The Pan-African Society of Cardiology (PASCAR) in conjunction with the African Union hosted the 4th All Africa Workshop on Acute Rheumatic Fever and Rheumatic Heart Disease in Addis Ababa, Ethiopia on 4-6 March 2016. The purpose of the meeting was to assemble experts to discuss practical steps and programs to eradicate Acute Rheumatic Fever and Rheumatic Heart Disease (RHD) in Africa using the structure of the seven recommendations set forth in the African Union Communiqué adopted in 2015 and since ratified by 54 African heads of state. 

The African Union Communiqué is a formal acknowledgement of the burden of RHD on the African continent and a roadmap outlining a unified plan of action to eradicate this disease. The plan encompasses seven detailed recommendations that include methods, stakeholder identification, and milestones toward that effort.

The meeting embraced a wide range of clinicians, policy-makers, scholars, and researchers who represented nearly 20 African countries.  Long-standing players from countries such as Egypt, South Africa, Sudan, Uganda, Kenya, Namibia and Mozambique were joined by new advocates from Botswana, Niger, Zimbabwe, Angola, Senegal and Tanzania. International attendees included WHO (Geneva), WHO AFRO (Brazzaville), WHF (Geneva), RHD Action, Medtronic Foundation (Minneapolis) and Novartis/Sandoz (USA and Germany). The meeting agenda provided a platform for each country to showcase their country programmes, addressing both successes and challenges, and afterward provided opportunities for feedback, discussion and networking. 

The meeting ended with the seven objectives being laid out in a SMART framework - Specific, Measureable, Achievable, Relevant and Time-bound – using quick wins and longer-term activities that were identified during group discussions. 

The SMART-based AU Communique Objectives focus on

1. The development, promotion and dissemination of RHD registers in African countries based on the eRegister currently being developed by a team at the University of Cape Town
2. The development of a safe and efficacious supply of Benzathine penicillin (BPG) and oral penicillin starting with the establishment of an African penicillin database, and an initiative to provide training in the safe and humane administration of (injectable) BPG
3. The integration of cardiac care into reproductive health services by introducing protocols for cardiac management that include guidelines for the care of pregnant women with heart disease
4. The decentralisation of expertise, tests and management by using a successful Rwandan model where A/RF and RHD care guidelines have been integrated into the larger country-wide NCD programme guidelines
5. The development of centres of excellence for cardiac surgery, training and research by first mapping and assessing what already exists, promoting research collaborations in surgery, and finally by developing a long-term Foresight Plan for Africa (2063)
6. The development of National RHD control programmes by giving each conference participant the mandate to identify RHD Champions in their countries and to liaise directly with their Health Ministry.  The creation of a multi-sectoral RHD Task Force was used successfully in Namibia to lead to the implementation of an RHD Country Control Programme.  Participating countries were encouraged to use this model to bring RHD to the attention of the ministerial level for action.  
7. The strengthening of existing partnerships and the development of new partnerships to promote the AU Communiqué more widely in Africa.  This strategy includes hiring a communications specialist to manage outreach and linkages, consolidating partnerships related to training, research and acute needs, and the preparation of a costed implementation plan.  

A team leader was assigned for each objective. Each of these team leaders is now a member of the PASCAR RHD Task Force who will undertake to produce a meeting report, refine the implementation plan and achieve “quick wins” by producing technical papers to serve as pillars to anchor advocacy and other work.    

The initiative to eradicate RHD on the African continent has come a long way since the Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa back in 2005. The dedicated core group from that meeting 11 years ago is still relatively intact, and now enjoys added momentum with the addition of new faces with new energy, resources and ideas, bringing the end of RHD into closer view.

For further information:
Health policy: Reducing rheumatic heart disease in Africa — time for action (Nature Reviews Cardiology)
African Union - Press Release
World Heart Federation
Modern Ghana