A Ghana Health Service nurse screens a patient for hypertension during an outreach activity.
Hypertension is a serious public health issue, with nearly one billion people across the world currently hypertensive. And the numbers are increasing every day. In Ghana, where we are based, the number of reported new cases in outpatient public health facilities increased more than tenfold between 1988 and 2007. A recent estimate of the prevalence of hypertension in Ghana was 27.3 percent.
If hypertension is identified early, it can be treated and managed to prevent life-threatening diseases such as stroke and heart failure.
In the Lower Manya Krobo, a district in the eastern region of Ghana with a population of nearly 100,000, there is a growing recognition of the increasing burden of hypertension. Unpublished 2014 data from the Lower Manya Krobo District ranked the disease as the eighth leading cause of mortality in the district, accounting for 3.8 percent of all deaths. This figure underestimates the overall impact of hypertension because it has a role as a risk factor for other, potentially fatal diseases, such as cardiac diseases, congestive heart failure and cerebrovascular disease. When combined, these conditions would rank as the leading cause of death (25.4 percent) in the district.
Raising awareness
The World Health Organization has called hypertension a silent killer, because it seldom causes symptoms. For this reason, prevention hinges on raising awareness and detecting it early.
FHI 360’s work has called attention to the prevalence of hypertension and its associated risk factors within the Lower Manya Krobo District.
An FHI 360 project conducted there between 2009 and 2012 found that more than half of clients screened at the outpatient department of a district hospital had elevated blood pressure. The project further demonstrated a low awareness of hypertension among community members, significant lapses in the knowledge and skills of health staff and a lack of relevant working tools, such as clinical guidelines and blood pressure monitors. The findings underscored the district’s need for a coordinated response to tackle the increasing burden of hypertension.
Dr. Christian Kwatchey, the physician in charge of the hypertension clinic at the district hospital noted, “We have a huge problem here. Our facilities lack the needed laboratory resources, and we have very few training opportunities. Among patients, there is a high nonadherence rate. Many tend to believe that there is a cure for hypertension. This has been worsened by the fact that in our local language there is no distinction between treatment and cure.”
A new way forward
The local knowledge gained from FHI 360’s project informed the design of a new community-based model of health care delivery that uses information and communication technologies (ICTs) to enhance the capacity of the Ghana Health Service, the private sector and individuals to control hypertension.
The model will be tested under the Community-based Hypertension Improvement Project (ComHIP), a three-year (2014-2017) collaboration between the Ghana Health Service, Novartis Foundation, FHI 360, the London School of Hygiene & Tropical Medicine, the University of Ghana School of Public Health and other institutions.
ComHIP focuses on community-level screening, hypertension management and patient and community empowerment. The core interventions include blood pressure screening and monitoring at licensed chemical sellers (private drug outlets) and community-based health planning and services compounds; improved management of hypertension with community-based diagnosis, counseling, treatment and adherence; and where needed, consultation with physicians. Patients will also receive regular text messages on healthy lifestyle tips, treatment adherence support and prescription refill reminders.
ComHIP is leveraging local leadership and working with existing structures within the Ghanaian health system to ensure scalability and sustainability. The Lower Manya Krobo district health management team, Ghana Health Service and the Ministry of Health are taking leading roles in shaping the project and making significant technical inputs.
As we mark this year’s World Hypertension Day, we must consider the wider challenges of hypertension control. We must test new, locally led, health care delivery models to determine whether they can effectively tackle the rising burden of hypertension and related cardiovascular diseases across the developing world.
In Ghana, ComHIP is leading the way. This innovative public–private model is one promising step toward addressing the growing hypertension epidemic in the country and an entry into the control of other cardiovascular diseases. Evidence from the project will inform broader approaches, and lessons learned will shape future models of care while highlighting the critical role of local leadership in bringing us closer to controlling this silent killer.