Abstract P119: Gap Between Need and Supply for Hypertension Care in Low- and Middle-Income Countries

Abstract

Background: The ‘Resolve to Saves Lives’ initiative aims to save 100 millions lives, in part by improving hypertension control. Since only physicians can prescribe antihypertensive medication in most countries, the scalability of such an initiative will depend on physician capacity. We estimated the # of physician visits needed by hypertensive patients and available capacity in the 20 LMICs with the highest # of hypertensive patients. Methods: Total # of physicians and hypertensive patients were estimated using data from World Bank and World Health Organization (WHO). We estimated a) 3 visits/patient/yr; b) total available visits by physicians in a lower capacity scenario (5000 visits/physician/year) and higher capacity scenario (10000 visits/physician/year); c) physicians could spend 10% of total visits on hypertension care. Results: The Table summarizes need and supply (capacity) of physician visits for hypertension care. In the lower and higher capacity scenarios, 50% and 25% of those countries have a deficit of visits for hypertension care, respectively. Indonesia, Bangladesh, Ethiopia, Thailand, and Congo have a deficit in both scenarios. India has the highest deficit in lower capacity scenario. Indonesia has the highest deficit in higher capacity scenario. Conclusion: The gap between supply and need for physician visits to manage hypertension is substantial in several large LMICs. Even in countries without national-level deficit, substantial intra-country deficits may exist due to patient-physician mismatch in urban-rural areas. Options to fill this gap include increasing # of physicians, increasing fraction of physician time for hypertension care, or task sharing with, e.g., nurses and community health workers. Of these, task sharing seems most practical.