Consensus-based strategies to guide system-wide implementation of the World Health Assembly resolution on acute rheumatic fever and rheumatic heart disease in African countries.
1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
2
Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
3
Department of Medicine, University of Cape Town, Cape Town, South Africa
4
Office of the Vice-President, South African Medical Research Council, Cape Town, South Africa
5
Department of Paediatrics, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
6
Department of Global Health, Stellenbosch University, Cape Town, South Africa
7
Centre for Caring and Sustainable Systems, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1758
ABSTRACT
INTRODUCTION:
In 2018, the World Health Assembly adopted a resolution on rheumatic heart disease (RHD), calling for action across multiple priority areas for addressing the burden of RHD. In the absence of context-specific and system-level guidance, translating the global commitments into actionable implementation strategies remains a challenge. We developed a consensus-based set of strategies for implementing the resolution, through a strategy rating process with stakeholders across Africa.
METHODS:
We conducted a two-round, modified Delphi study, with a panel of 22 RHD stakeholders from 10 African countries. Round one assessed preferences with respect to 30 literature-derived strategies; round two reassessed strategies for which there was no consensus as well as further participant-proposed strategies. Strategies were rated using a five-point Likert scale across five categories: national prevention programmes; governance structures; surveillance systems; access to healthcare services, including primary health care (PHC) and surgical care; and access to Benzathine penicillin G (BPG). Positive consensus on inclusion of a strategy required that 80% of participants rated it a four or higher. These were then compiled into a consensus-based list.
RESULTS:
Consensus was reached on 31 strategies. Four strategies focus on national prevention programmes for RHD, with 95% supporting the integration of sore throat management into PHC. Among the three governance strategies, establishing a national advisory group received the highest support (95%). Four strategies addressed surveillance, and embedding RHD indicators into health information systems received the highest support (91%). Twelve strategies targeted healthcare access—six for PHC and six for surgery, with 100% support for PHC worker training, strengthening surgical capacity. Eight strategies centred on BPG availability, with 100% agreement on its inclusion in essential medicines lists.
CONCLUSIONS:
We present a stakeholder-informed, consensus-based set of strategies for guiding health system-wide implementation of the resolution in African countries, providing a foundation for improving RHD health outcomes.
In 2018, the World Health Assembly adopted a resolution on rheumatic heart disease (RHD), calling for action across multiple priority areas for addressing the burden of RHD. In the absence of context-specific and system-level guidance, translating the global commitments into actionable implementation strategies remains a challenge. We developed a consensus-based set of strategies for implementing the resolution, through a strategy rating process with stakeholders across Africa.
METHODS:
We conducted a two-round, modified Delphi study, with a panel of 22 RHD stakeholders from 10 African countries. Round one assessed preferences with respect to 30 literature-derived strategies; round two reassessed strategies for which there was no consensus as well as further participant-proposed strategies. Strategies were rated using a five-point Likert scale across five categories: national prevention programmes; governance structures; surveillance systems; access to healthcare services, including primary health care (PHC) and surgical care; and access to Benzathine penicillin G (BPG). Positive consensus on inclusion of a strategy required that 80% of participants rated it a four or higher. These were then compiled into a consensus-based list.
RESULTS:
Consensus was reached on 31 strategies. Four strategies focus on national prevention programmes for RHD, with 95% supporting the integration of sore throat management into PHC. Among the three governance strategies, establishing a national advisory group received the highest support (95%). Four strategies addressed surveillance, and embedding RHD indicators into health information systems received the highest support (91%). Twelve strategies targeted healthcare access—six for PHC and six for surgery, with 100% support for PHC worker training, strengthening surgical capacity. Eight strategies centred on BPG availability, with 100% agreement on its inclusion in essential medicines lists.
CONCLUSIONS:
We present a stakeholder-informed, consensus-based set of strategies for guiding health system-wide implementation of the resolution in African countries, providing a foundation for improving RHD health outcomes.
| eISSN: | 2654-1459 |
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