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dc.contributor.authorLaar, Amos K.
dc.contributor.authorAdler, Alma J.
dc.contributor.authorKotoh, Agnes M.
dc.contributor.authorLegido-Quigley, Helena
dc.contributor.authorLange, Isabelle L.
dc.contributor.authorPerel, Pablo
dc.contributor.authorLamptey, Peter
dc.description.abstractBackground 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.
dc.description.sponsorshipThe study was supported by the Novartis Foundation, Basel, Switzerland. Grant Recipient: Professor Peter Lamptey.
dc.publisherBioMed Central
dc.relation.isformatofReproducció del document publicat a:
dc.relation.ispartofBmc Health Services Research, 2019, vol. 19, p. 1-13
dc.rightscc-by (c) Laar, Amos K. et al., 2019
dc.subjectHypertension prevention and treatment
dc.subjectNon-communicable diseases
dc.titleHealth system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders

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cc-by (c) Laar, Amos K. et al., 2019
Except where otherwise noted, this item's license is described as cc-by (c) Laar, Amos K. et al., 2019