Abstract
BackgroundUncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system.MethodsWe conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers.ResultsMajor challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor.ConclusionsThis multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach.
Highlights
Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries
Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall
The primary short-term needs within the public primary health care system identified during the needs assessment that fall within the scope of our hypertension control study were: limited availability of treatment guidelines, low level of training in hypertension prevention and care, lack of consistent reporting of hypertension in practice, and limited access to medications other than enalapril at the community level; enalapril was preferred since it is cheaper than hydrochlorothiazide
Summary
Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. Uncontrolled hypertension represents a substantial and growing health burden in Guatemala and many other low- and middle-income countries (LMICs). Especially in LMICs, lack developed programs that address non-communicable diseases (NCD). There is recognition that health systems in LMIC contexts need support to improve their capacity to deliver interventions focused on the management of NCDs [3]. The World Health Organization’s (WHO) health system building blocks framework can help define priority needs within different components of the healthcare system [4]. The six building blocks are: service delivery, human resources, medications and technologies, health information systems, financing, and governance and leadership. The building blocks provide a way of viewing the system in its entirety rather than just one component, it does not capture interactions between levels [5]
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