Consultant for Cardiac Surgery in Africa Report

Background

Cardiac surgery is an essential health service to address priority conditions affecting children in Africa such as congenital and rheumatic heart disease. Cardiac surgery has developed substantially in some North African countries and in South Africa. Additionally, many countries on the continent have established facilities for cardiac surgery. At most of these facilities, however, surgical volumes remain low, costs are high, and operative outcomes are uncertain. Some patients either seek care abroad independently or are referred for surgery abroad using very limited public funds. Most people on the continent who need cardiac surgery die without diagnosis or treatment. Issues that have been previously identified include a lack of adequate case-finding, financing for surgery, and follow-up systems. In contrast with South Asia, there are few examples of low-cost, high-volume, high-quality surgery.

One initiative that is expected to increase demand and financing for cardiac surgery in Africa is PEN-Plus. PEN-Plus—the Package of Essential Noncommunicable Disease (NCD) Interventions – Plus—is a strategy to decentralize access to echocardiography and anticoagulation management in rural areas by training mid-level providers at first-level hospitals to address a set of severe chronic NCDs such as heart failure, type 1 diabetes, and sickle cell disease.[1] In August 2022, all 47 countries of WHO’s African Region adopted a resolution and strategy to achieve high levels of PEN-Plus coverage by the end of the decade. PEN-Plus is expected to increase demand and financing for cardiac surgery by identifying patients with advanced cardiac disease in rural and remote areas and generating humanitarian financing through the NCDI Poverty Network’s PEN-Plus Partnership. The Center for Integration Science in Global Health Equity at Harvard’s Brigham and Women’s Hospital serves as the co-secretariat for the Network, together with the Universidade Eduardo Mondlane in Mozambique.

Now is an excellent time to concentrate efforts on improving the state of cardiac surgery in Africa. Previously identified opportunities have included regionalization and pooled/coordinated procurement to increase surgical volumes, reduce costs, and ensure good outcomes. However, there has not been sustained movement on these ideas.

The Africa CDC is well positioned to lead coordination of cardiac surgical efforts on the continent given its relationship to heads of state and its ability to engage experienced North and South-African cardiac surgical centers.

A first step toward the goal of engaging the Africa CDC in regional cardiac surgery efforts would be to produce a report that takes stock of existing knowledge and proposes recommendations for future action.

Objectives

The goal of this project is to produce a report assessing the current state of cardiac surgery in Africa and opportunities for improvement. The report will compile and assess existing efforts and existing knowledge of the state of the cardiac surgery landscape in Africa. Recommendations issued from this exercise would reflect what the Africa CDC could be doing in this space. The final report could be shared with stakeholders who have an interest in cardiac surgery programs in Africa and opportunities for central financing to implement them.

Key Deliverables

• A report of approximately 10,000 words on the cardiac surgery situation in Africa, with recommendations for the Africa CDC.

• Depending on the resources required to execute this deliverable, an investment case could be produced for coordinated action on cardiac surgery in Africa.

Expected Outcomes

The expected report will provide an up-to-date summary regarding existing information about the state of cardiac surgery, highlight gaps that could benefit from additional research, and identify promising areas where work by the Africa CDC could provide unique and added value. The report will also bring together the African cardiovascular community and be disseminated widely to member states.

Timeline

The report is expected to be completed in 18 months, beginning in February 2024. The timeline will entail three checkpoint meetings, once every six months with the CIS team to assess and provide input. The first check-in could be at the International Conference on PEN-Plus in Africa, to be held in Tanzania from April 23 to 25, 2024.

Responsibilities and Governance Structure

The Center for Integration Science will serve as the secretariat or principal body that will write the report drafts to be presented. The report co-chairs should include (1) a leading African cardiac surgeon; (2) a leading African cardiologist; and (3) a member of the Africa CDC.

Expected Deliverables of the Consultant

The Consultant will be responsible for:

• Joining and coordinating various stakeholders to collect data on the regional state of cardiac surgery

• Collaborating with various participating organizations for data collection and analysis

• Developing a methodology for the project and refining the scope for achieving the objectives of the project

• Preparing an assessment report of the key findings and trends on the state of cardiac surgery in Africa

• Developing recommendations for the Africa CDC / African Union to inform opportunities to improve the state of cardiac surgery in Africa

• Best Practices report: Creating as part of the report best practices and innovative approaches identified during the assessment of the cardiac surgery situation in Africa

• Monitoring and Evaluation Framework: Designing a framework for monitoring and evaluating activities to improve cardiac surgery in Africa, including baseline indicators

• Articles for Publication: Producing one to three articles for publication

• Dissemination Tools: Developing a dissemination plan and identifying conferences and other opportunities for sharing the report

Qualifications

• Education: Master’s degree level in public health and/or a degree in medicine

• Essential: At least five to seven years of experience in research on noncommunicable diseases, including at least one of the major severe noncommunicable diseases. Relevant experience with a successful track record in epidemiology, surveillance and/or population-based surveys, and health information management.

• Ideal: Experience with cardiac surgery policy planning in Africa

Skills/Competencies

·       Excellent communication skills, including report writing and presentation skills

·       Extensive writing and editing experience

·       Experience in global health

·       Ability to work well under pressure and meet tight deadlines

·       Strategic and creative mindset

·       Ability to build and promote partnerships across organizations

·       Commitment to ensuring an effective use of resources

·       Respect for—and promotion of—individual and cultural differences

Application Process

To apply, submit a cover letter and a CV to Arianna Wolgin at integrationscience@bwh.harvard.edu.

[1] Coates, M. M. et al. An investment case for the prevention and management of rheumatic heart disease in the African Union 2021–30: a modelling study. Lancet Global Heal 9, e957–e966 (2021). https://doi.org/10.1016/s2214-109x(21)00199-6

Photo: Professor Fastone Goma provides training on advanced electrocardiography and cardiac ultrasound at the PEN-Plus clinic in Matero, Zambia. Photo by Patrick Slavin