyle choice and CVD risk factors
- Training providers and driving care to lower levels of the healthcare system
- Facilitating access to low cost, high quality branded anti-hypertensives, where applicable
Healthy Heart Africa is central to our commitment to sustainability and improving access to healthcare, and we are committed to going even further as we put patients first – today and in the future.
Healthy Heart Africa Milestones
Since launching in Kenya in 2014, Ethiopia in 2016, Tanzania in 2018, Ghana in 2019 and Uganda in 2020 HHA has already:
- Conducted over 15.5 million blood pressure screenings in the community and in healthcare facilities1
- Trained over 7,290 healthcare workers, including doctors, nurses, community health volunteers and pharmacists to provide education and awareness, screening and treatment services for hypertension1
- Activated 800 healthcare facilities in Africa to provide hypertension services, including the establishment of secure supply chains for low cost, high-quality branded antihypertensive medicines1
- Identified over 2.8 million elevated blood pressure1 readings
There were approximately 80 million adults with high blood pressure in sub-Saharan Africa in 2000 and this figure is expected to rise to 150 million by 2025.2
Healthy Heart Africa’s public/private partnership model
The nature of non-communicable diseases (NCDs) and their risk factors call for multi-sector involvement in prevention and control measures. We therefore work with local stakeholders to align on our shared objectives and develop interventions that are optimised to address local challenges on a sustainable basis, while leveraging our experience in health programming.3 This not only enhances local ownership, but it also enables sustainability of the programme’s activities.
We have learned that our approach to fighting hypertension works best when integrated into existing health platforms. Our partnerships with public, private and faith-based facilities, supported by our joint global and local knowledge and expertise, are now helping to integrate blood pressure screening and hypertension treatment into routine care in Kenya, Ethiopia, Tanzania, Ghana and Uganda.
Additionally, our demonstration phase proved the potential of using hypertension as a new entry point for treatment of other disease areas, including HIV/AIDS.
Through our partnerships, we establish mechanisms for collaboration through, for example, joint coordination, planning and agreement of a set of core indicators for monitoring and evaluation.4
Healthy Heart Africa in Kenya
HHA was launched in Kenya in October 2014 in collaboration with the Ministry of Health (MOH) and in support of its commitment to combat NCDs in line with the Kenya National Strategy for the Prevention and Control of Non-Communicable Diseases,2015-20205. The initiative began with an 18-month demonstration phase to understand how to integrate hypertension services into the existing healthcare service infrastructure.
Given the novel nature of HHA, and the reality that there was a lack of evidence of successful implementation of NCD interventions within the primary care setting in African countries,6 AstraZeneca launched five different demonstration projects. In collaboration with a range of partners, HHA tested different models across a relatively fragmented healthcare system7 to identify what worked and at what cost, to inform future scale-up both within Kenya and across the region more broadly.
Since launch, we have continued to refine the model, applying resources where they have most impact and identifying learnings that we have built into our ongoing operation of the programme in Kenya and beyond. The Kenya Conference of Catholic Bishops (KCCB) is the HHA implementing partner.
Healthy Heart Africa and PEPFAR
Announced in September 2016, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and AstraZeneca embarked on an innovative global public-private partnership to tackle the burden of HIV and hypertension primarily among men in Africa. The partnership uses hypertension as a stigma-free entry point to find and reach those who need HIV services by integrating hypertension services into existing HIV platforms. It is expanding access to HIV/AIDS and hypertension services by offering them in an integrated manner at existing PEPFAR-supported HIV/AIDS sites, beginning in Kenya.8
At the foundation of the partnership is a shared commitment to reaching those outside of the traditional entry points to care, with a particular emphasis on men. The collaboration is designed to leverage PEPFAR’s sizable patient reach, and HHA’s access to hard-to-reach populations, to bring better care to those in need.8
HHA has identified new strategies for bringing hard-to-reach populations into hypertension care, including men from 25 – 50 years of age who are also a difficult population to engage for HIV care,8,9and HHA’s model presents a natural opportunity for partnership with PEPFAR to improve HIV care in the same population.
