Table 2

Action should involve all stakeholders (sections of ‘the bridge’)

StakeholdersExamples of actions and roles required to control CVD
PatientsEvidence-based cardiovascular health information/tips, educational materials, self-efficacy tools to be made available through novel multiple friendly channels to patients to enable them take, seek and evaluate appropriate preventive, therapeutic and restorative actions.
ProvidersHigh-level translatable customised recommendations to be made available/accessible to clinicians, physicians, pharmacists and other medical and paramedical personnel in LMICs using multipronged novel-friendly channels. Development of task-redistribution approaches. Training and capacity building. This will enable them to be aware of and implement such recommendations in eligible patients.
PopulaceUsing several novel channels, media, forums and community resources to engage the entire general populace across the lifespan about the burden, prevention and other interventions for the entire spectrum of CVDs (Cardiovascular Cascade) from ideal cardiovascular health to cardiovascular death. This includes population level screening for CVD and CVD risk factors and awareness campaigns in communities, schools, workplaces, places of worship, webspace, etc. This will enable them take, seek and evaluate appropriate preventive, therapeutic and restorative actions.
PolicymakersCollection and synthesis of the best available global and local evidence to produce evidence briefs for policy as the primary input into structured deliberate dialogues with the policymakers. Engagement of all layers/grades of policymakers using novel channels. This will enable them to provide relevant infrastructure, medications, facilities and equipment, develop evidence-based translatable policies and performance indicators and formulate policy networks and peer-review mechanisms for policy implementation.
PayersEngagement of payers to support the implementation of high-level recommendations with relevant resources. Discounts, subsidies, supplementation, local manufacture of generic products and donations could improve access to medications and devices.
PartnersNo single organisation can combat the CVD epidemic alone. It is inevitable to establish and nurture a broad-based synergistic system of collaborations among the implementation partners including:
  1. Researchers and research institutions to identify and resolve research gaps, set research agenda/priorities, along the entire cardiovascular cascade and cardiovascular quadrangle (epidemiological surveillance; primordial/primary/secondary prevention; acute/hyperacute intervention; and rehabilitation/reintegration).

  2. Relevant national, regional and global professional bodies to engage and learn from each other and interact with other implementation partners and stakeholders to develop and implement best interventions to combat CVDs in LMICs eg, World Hypertension League, International Society of Hypertension, Nigerian Stroke Society, World Federation for Neurorehabilitation, National Medical Associations, American Heart Association, European Academy of Neurology, American Society of Hypertension, European Hypertension Society, American Academy of Neurology, International Academy Medical Panel, NICE, World Stroke Organization, World Federation of Neurology, Pan-African Society of Cardiology, Indian Stroke Association, Chinese Society of Neurology, H3Africa CVD Consortium, societies relevant for ethical, legal social and policy-related issues as well as agricultural/pharmaceutical sector with influence on availability of healthy food and cost-effective drugs, Global Burden of Disease expert group, the Non Communicable Diseases Risk factor Collaboration (NCD-RiSC) consortium, etc.

  3. Relevant governmental and intergovernmental agencies (to set, facilitate, implement and evaluate a global agenda for the control of CVD in LMICs) eg, Federal and State Ministries of Health, WHO, African Union, NEPAD, European Union, European Commission, World Health Summit, G7, G20, World Bank, African Development Bank, National Health Research Councils, United Nations, National Institute of Health (USA), NHLBI, Medical Research Councils (UK, South Africa, etc), CIHR, ICMR, CAMS, INCMNSZ, NHMRC, Welcome Trust, and other funding agencies.

  4. Relevant non-governmental organisations and private sector eg, mobile phone companies which may offer free or subsidised text messaging platforms, film industries which may support applied theatre techniques (Bollywood, Nollywood, Hollywood, etc), philanthropic organisations (eg, Bill Gates Foundation, Dangote Foundation, etc), pharmaceutical and medical supplies companies may provide medications and materials at lower costs for LMICs as part of their social responsibility, print and electronic media houses: to support health awareness programmes in LMICs.

  5. Advocates and ambassadors: Volunteering individuals and groups, opinion leaders, professional, faith-based, community and political leaders who are affected by CVD or whose close relations are affected by CVD to advocate for control of CVDs.

  6. GACD-COUNCIL: The GACD is the first alliance of the world's biggest public research funding agencies, which currently is funding 15 hypertension and 16 diabetes implementation science projects in LMICs. The overall goal of GACD is ‘to tackle the burden of chronic non-communicable diseases in LMICs, by systematically building the evidence base for sound policymaking, as guided by global experts on NCDs’. In furtherance of this objective, COUNCIL initiative with the GACD (GACD-COUNCIL), a mega-consortium of global experts in CVDs, is poised to systematically develop an implementation pipeline that will stimulate, absorb, critically appraise and translate available and accruing evidence into pragmatic guidelines, policies and interventional practices using efficient, novel, interactive and multidirectional channels to reach all stakeholders. The GACD COUNCIL is poised to coordinate and facilitate the collaborations involving ‘A’ to ‘E’ above.

  • CAMS, Chinese Academy of Medical Sciences; CIHR, Canadian Institutes of Health Research; COUNCIL, COntrol UNique to Cardiovascular diseases In LMICs; CVD, cardiovascular disease; GACD, Global Alliance for Chronic Diseases; ICMR, Indian Council of Medical Research; INCMNSZ, National Institute of Medical Science and Nutrition Salvador Zubiran; LMICs, low and middle income countries; NHMRC, National Health and Medical Research Council; NICE, National Institute for health and Care Excellence. NCD-RiSC, Non-Communicable Disease Risk Factor Collaboration; NCDs, Non-Communicable Diseases; NEPAD, The New Partnership for Africa's Development; NHLBI, National Heart, Lung, and Blood Institute.