Publication: Improving Services for Chronic Non-communicable Diseases in Samoa: An Implementation Research Study Using the Care Cascade Framework
Loading...
Files in English
232 downloads
Published
2021-07-26
ISSN
Date
2021-07-28
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
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
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 Smoke in the Water : The Use of Tariff Policy Flexibility in Crises(2009-09-01)As the economic crisis deepens and widens, fears of a return to the protectionist spiral of the 1930s become more common. However, an important difference between the 1930s and today is the existence of the World Trade Organization and the legal limits it imposes on the protectionist responses members can pursue. The objective of this paper is threefold. First, to assess the extent to which applied tariff can legally be raised without violating tariff-bound obligations, and compare it with what is economically possible. Second, to examine what has been the protectionist response of individual countries when facing an economic crisis since the creation of the WTO. Finally, to predict how far the protectionist responses will go during the current crisis. Results suggest that the policy space left when looking at what is economically possible is indeed quite large. However, in the recent past very little of the available policy space has been used by countries suffering from an economic crisis. Our predictions for the current crisis are modest tariff hikes in the order of 8 percent.Publication Global Economic Prospects, January 2025(Washington, DC: World Bank, 2025-01-16)Global growth is expected to hold steady at 2.7 percent in 2025-26. However, the global economy appears to be settling at a low growth rate that will be insufficient to foster sustained economic development—with the possibility of further headwinds from heightened policy uncertainty and adverse trade policy shifts, geopolitical tensions, persistent inflation, and climate-related natural disasters. Against this backdrop, emerging market and developing economies are set to enter the second quarter of the twenty-first century with per capita incomes on a trajectory that implies substantially slower catch-up toward advanced-economy living standards than they previously experienced. Without course corrections, most low-income countries are unlikely to graduate to middle-income status by the middle of the century. Policy action at both global and national levels is needed to foster a more favorable external environment, enhance macroeconomic stability, reduce structural constraints, address the effects of climate change, and thus accelerate long-term growth and development.Publication Financial Globalization and the Russian Crisis of 1998(2010-05-01)Russia had more-or-less completed the privatization of its manufacturing and natural resource sectors by the end of 1997. And in February 1998, the annual inflation rate at last dipped into the single digits. Privatization should have helped with stronger micro-foundations for growth. The conquest of inflation should have cemented macroeconomic credibility, lowered real interest rates, and spurred investment. Instead, Russia suffered a massive public debt-exchange rate-banking crisis just six months later, in August 1998. In showing how this turn of events unfolded, the authors focus on the interaction among Russia's deteriorating fiscal fundamentals, its weak micro-foundations of growth and financial globalization. They argue that the expectation of a large official bailout in the final 10 weeks before the meltdown played an important role, with Russia's external debt increasing by $16 billion or 8 percent of post-crisis gross domestic product during this time. The lessons and insights extracted from the 1998 Russian crisis are of general applicability, oil and geopolitics notwithstanding. These include a discussion of when financial globalization might actually hurt and a cutoff in market access might actually help; circumstances in which an official bailout could backfire; and why financial engineering tends to fail when fiscal solvency problems are present.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Regional Poverty and Inequality Update: Latin America and the Caribbean, October 2025(Washington, DC: World Bank, 2025-10-23)This brief summarizes recent facts related to poverty and inequality in Latin America and the Caribbean (LAC) using the latest wave of harmonized household surveys from the Socio-Economic Database for LAC (SEDLAC). This brief was produced by the Poverty Global Practice in the LAC Region of the World Bank.