Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases

Abstract

Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on ‘lessons learnt ’ throughout the implementation process and ‘design to implementation’ changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.

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

“…CHPS' current infrastructure struggles to provide the 23 medications that HEARTS considers essential for primary care CVD interventions [16], in large part due to lack of timely reimbursement by the NHIS; furthermore, CHOs are prohibited from prescribing them when available. However, CHOs expressed confidence in their capacity to prescribe and monitor patients taking these medications, consistent with evidence from other contexts that nurses can safely render such care [66,67,68,69]. Abdel-All et al (2017) found that training was effective in raising pre-training scores in assessments of knowledge about CVD, with moderate decline in scores six to eight months post-training, which could be minimized with refresher trainings [66].…”

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

“…CHPS' current infrastructure struggles to provide the 23 medications that HEARTS considers essential for primary care CVD interventions [16], in large part due to lack of timely reimbursement by the NHIS; furthermore, CHOs are prohibited from prescribing these medications when available. However, CHOs expressed confidence in their capacity to prescribe and monitor patients taking these medications, consistent with evidence from other contexts that nurses can safely render such care [51,52,53,54]. Abdel-All et al (2017) found that training was effective in raising pre-training scores in assessments of knowledge about CVD, with moderate decline in scores six to eight months posttraining, which could be minimized with refresher trainings [51].…”

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

“…CHPS' current infrastructure struggles to provide the 23 medications that HEARTS considers essential for primary care CVD interventions [16], in large part due to lack of timely reimbursement by the NHIS; furthermore, CHOs are prohibited from prescribing them when available. However, CHOs expressed confidence in their capacity to prescribe and monitor patients taking these medications, consistent with evidence from other contexts that nurses can safely render such care [66,67,68,69]. Abdel-All et al (2017) found that training was effective in raising pre-training scores in assessments of knowledge about CVD, with moderate decline in scores six to eight months post-training, which could be minimized with refresher trainings [66].…”