Table 7 Ongoing challenges in existing hypertension programs and corresponding solutions.
From: A simple six-step guide to National-Scale Hypertension Control Program implementation
Step | Challenge | Solution |
---|---|---|
1→ Establishing administrative structure | • Transitioning from donor-funded program to government-owned program. | • Jointly implement program with ministry of health from program start. • Develop a transition plan that considers roles, responsibilities, and budgeting for products and services long-term. |
2 → Treatment protocols | • Converging on a universal treatment protocol. | • Build evidence for treatment protocols through demonstration programs. |
3→ Medications and BP devices | • Medication stock-outs • Limited uptake of fixed dose combination medications. • Variable medication quality and affordability • Lack of availability of validated BP devices. • Poor awareness among providers and program managers of the importance of BP device validation. • High cost of BP devices. | • Market shaping to reduce prices of fixed dose combination antihypertensive medications. • Strengthen procurement and supply chains in LMICs. • Build capacity of ministry of health staff to forecast medication supply needs. • Advocate for reduced out-of-pocket medication fees for patients • Advocate for coverage of NCD medications and services under national health insurance schemes. |
4→ Training of health care workers and supervision | • Learnings from training not being implemented or sustained. • Need for frequent trainings due to frequent turnover of staff. | • Assess the impact of training and areas for improvement. • Conduct refresher training. • Provide ongoing clinical mentorship. • Expand training to include community health workers, patient champions, and community-based providers. |
5→ Information systems | • Lack of electronic health records • Limited use of data for program improvement. | • Government investment in electronic health records. • Build capacity for continuous quality improvement utilizing program data. • Include key hypertension control indicators in program reviews at national/subnational levels. |
6→ Enroll patients and pilot | • Transitioning from pilot projects to scale-up. • Lack of human resources for scale-up. | • Scale-up team-based care through capacity building of existing health care workers and training new cadres of health care workers. • Roll-out packages of differentiated service delivery specific to location context. • Government investment in hypertension care. |