Development and validation of a scorecard to monitor implementation of the World Health Assembly resolution on acute rheumatic fever and rheumatic heart disease in Africa
1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
2
Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
3
Uganda Heart Institute, Kampala, Uganda
4
Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
5
National Institute for Medical Research, Dar es Salaam, Tanzania, United Republic of
6
Non-Communicable Diseases Division, Ministry of Health, Nairobi, Kenya
7
Department of Nursing and Midwifery, The International University of Management, Windhoek, Namibia
8
Partners In Health/Abwenzi Pa za Umoyo, Neno, Malawi
9
Department of Global Health, Stellenbosch University, Cape Town, South Africa
10
Centre for Caring and Sustainable Systems, Cape Town, South Africa
11
Cochrane South Africa, The South African Medical Research Council, Cape Town, South Africa
12
Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
13
Office of the Vice-President, The South African Medical Research Council, Cape Town, South Africa
14
Department of Paediatrics, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3818
ABSTRACT
INTRODUCTION:
In May 2018, the 71st World Health Assembly adopted a resolution on acute rheumatic fever (ARF) and rheumatic heart disease (RHD), outlining five
RECOMMENDATIONS:
addressing social determinants, strengthening data collection, improving access to primary healthcare (PHC), ensuring access to essential diagnostics and medicines, and enhancing national and regional cooperation. However, standardised tools for monitoring implementation of the resolution remain limited. We aimed to develop and validate a scorecard to monitor the implementation of the resolution in African countries.
METHODS:
The scorecard was developed through sequential phases. The resolution was analysed to define its goals. Systematic literature reviews identified mechanisms to achieve these goals and effective RHD interventions aligned with them, which were used as progress indicators. The preliminary scorecard then underwent peer review to assess its utility across African contexts. Finally, content validity was evaluated by a multi-country survey among policymakers and researchers in Kenya, Malawi, Namibia, Uganda and Tanzania.
RESULTS:
The final validated scorecard comprises 18 goals, 49 outcomes, and 363 progress indicators. Indicators capture multisectoral action on social determinants across health, education, and housing, alongside governance measures of leadership, policy frameworks, and financing. Surveillance indicators include integration of RHD metrics into health information systems, establishment of hospital registers, and the implementation of screening programmes. PHC access is reflected through indicators on healthcare worker training programmes, service accessibility, affordability, and acceptability. Diagnostics and medicines are monitored through inclusion of RHD diagnostic tests and medicines in national essential medicines lists, and initiatives to improve treatment uptake. National and international cooperation is assessed through specialised training initiatives, and collaborative programmes for diagnosis, treatment, and surgical care. Content validation demonstrated high relevance across participating countries.
CONCLUSIONS:
This study presents the first scorecard operationalising the resolution, providing a context-specific tool to strengthen accountability and track national progress in RHD prevention and care.
In May 2018, the 71st World Health Assembly adopted a resolution on acute rheumatic fever (ARF) and rheumatic heart disease (RHD), outlining five
RECOMMENDATIONS:
addressing social determinants, strengthening data collection, improving access to primary healthcare (PHC), ensuring access to essential diagnostics and medicines, and enhancing national and regional cooperation. However, standardised tools for monitoring implementation of the resolution remain limited. We aimed to develop and validate a scorecard to monitor the implementation of the resolution in African countries.
METHODS:
The scorecard was developed through sequential phases. The resolution was analysed to define its goals. Systematic literature reviews identified mechanisms to achieve these goals and effective RHD interventions aligned with them, which were used as progress indicators. The preliminary scorecard then underwent peer review to assess its utility across African contexts. Finally, content validity was evaluated by a multi-country survey among policymakers and researchers in Kenya, Malawi, Namibia, Uganda and Tanzania.
RESULTS:
The final validated scorecard comprises 18 goals, 49 outcomes, and 363 progress indicators. Indicators capture multisectoral action on social determinants across health, education, and housing, alongside governance measures of leadership, policy frameworks, and financing. Surveillance indicators include integration of RHD metrics into health information systems, establishment of hospital registers, and the implementation of screening programmes. PHC access is reflected through indicators on healthcare worker training programmes, service accessibility, affordability, and acceptability. Diagnostics and medicines are monitored through inclusion of RHD diagnostic tests and medicines in national essential medicines lists, and initiatives to improve treatment uptake. National and international cooperation is assessed through specialised training initiatives, and collaborative programmes for diagnosis, treatment, and surgical care. Content validation demonstrated high relevance across participating countries.
CONCLUSIONS:
This study presents the first scorecard operationalising the resolution, providing a context-specific tool to strengthen accountability and track national progress in RHD prevention and care.
| eISSN: | 2654-1459 |
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