Publication: Improving Services for Chronic Non-communicable Diseases in Samoa: An Implementation Research Study Using the Care Cascade Framework
Loading...
Files in English
211 downloads
Date
2021-07-26
ISSN
Published
2021-07-26
Editor(s)
Abstract
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.
Link to Data Set
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Citations
- Cited 6 times in Scopus (view citations)
Collections
Related items
Showing items related by metadata.
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. The PEN Fa’a Samoa is oriented toward community participation and outreach services. It places emphasis on early detection of NCDs, effective referral and increasing population awareness of NCD risk factors. However four years after initiating PEN Fa’a Samoa program, it had only been rolled out to 17 out of total 431 villages in the country indicating the stagnant status of the screening. A World Bank study of NCD cost analysis in 2017 flagged low hypertension (HTN) treatment levels in Samoa as an issue of concern. The widespread HTN and the significant cardiovascular disease burden and high premature deaths suggest that the continuum of HTN care is sub-optimal in Samoa. To support the Government in improving NCD care, the World Bank joined the Ministry of Health (MOH) in 2018 to conduct a study on HTN and chronic care. The primary aim was to identify breakpoints and gaps in the continuum of HTN care and determine issues in chronic care and propose potential solutions. The study findings inform Samoa’s policy formulation, intervention implementation and the World Bank’s Samoa NCD control project. As the first in the Pacific Region to do an implementation cascade study, other Pacific Island Countries (PICs) may also draw on the findings of the study.Publication Promoting Healthy Living and Aging in Central America : Multi-sectoral Approaches to Prevent Chronic Noncommunicable Diseases(World Bank, Washington, DC, 2012-03)Non-communicable diseases (NCDs) are the main cause of death and disability in Central America. However, communicable diseases and maternal and child conditions remain important causes of death and disability as well as injuries. With the aging of the population and improvements in the control of infectious diseases, the share of NCDs in the total burden of disease is likely to increase. However, in Central America these diseases cause death at a much younger age than in higher-income countries. It is critical to prevent and control NCDs, both for their impact on health, as well as the economy. When not controlled, they can cause costly hospitalizations and large productivity losses due to absenteeism, disability and premature deaths. Finally, they can impoverish households hit by out-of-pocket payments for health services and drugs. A large share of NCDs can be prevented since they result from exposure to health risk factors such as unhealthy diets, physical inactivity, tobacco use, and the harmful use of alcohol. Central Americans have very high caloric diets that are rich in sodium and refined sugars, and lifestyles that often involve low levels of physical activity. Similarly, large shares of youth in some of the countries smoke, while alcohol consumption among drinkers and the frequency of binge drinking in Nicaragua and Guatemala are very high. Although all countries in the region have introduced multi-sectoral interventions to prevent NCD risk factors, much remains to be done: for example, countries have been more successful controlling smoking than addressing physical inactivity, alcohol abuse and poor diets. The role of the health sector is central to preventing NCDs: It needs to ensure their surveillance, along with the risk factors. In addition, the sector needs to ensure that effective multi-sectoral efforts to prevent these conditions take place.Publication The Economic Costs of Noncommunicable Diseases in the Pacific Islands : A Rapid Stocktake of the Situation in Samoa, Tonga, and Vanuatu(World Bank, Washington, DC, 2013-09)There is increasing recognition that non-communicable diseases (NCDs) are an important international and development issue globally, undermining health gains and imposing financial and economic costs on governments and households. NCDs are an important health challenge in the Pacific. First, (NCDs) can impose large but often preventable health, financial, and economic costs on countries. This is particularly important in the Pacific, where government already finances and provides the bulk of health services. Second, risk factors in the Pacific are feeding a pipeline of potentially expensive-to-treat NCDs, including diabetes and heart disease, but governments are already fiscally constrained in how much more they can provide to the health system. Third, from a public health and public finance perspective, many of the NCDs are avoidable or their health and financial costs can at least be postponed through good primary and secondary prevention. This will require a more coherent approach to health system financing and to health system operations, more generally. Improving both allocative efficiency ("doing the right things") and technical efficiency ("doing things right") are critical strategies to improve health outcomes in a financially sustainable way in the resource-constrained Pacific.Publication Public Policy and the Challenge of Chronic Noncommunicable Diseases(Washington, DC: World Bank, 2007)Since the early 1990s, the importance of chronic non-communicable diseases (NCDs) to global health has gained increased recognition. This report contains an agenda for action in response to the growing economic, social, and health problems posed by NCDs. Its objective is to enable the World Bank and its clients to examine and, where appropriate, strategically shift their approaches to public policy as a tool to prevent and control NCDs. The report highlights two broad themes. First, public policies need to prevent NCDs to the greatest extent possible and, in doing so, promote healthy aging and avoid premature deaths. 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. Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery challenges.
