With the rise in cases of cardio-related non-communicable diseases (NCDs), particularly hypertension in the country, and the resulting impact on lives and livelihoods, one pro is supplementing the State’s efforts to buck the trend, with more than 817,000 screenings conducted, most of them first-timers, screened for hypertension in the Ashanti Region under the Phase One of the Healthy Heart Africa (HHA) programme.
Following its introduction in July 2019, the programme, which was developed by leading pharmaceutical and biotechnology company AstraZeneca has linked more than 165,000 persons with elevated blood pressure to local health facilities for diagnosis, treatment, and management.
This comes at a time when data points to an exponential rise in incidents of hypertension, especially in lower-income countries, which has experts worried that the trend could derail entire economies post-pandemic as hypertension significantly increases the risk of heart, brain, and kidney diseases, and ranks in the top five causes of death globally.
The results from a recently released “first comprehensive global analysis of trends in hypertension prevalence, detection, treatment and control” undertaken by the Imperial College London and the World Health Organisation (WHO) makes for grim reading as it revealed that across 184 countries, the number of adults aged 30–79 years with hypertension has doubled over the last 30 years, from 650 million to 1.28 billion, as at 2019.
Worse still, the report suggests that more than half of these persons were unaware of their condition because they had never been diagnosed, and perhaps, even more worrying is the disclosure that 82% of all people with hypertension, that is, around one billion, live in low and middle-income countries.
In Ghana, it was attributed as being the third leading cause of admission and the leading cause of deaths, accounting for 4.7% of the total admissions and 15.3% of the total deaths in Ghana in 2017, the most conservative estimates suggest that 1 in 4, that is, 25% of the population aged 15 and upward, have hypertension.
AstraZeneca, acutely aware of the fiscal and logistic constraints faced in healthcare delivery on the continent, has the HHA programme jointly operated in collaboration with national governments, their ministries of health, and relevant agencies. In Ghana, it is implemented through the Ghana Health Service (GHS) and nonprofit global health institution, PATH.
Commenting on the necessity of public-private partnerships to improve health outcomes, Associate Director, Government Affairs, Global Sustainability – Access to Healthcare at AstraZeneca, Dr. Allan Mackenzie said State involvement was indispensable for the long-term sustainability of the programme.
According to him, incidents of beneficial initiatives folding up once initial funding dries up is excessively prevalent, and, in many instances, leaves the awakened beneficiaries worse off as the health systems are not adequately strengthened.
“It is very critical that the government is involved; it is very critical for the long-term sustainability of the programme that there is local government participation and ownership, as we have seen with other programmes that when the funding ends, the programme collapses.
So it was very critical for us to have the government as a key partner so that we are actually strengthening the existing infrastructure to be able to address the rising burden. So should the programme come to an end in the future, the system would be ready and resilient in addressing cardiovascular diseases,” he explained in an interview with the B&FT.
He added that lessons learned from the unique experiences in the country would aid all stakeholders in their expansionary drive and policy direction for the second phase of the HHA programme.
Reception and Impact
On the ground, stakeholders are elated by the reception and impact of HHA thus far. For the Ashanti Regional Director of Health Services, Dr. Emmanuel Tenkorang, at the success which the programme has had in creating awareness around the subject matter and demystifying erroneous notions around cardiovascular diseases, particularly among the male population. This, he noted, had been the bane of previous efforts.
HHA has helped health professionals with capacity building, by improving their skills and knowledge in the screening, diagnosis, and management, says Dr. Victoria Agyemang, from Church of Christ Mission Clinic.
“It is a holistic approach, in the sense that it does not leave hypertension management to just the teaching or regional hospitals, particularly when it comes to giving the right information to health promotion officers.”
She added that a lasting benefit has been how nurses and other healthcare professionals have been equipped to undertake accurate blood measurement, identify risk factors, and enhanced
data management skills.
The advent of COVID-19 was a gift and a curse, says the Senior Technical Advisor, Non-Communicable Diseases at PATH Ghana Dr. Robert Yeboah. Whilst it disrupted community outreach programmes, it allowed for strategic innovation as HHA leveraged instances of child vaccination as well as COVID-19 vaccinations to screen persons, particularly caregivers and the aged for hypertension.
This was in addition to measures such as the provision of PPEs to healthcare workers, the printing of posters with an emphasis on hand hygiene and cough etiquette, aggressive preventive health measures on the radio and community information centers as well as the training of frontline health workers.
Amplifying sentiments earlier expressed, Dr. Yeboah said all stakeholders have enjoyed a “fruitful partnership” which would be crucial for the long-term sustainability of the programme. He was particularly buoyed by the liaising with health insurance providers for care as well as the data which HHA is feeding into the wider national database.
“We are not just interested in the clinical aspect where patients are just diagnosed but we are interested in getting a sense of what is the true burden of hypertension in the country is and consequently improving on the quality of data that is being reported to the Ghana Health Service for the national database… we have our eyes on sustainability, hence the participatory approach. At every step, key stakeholders have been engaged and are fully aware of the programme run and are able to address bottlenecks and actively contribute to its success.”