MISMATCH BETWEEN AVAILABLE CAPACITY AND ESTIMATED NUMBER OF PHYSICIAN VISITS NEEDED FOR HYPERTENSION CARE: AN ANALYSIS OF WORLDWIDE DATA

Abstract

Objective: In most countries, only physicians are allowed to prescribe antihypertensive medication. Thus physician capacity (number of clinic visits physicians can allocate for hypertension care) is a key determinant of hypertension control. The objective of this study is to estimate the gap in clinic visits between available visit capacity and number of visits needed for hypertension care worldwide. Design and method: Data from the Global Health Observatory of World Health Organization and the World Bank were used to calculate the total number of hypertensive patients in each country. We assumed that the average physician would have 5,000 clinic visits/year and patients with hypertension require at least three visits a year. The gap in clinic visits between available capacity and patient need was calculated for each country. The analysis was further stratified based on income group according to the World Bank classification. Results: We estimated that 67 countries do not have the capacity to provide at least three visits to each hypertensive patient (countries in light to dark orange/red in Figure). Most of those countries are in Sub-Sharan Africa (63%), East Asia and Pacific (16%) and South Asia (9%), and all are in lower middle income or low-income countries. Of these countries, 38 countries cannot provide even a single visit to a hypertensive patient. On the other hand, 98% of high-income countries and 77% of upper-middle-income countries have the capacity to provide at least three visits per patient per year. The largest gap is seen in India followed by Indonesia, Ethiopia and Bangladesh. Conclusions: There is a huge gap in clinic visits between available capacity and the estimated need for hypertension care in low and middle income countries. To fill this gap, countries will need additional physicians or more likely implement a system of task sharing with allied health workers, such as nurses and community health workers.