Initial pilot projects ran in Homabay and Kisumu Counties8, and the latest PEPFAR partnership project is being implemented in Bungoma County, Western by the Academic Model Providing Access to Healthcare (AMPATH) Kenya. As the Government of Kenya is also a key partner for both AstraZeneca and PEPFAR through existing initiatives, we are working closely together to contribute to both the HIV and NCD programming priorities of the country.8
Healthy Heart Africa in Ethiopia
After the success of the HHA programme in Kenya, AstraZeneca developed a partnership with the Federal Ministry of Health in Ethiopia in February 2016 to integrate HHA programming into the Ethiopian healthcare system in support of the Government of Ethiopia’s National Strategic Action Plan for Non-Communicable Diseases10. The HHA partnership in Ethiopia is designed to provide the same elements that have been successful in Kenya while ensuring their appropriate adoption to meet the needs of the Ethiopian healthcare system by utilising the Government’s extensive Health Extension Programme to bring care closer to the community.
The goal for the Ethiopia-HHA partnership is to address the growing burden of hypertension, through decentralising and scaling up high-quality hypertension care and treatment in health facilities across Ethiopia. Population Services International (PSI) in Ethiopia is the HHA implementing partner.
Healthy Heart Africa in Tanzania
In June 2018, AstraZeneca unveiled a partnership with the Ministry of Health Community Development, Gender, Elderly and Children and the Touch Foundation to spearhead implementation of the HHA programme in Tanzania, in support of the Government of Tanzania's Strategic Action Plan for the Prevention and Control of Non-Communicable Diseases.
The goal of the Tanzania-HHA partnership is primarily to improve the capacity of the Tanzanian health system to address the burden of hypertension in pregnant and postpartum women, by strengthening the health workforce and enhancing maternal patient pathways. The programme aims to train 350 health workers on hypertension care modules, as well as to screen 1,800 health workers and 50,000 pregnant women over a three-year period, directing them, if needed, for required treatment11.
Healthy Heart Africa in Ghana
In July 2019, AstraZeneca expanded the HHA programme into Ghana in partnership with the Ghana Health Service. The partnership seeks to contribute to the prevention and control of cardiovascular diseases (CVD) in Ghana with emphasis on hypertension. Although hypertension is a rising problem in Ghana, knowledge of the prevalence, awareness, treatment and control at the national level is limited12. PATH International in Ghana is the HHA implementing partner.
Healthy Heart Africa in Uganda
In May 2020, Uganda became the fifth African country to participate in AstraZeneca’s HHA programme. In collaboration with the Ugandan Ministry of Health (MoH) and the Uganda Protestant Medical Bureau (UPMB), the partnership aims to strengthen the provision of services for managing and preventing hypertension, using MoH guidelines to standardise care and upskilling health workers through training. It will also work to increase education and awareness of high blood pressure and lifestyle risk factors for CVD. Uganda has a high burden of undiagnosed and uncontrolled blood pressure, with the prevalence of hypertension and pre-hypertension estimated to affect 24% and 37% of the population, respectively.13,14 The programme in Uganda will also screen for respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and asthma, a significant burden on low and middle-income countries.15
Our Implementing Partners
Hypertension – the facts
Hypertension – also known as high blood pressure – is an entry point for addressing the growing NCD burden across Africa.16
- Hypertension is associated with an increased risk of cardiovascular disease (CVD).17
- In 2015, an estimated 37% of 17 million premature deaths (under the age of 70) were due to CVDs.18
- By 2025,150 million adults are expected to be living with high blood pressure in Sub-Saharan Africa.2
- NCDs are projected to become the most common cause of death in Africa by 2030, exceeding the mortality burden of communicable diseases, nutritional diseases and maternal and perinatal deaths.19
- At present a person in Africa, aged 30–70 years, has a 20.7% chance of dying from one of the major NCDs (chronic lung disease, CVD, diabetes and cancer).20
1. AstraZeneca data on file. Total Programme Numbers Since Start – as at 31 August 2020.
2. Van de Vijver S, Akinyi H, Oti S, et al. Status report on hypertension in Africa: Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD’s. Pan African Med J. 2013;16:38. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932118/pdf/PAMJ-16-38.pdf Last accessed October 2020.
3. Kenya National Strategy for the Prevention and Control Of Non-Communicable Diseases. Available at: https://extranet.who.int/nutrition/gina/sites/default/files/KEN-2015-NCDs.pdf Last accessed October 2020.
