Health system factors influencing rheumatic heart disease prevention in nine African countries

Background: Rheumatic heart disease (RHD) is a public health concern in Africa despite prevention and treatment interventions being available. Aim: To gather stakeholders’ viewpoints on health system factors influencing the implementation of RHD interventions in African countries. Setting: Cameroon, Malawi, Namibia, Rwanda, South Africa, Sudan, Tanzania, Uganda and Zambia. Methods: Thirty-one in-depth interviews were conducted with individuals who work in or have received RHD services in any of the nine African countries to explore health system factors influencing RHD diagnosis and treatment, access to RHD surgery and policy decisions regarding RHD. The analysis followed an inductive thematic approach, coding segments of transcripts based on the research objectives and grouping codes with similar meanings into categories, which were subsequently consolidated into themes. Results: Inadequate health promotion, financial constraints, geographic distance, and limited knowledge and skills among healthcare workers hinder the diagnosis and treatment of RHD. Low health literacy, affordability, and geography reduce access to RHD surgery. The low prioritisation of RHD in health agendas, poor data collection, and the influence of international stakeholders and local politics affect health ministers’ decisions regarding RHD programs. Conclusion: Limited knowledge of RHD among healthcare workers hampers both service delivery and data collection for policymaking. Although advocacy has successfully raised RHD awareness in policy spaces, increased efforts are necessary to elevate RHD on national agendas. Contribution: These findings can support RHD programmes by providing insights into how individuals and groups at different health levels across various African countries might respond to interventions.