Equitable Cardiovascular Prevention in South Africa: Decision-Maker Perspectives on Cardiovascular Polypills
1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
2
Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
3
Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
4
Office of the President, South African Medical Research Council, Cape Town, South Africa
5
Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
6
Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2953
ABSTRACT
BACKGROUND:
Non-communicable diseases (NCDs), particularly cardiovascular disease (CVD), are a leading cause of premature mortality globally, disproportionately affecting low- and middle-income countries (LMICs). Fixed-dose combination therapies, including cardiovascular (CV) polypills, improve adherence and reduce major adverse cardiovascular events; however, despite inclusion on the World Health Organization Essential Medicines List, equitable uptake remains limited, especially in sub-Saharan Africa.
METHODS:
We conducted a qualitative study exploring stakeholder perspectives on the feasibility, acceptability, and policy pathways for implementing cardiovascular (CV) polypills in South African primary care. Semi-structured interviews were conducted with 15 purposively sampled stakeholders from clinical, policy, regulatory, funding, and advocacy sectors. Data were analysed thematically using a reflexive approach to identify system-level enablers, barriers, and equity considerations shaping implementation.
RESULTS:
Stakeholders broadly recognised the potential of CV polypills to simplify treatment, improve adherence, and strengthen population-level prevention. However, uptake was perceived to be constrained by regulatory complexity, limited commercial incentives, fragmented policy leadership, inequitable access between public and private sectors, and insufficient locally generated evidence. Pharmacological strategies were consistently viewed as complementary to broader prevention approaches, including risk screening, lifestyle interventions, and continuity of care. Single-pill antihypertensive combinations were frequently identified as a pragmatic entry point for scale-up within public sector systems. Participants emphasised the need for strong government leadership, coordinated advocacy, and market-shaping procurement mechanisms to achieve equitable access.
CONCLUSIONS:
Cardiovascular polypills offer a promising and potentially scalable approach to reducing CVD inequities in LMICs. However, their real-world impact is likely to depend on context-sensitive policy alignment, enabling regulatory pathways, and continued investment in health systems. Generating locally relevant clinical and economic evidence, along with coordinated multisectoral action, may be critical to integrate fixed-dose combination therapies within equitable and sustainable NCD strategies.
Non-communicable diseases (NCDs), particularly cardiovascular disease (CVD), are a leading cause of premature mortality globally, disproportionately affecting low- and middle-income countries (LMICs). Fixed-dose combination therapies, including cardiovascular (CV) polypills, improve adherence and reduce major adverse cardiovascular events; however, despite inclusion on the World Health Organization Essential Medicines List, equitable uptake remains limited, especially in sub-Saharan Africa.
METHODS:
We conducted a qualitative study exploring stakeholder perspectives on the feasibility, acceptability, and policy pathways for implementing cardiovascular (CV) polypills in South African primary care. Semi-structured interviews were conducted with 15 purposively sampled stakeholders from clinical, policy, regulatory, funding, and advocacy sectors. Data were analysed thematically using a reflexive approach to identify system-level enablers, barriers, and equity considerations shaping implementation.
RESULTS:
Stakeholders broadly recognised the potential of CV polypills to simplify treatment, improve adherence, and strengthen population-level prevention. However, uptake was perceived to be constrained by regulatory complexity, limited commercial incentives, fragmented policy leadership, inequitable access between public and private sectors, and insufficient locally generated evidence. Pharmacological strategies were consistently viewed as complementary to broader prevention approaches, including risk screening, lifestyle interventions, and continuity of care. Single-pill antihypertensive combinations were frequently identified as a pragmatic entry point for scale-up within public sector systems. Participants emphasised the need for strong government leadership, coordinated advocacy, and market-shaping procurement mechanisms to achieve equitable access.
CONCLUSIONS:
Cardiovascular polypills offer a promising and potentially scalable approach to reducing CVD inequities in LMICs. However, their real-world impact is likely to depend on context-sensitive policy alignment, enabling regulatory pathways, and continued investment in health systems. Generating locally relevant clinical and economic evidence, along with coordinated multisectoral action, may be critical to integrate fixed-dose combination therapies within equitable and sustainable NCD strategies.
| eISSN: | 2654-1459 |
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