Register based programs for RHD control have been recommended by the World Health Organization and World Heart Federation for many years. In reality, most programs are more than a register – they include efforts to treat sore throats, educate communities, arrange antibiotic supplies and treat the complications of advanced RHD. These programs are called ‘comprehensive’ because they include primary, secondary and tertiary components.  Comprehensive control programs require robust health systems.

Health systems are critical determinants of RHD control. Policy makers, program managers and administrative staff working within these systems are essential for delivering preventative and therapeutic care to people living with RHD. Governments are critical stakeholders, often are responsible for overseeing the health and education systems critical for the prevention and treatment of the disease. Government policies also have a significant impact on the primordial determinants of disease.

Successful RHD control programmes do more than simply deliver clinical care. Control programmes must interact with communities and the wider health system to provide effective prevention and treatment of RF and RHD. These collaborations are likely to be needed over many years before the burden of disease is significantly reduced. Robust programmes have a strong foundation of planning and strategy to support partnerships and deliver sustainable services.