Users also downloaded
Showing related downloaded files
Publication Europe and Central Asia Economic Update, Fall 2024: Better Education for Stronger Growth(Washington, DC: World Bank, 2024-10-17)Economic growth in Europe and Central Asia (ECA) is likely to moderate from 3.5 percent in 2023 to 3.3 percent this year. This is significantly weaker than the 4.1 percent average growth in 2000-19. Growth this year is driven by expansionary fiscal policies and strong private consumption. External demand is less favorable because of weak economic expansion in major trading partners, like the European Union. Growth is likely to slow further in 2025, mostly because of the easing of expansion in the Russian Federation and Turkiye. This Europe and Central Asia Economic Update calls for a major overhaul of education systems across the region, particularly higher education, to unleash the talent needed to reinvigorate growth and boost convergence with high-income countries. Universities in the region suffer from poor management, outdated curricula, and inadequate funding and infrastructure. A mismatch between graduates' skills and the skills employers are seeking leads to wasted potential and contributes to the region's brain drain. Reversing the decline in the quality of education will require prioritizing improvements in teacher training, updated curricula, and investment in educational infrastructure. In higher education, reforms are needed to consolidate university systems, integrate them with research centers, and provide reskilling opportunities for adult workers.Publication World Development Report 2011(World Bank, 2011)The 2011 World development report looks across disciplines and experiences drawn from around the world to offer some ideas and practical recommendations on how to move beyond conflict and fragility and secure development. The key messages are important for all countries-low, middle, and high income-as well as for regional and global institutions: first, institutional legitimacy is the key to stability. When state institutions do not adequately protect citizens, guard against corruption, or provide access to justice; when markets do not provide job opportunities; or when communities have lost social cohesion-the likelihood of violent conflict increases. Second, investing in citizen security, justice, and jobs is essential to reducing violence. But there are major structural gaps in our collective capabilities to support these areas. Third, confronting this challenge effectively means that institutions need to change. International agencies and partners from other countries must adapt procedures so they can respond with agility and speed, a longer-term perspective, and greater staying power. Fourth, need to adopt a layered approach. Some problems can be addressed at the country level, but others need to be addressed at a regional level, such as developing markets that integrate insecure areas and pooling resources for building capacity Fifth, in adopting these approaches, need to be aware that the global landscape is changing. Regional institutions and middle income countries are playing a larger role. This means should pay more attention to south-south and south-north exchanges, and to the recent transition experiences of middle income countries.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication Business Ready 2024(Washington, DC: World Bank, 2024-10-03)Business Ready (B-READY) is a new World Bank Group corporate flagship report that evaluates the business and investment climate worldwide. It replaces and improves upon the Doing Business project. B-READY provides a comprehensive data set and description of the factors that strengthen the private sector, not only by advancing the interests of individual firms but also by elevating the interests of workers, consumers, potential new enterprises, and the natural environment. This 2024 report introduces a new analytical framework that benchmarks economies based on three pillars: Regulatory Framework, Public Services, and Operational Efficiency. The analysis centers on 10 topics essential for private sector development that correspond to various stages of the life cycle of a firm. The report also offers insights into three cross-cutting themes that are relevant for modern economies: digital adoption, environmental sustainability, and gender. B-READY draws on a robust data collection process that includes specially tailored expert questionnaires and firm-level surveys. The 2024 report, which covers 50 economies, serves as the first in a series that will expand in geographical coverage and refine its methodology over time, supporting reform advocacy, policy guidance, and further analysis and research.