Publication: Improving Services for Chronic Non-communicable Diseases in Samoa: An Implementation Research Study Using the Care Cascade Framework
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2021-07-26
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2021-07-26
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Samoa needs to intensify the response to the growing non-communicable disease burden. This study aimed to assess bottlenecks in the care continuum and identify possible solutions. The mixed-methods study used the cascade framework as an analysis tool and hypertension as a tracer condition for chronic non-communicable diseases. Household survey data were integrated with medical record data of hypertension patients and results from focus group discussions with patients and healthcare providers. Hypertension prevalence was 38.1% but only 4.7% of hypertensive individuals had controlled blood pressure. There were large gaps in the care continuum especially at screening and referral due to multiple socio-cultural, economic and service delivery constraints. In Samoa, care for chronic non-communicable diseases is not effectively addressing patient needs. This calls for better health communication, demand creation, treatment support, nutritional interventions and health service redesign, with a focus on primary healthcare and effective patient and community engagement.
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Publication Care for Hypertension and Other Chronic Conditions in Samoa(World Bank, Washington, DC, 2020-01-22)The importance of non-communicable diseases (NCD) for the health status of Samoa’s population cannot be overstated - NCD causes are responsible for 7 of 10 pre-mature deaths with 3 of 10 due to cardiovascular causes alone1. Many adults are hypertensive while rates of type diabetes and obesity are among the highest in the world and on an increasing trend. The 2013 Stepwise Approach to Surveillance (STEPS) survey found that 28.9 percent of the Samoa population are hypertensive, and 24.8 percent have diabetes. In response, the Government of Samoa has made NCD control and people, centered health services a priority in its Strategy for the Development of Samoa 2016/17-2019/20 and issued the National NCD Policy 2019-2023. In 2015, it contextualized and piloted WHO’s Package of Essential Non-communicable diseases (PEN) interventions and collected implementation experiences. 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Second, at the same time, public policies need to recognize that the burden of NCDs will increase because of population aging, and therefore public policy has a role to play in dealing with the pressures that this will impose on health services. Thus the report has a dual purview: how to avoid the burden of NCDs as much as possible and how to prepare for the consequences of more NCDs associated with demographic change.Publication Challenges and Opportunities in the Continuity of Care for Hypertension(Springer Nature, 2019-12-03)Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of hypertension case detection and retention in care within Tajikistan’s primary health care system, and to identify challenges and appropriate solutions. We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about 10% have been diagnosed in Khatlon and only 5% in Sogd. Barriers to case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increase provider supply, and introducing job aids for providers. 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