Adapting a nurse-led primary care initiative to cardiovascular disease control in Ghana: a qualitative study

Leah A Haykin,Edith Dambayi,Denis Awuni,Jordan A Francke,Raymond Aborigo,David J Heller,Aurelia Abapali,Abraham R Oduro,James F Phillips,Elliasu Yakubu,Ayaga A Bawah,Engelbert A Nonterah,Elizabeth F Jackson

doi:10.1186/s12889-020-08529-4

Abstract

BackgroundCardiovascular Disease (CVD) is a growing cause of morbidity and mortality in Ghana, where rural primary health care is provided mainly by the Community-based Health Planning and Services (CHPS) initiative. CHPS locates nurses in community-level clinics for basic curative and preventive health services and provides home and outreach services. But CHPS currently lacks capacity to screen for or treat CVD and its risk factors.MethodsIn two rural districts, we conducted in-depth interviews with 21 nurses and 10 nurse supervisors to identify factors constraining or facilitating CVD screening and treatment. Audio recordings were transcribed, coded for content, and analyzed for key themes.ResultsRespondents emphasized three themes: community demand for CVD care; community access to CVD care; and provider capacity to render CVD care. Nurses and supervisors noted that community members were often unaware of CVD, despite high reported prevalence of risk factors. Community members were unable to travel for care or afford treatment once diagnosed. Nurses lacked relevant training and medications for treating conditions such as hypertension. Respondents recognized the importance of CVD care, expressed interest in acquiring further training, and emphasized the need to improve ancillary support for primary care operations.ConclusionsCHPS staff expressed multiple constraints to CVD care, but also cited actions to address them: CVD-focused training, provision of essential equipment and pharmaceuticals, community education campaigns, and referral and outreach transportation equipment. Results attest to the need for trial of these interventions to assess their impact on CVD risk factors such as hypertension, depression, and alcohol abuse.

Highlights

Cardiovascular Disease (CVD) is a growing cause of morbidity and mortality in Ghana, where rural primary health care is provided mainly by the Community-based Health Planning and Services (CHPS) initiative
Study design and theoretical framework This qualitative research is a component of a mixedmethods implementation science study that aims to develop a protocol for leveraging CHPS nurses to provide CVD care through the World Health Organization (WHO)-Package of Essential Non-Communicable Disease Interventions (PEN) protocol
Community member engagement barriers to CVD care This theme refers to challenges Non-physician health worker (NPHW) face with rendering CVD care

Summary

Introduction

Cardiovascular Disease (CVD) is a growing cause of morbidity and mortality in Ghana, where rural primary health care is provided mainly by the Community-based Health Planning and Services (CHPS) initiative. In 2013, the WHO released a Global Action Plan for the Prevention and Control of NCDs, with a goal to achieve a 25% relative reduction in worldwide premature mortality from the estimated prevalence of NCDs in 2013 by 2025, via six action objectives [14]. Objective 4 of this Global Action Plan calls for adapting existing health systems by improving NCD primary health care prevention and services. The WHO released the HEARTS intervention package in 2016, which builds on WHO-PEN by detailing cost-effective interventions to prevent and treat CVD and its risk factors using community-based primary health workers [15, 16]

Methods

Results

Conclusion