Building context-specific tools to act on hypertension in primary care
In Burkina Faso, around 1.5 million people have or are at high risk of heart disease. Cardiovascular disease is responsible for roughly one in three deaths, approximately 20 600 each year, more than from any other noncommunicable disease (NCD). Around one in three adults live with raised blood pressure (also known as hypertension). Yet, only about 30% of people living with the condition are treated of whom less than half have their condition under control.
Burkina Faso’s Ministry of Health has been proactive in tackling the burden of NCDs and has even gone so far as to create a directorate dedicated to working on preventing and controlling NCDs. In addition to an integrated NCD strategic plan, several national strategies have been launched, including actions on cancer, eye and oral health, mental illness and tobacco control. However, several challenges persist. These include a lack of standardized and context-specific medical protocols as well as inconsistent access to basic equipment, essential medicines and consumables needed to diagnose and manage hypertension in primary healthcare facilities. For Dr Arthur Seghda, a cardiologist at Centre Hospitalier Universitaire de Bogodogo, health worker capacity building is vital. As he elaborates:
“Learning to assess high blood pressure and a person's risk of heart attack or stroke can enable health workers to provide quality care, and behaviour change counseling to patients locally.”
Integrating NCDs into existing health services requires the right policies, guidance and training, designed with the context of the local health system in mind. In Burkina Faso, few health workers have adequate equipment to monitor individuals living with hypertension. In addition, primary care centres do not routinely assess for cardiovascular risk, a process to identify those most vulnerable and tailor their treatment, because practical guidelines for screening, diagnosing and treating heart conditions are lacking.
To address these challenges, it was necessary to adapt WHO’s global technical package to help manage cardiovascular diseases (HEARTS) to the local context. WHO worked with Burkina Faso’s Ministry of Health, in conjunction with other key partners, such as the Burkinabè Society for Cardiology, the Burkinabe Society of Internal Medicine and patient associations, to create a context-specific training manual for healthcare staff to diagnose, treat and manage hypertension. This involved equipping and training health workers in urban and rural settings to use the new tools.
The Kombissiri Health District, of the Bazèga province in the Center-Sud region of Burkina Faso, was chosen as the pilot site. In Kombissiri, almost two-thirds of outpatient consultations at the district hospital were either for hypertension or diabetes. Dr Compaoré W.A. Sandrine, a physician in the Kombissiri Health District, believes the new tools and training in the district’s health and social promotion centers will help improve care for the local community:
“Previously, managing hypertension was impossible at the local health center level. Many patients who were referred to the district hospital can be now managed in primary health centres, with any diagnosis, treatment and medication of hypertension delivered closer to home.”
Within a few months, a new protocol and training manual for the management of hypertension was developed for health care workers. Thirty-two health care workers across the Kombissiri Health District, including head nurses, midwives and maieuticians, were trained, giving them the building blocks to embed hypertension management in their health systems. Ten local primary health clinics across the Kombissiri Health District were also supplied with blood pressure monitors, blood glucose meters, weighing scales and tape measures. According to Dr Marie Emmanuelle Zouré, Director of Prevention and Control of NCDs, Ministry of Health, the pilot project is a real opportunity for Burkina Faso:
“Hypertension is the main cause of morbidity and mortality for NCDs in Burkina Faso. Improvements are already visible at the end of training we have conducted. We hope that the implementation of the hypertension protocol will happen more widely, so that the entire population of Kombissiri can benefit from better NCD care.”
As Dr Zoure hopes, work will now be undertaken to further strengthen and standardize hypertension care across primary care services, including scaling care to other health districts. This will include setting up data collection systems to capture data on NCD management in primary care. Looking forward, to make sure the tools and training remain helpful and effective, the team will continue to work with those 32 trained nurses and midwives to learn from their experiences.
Photo Credit: © Ministry of Health Burkina Faso
Photo Caption: Dr Arthur Seghda demonstrating blood pressure measurement with a patient during hypertension training