4. The World Bank. The Challenge of NCDs and Road Traffic Injuries in SSA: an Overview. Available at: https://ncdalliance.org/sites/default/files/The%20Challenge%20of%20Non-Communicable%20Diseases%20and%20Road%20Traffic%20Injuries%20in%20Sub-Saharan%20Africa%20-%20AN%20OVERVIEW.pdf Last accessed October 2020.
5. Kenya National Strategy for the Prevention and Control of Non-Communicable Diseases. Available at: https://extranet.who.int/nutrition/gina/sites/default/files/KEN-2015-NCDs.pdf Last accessed October 2020.
6. F. Temu et al. Integration of non-communicable diseases in health care: tackling the double burden of disease in African settings. Pan Afr Med J. 2014; 18:202. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237574/pdf/PAMJ-18-202.pdf Last accessed October 2020.
7. Business Daily. Kenya can also achieve quality healthcare goal. October 2013. Available at: http://www.businessdailyafrica.com/analysis/Kenya-can-also-achieve-quality-healthcare-goal/539548-2055302-axtjy2z/index.html Last accessed October 2020.
8. AstraZeneca. PEPFAR and AstraZeneca launch partnership across HIV and hypertension services in Africa. 8 September 2016. Available at: https://www.astrazeneca.com/media-centre/press-releases/2016/pepfar-and-astrazeneca-launch-partnership-across-hiv-and-hypertension-services-in-africa-080920161.html# Last accessed October 2020.
9. Nglazi M, van Schaik N, Kranzer K, Lawn S, Wood R, Bekker L. An Incentivized HIV Counseling and Testing Program Targeting Hard-to-Reach Unemployed Men in Cape Town, South Africa. J Acquir Immun Defic Syndr. 2012;59:e28-e34. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801093/ Last accessed October 2020.
10. International Cancer Control Partnership. Federal Democratic Republic of Ethiopia, Ministry of Health. National Strategic Plan (NSAP) for Prevention & Control of Non-Communicable Diseases in Ethiopia. https://www.iccp-portal.org/system/files/plans/ETH_B3_National%20Strategic%20Action%20Plan%20%28NSAP%29%20for%20Prevention%20and%20Control%20of%20Non-Communicable%20Diseases%20-%20Final.pdf Last accessed October 2020.
11. Touch Foundation. Non-Communicable Diseases. https://touchfoundation.org/our-work/non-communicable-diseases/ Last accessed October 2020.
12. Sanuade OA, Boatemaa S, Kushitor MK (2018) Hypertension prevalence, awareness, treatment and control in Ghanaian population: Evidence from the Ghana demographic and health survey. PLoS ONE 13(11): e0205985. https://doi.org/10.1371/journal.pone.0205985 Last accessed October 2020.
13. WHO. Uganda STEPwise Report. Available at: https://www.who.int/ncds/surveillance/steps/Uganda_2014_STEPS_Report.pdf Last accessed October 2020.
14. Plos One Journal. The Epidemiology of Hypertension in Uganda: Findings from the National Non-Communicable Diseases Risk Factor Survey. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138991 Last accessed October 2020.
15. Van Gemert, F., van der Molen, T., Jones, R. et al. The impact of asthma and COPD in sub-Saharan Africa. Prim Care Respir J 20, 240–248 (2011). https://doi.org/10.4104/pcrj.2011.00027. Last accessed October 2020
16. Musinguzi G, Bastiaens H, Wanyenze R, et al. Capacity of health facilities to manage hypertension in Mukono and Buikwe districts in Uganda: challenges and recommendations. PLoS One. 2015;10:e0142312.
17. World Heart Federation. Risk Factors: Cardiovascular Risk Factors. Available at: https://www.world-heart-federation.org/resources/risk-factors/ Last accessed October 2020.
18. World Health Organization. Cardiovascular Diseases. Available at: http://afro.who.int/health-topics/cardiovascular-diseases Last accessed October 2020.
19. World Health Organization. Global status report on non-communicable diseases 2010. Available at: http://www.who.int/nmh/publications/ncd_report_full_en.pdf. Last accessed October 2020.
20. World Health Organization. The State of Health in the WHO African Region. Available at: https://afro.who.int/sites/default/files/2018-08/State%20of%20health%20in%20the%20African%20Region.pdf Last accessed October 2020.
Veeva ID: Z4-27809
Date of preparation: October 2020
Date of expiry: October 2022