Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders

Abstract

Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. Results Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. Conclusions This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.

Prevalence of hypertension in Ghanaian society: a systematic review, meta-analysis, and GRADE assessment

“…This has implications for the healthcare system and calls for more innovative and impact-driven public health strategies to curb the trend [ 90 ]. Home-grown strategies that have shown promising results will need to be identified and aggressively scaled up in the general population [ 8 , 14 , 19 , 24 ]. Commonly held myths about the distribution of hypertension in the population need to be dispelled [ 32 ].…”

“…A number of factors such as positive perception of obesity, more sedentary lifestyles, excessive consumption of high-calorie diets, genetic predisposition, high intake of salt, and increasing life-expectancy have been cited for this disturbing trend [ 12 , 13 ]. Without urgent attention, the current epidemic of hypertension in the country is expected to worsen [ 14 ].…”

Management of chronic non-communicable diseases in Ghana: a qualitative study using the chronic care model

“…The conceptual framework of the present study, therefore, recognises that to support patients in dealing with the vicissitudes of living with the CNCDs, effective management should have a properly systematised healthcare delivery system [ 50 ]. The institutional challenges of poor utility supply and inadequate logistics, staffing, motivation, infrastructure, and in-service training which were realised in the present study, therefore, point to the possible deficiencies that impede the ability of the health system to effectively handle CNCDs in the country [ 53 ]. Our findings regarding the institutional challenges also resonate with a WHO report which opined that the management of CNCDs exerts great indirect and direct costs on health system budgets [ 54 ].…”

Providing Measurement, Evaluation, Accountability, and Leadership Support (MEALS) for Non-communicable Diseases Prevention in Ghana: Project Implementation Protocol

“…Locally, the government of Ghana published national NCDs prevention policies in 2012 and 2020, which recognizes the need for interventions (such as regulating the advertising of unhealthy foods and non-alcoholic beverages particularly to children) to promote healthy diets as crucial (2,29). However, given its traditional focus on addressing communicable diseases, and maternal and child health and undernutrition, existing initiatives by the health system to address NR-NCDs are nascent, limited in scope, scale, and success (23,30). Existing policies have mainly been informed by evidence from high-income countries (HICs) and have paid little attention to local evidence on the food environment.…”