and Abstract The burden of disease in sub-Saharan Africa is shifting rapidly towards non-communicable disease (NCD), of which cardiovascular disease (CVD) is the leading cause and hypertension the leading risk factor. A validated package of interventions for hypertension control and cardiovascular disease prevention exists, and has been piloted in select regions of Africa. However, the potential impact of this program on disease burden across populations remains unclear, because the sustainability of its implementation within established health systems remains unknown. We therefore propose to develop a pilot hypertension and CVD prevention program, based on the cardiovascular disease elements of the World Health Organization's Package for Essential Noncommunicable Disease (PEN-NCD) protocol [1,2], to successfully screen, diagnose, and control hypertension and other CVD risk factors as an element of the Community-Based Health Planning and Service (CHPS) program in Northern Ghana. We will develop and refine this approach based on the health beliefs of local communities, and the locally available health system building blocks, such as community health workers, outreach volunteers, and basic medication kits. Our research plan involves three phases. First, we will use multiple-decrement quantitative analyses, chart review and audits, structured provider observations, and provider written exams, to evaluate the capacity of CHPS' existing hypertension surveillance, screening, referral, and treatment programs. Second, we will use focus groups and structured interviews to identify gaps in this infrastructure and barriers to care. We will aim to identify barriers to hypertension care across health system building blocks. Third, we will use focus groups and structured interviews to identify solutions to identified barriers, which we will evaluate via structured observation of pilot test programs This analysis will aim to generate a complete pilot intervention to address hypertension and cardiovascular disease, based on WHO guidelines but adapted (in terms of use of health worker training; medication use; patient tracking; and all aspects of the health system) to the Navrongo context as delineated in the first two phases above. Our work will improve capacity for NCD care in sub-Saharan Africa in three ways. First, it will permit more accurate disease surveillance in a context in which even the extent of disease burden (let alone its root causes and means for control) remains a matter of debate. Second, it will generate a pilot regimen to determine whether a CHW-led primary care package can effectively help control the large and growing tide of preventable CVD in Ghana, a process that could lead to its implementation across the country. Thirdly, it will suggest the processes by which NCD programs such as WHO-PEN require modification across health systems, and hence how this program could be implemented nationwide across other contexts in Africa and developing countries.
This project proposes using mixed-method contextual and implementation science research to generate a pilot program for leveraging a validated nationwide community health prevention and treatment program for hypertension and CVD screening and control. By identifying barriers and solutions to implementing such a program, it will generate crucial data on whether and how programs for CVD and other NCDs can be adapted to the resources and community needs of local and national primary health systems.
| Heller, David J; Kishore, Sandeep P (2017) Closing the blood pressure gap: an affordable proposal to save lives worldwide. BMJ Glob Health 2:e000429 |
