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Giraldo GP, Joseph KT, Angell SY, Campbell NRC, Connell K, DiPette DJ, Escobar MC, Valdés-Gonzalez Y, Jaffe MG, Malcolm T, Maldonado J, Lopez-Jaramillo P, Olsen MH, Ordunez P. Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries: A qualitative study. J Clin Hypertens (Greenwich) 2021; 23:755-765. [PMID: 33738969 PMCID: PMC8678790 DOI: 10.1111/jch.14157] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 12/24/2022]
Abstract
The World Health Organization (WHO) Global Hearts Initiative offers technical packages to reduce the burden of cardiovascular diseases through population-wide and targeted health services interventions. The Pan American Health Organization (PAHO) has led implementation of the HEARTS in the Americas Initiative since 2016. The authors mapped the developmental stages, barriers, and facilitators to implementation among the 371 primary health care centers in the participating 12 countries. The authors used the qualitative method of document review to examine cumulative country reports, technical meeting notes, and reports to regional stakeholders. Common implementation barriers include segmentation of health systems, overcoming health care professionals' scope of practice legal restrictions, and lack of health information systems limiting operational evaluation and quality improvement mechanisms. Main implementation facilitators include political support from ministries of health and leading scientific societies, PAHO's role as a regional catalyst to implementation, stakeholder endorsement demonstrated by incorporating HEARTS into official documents, and having a health system oriented to primary health care. Key lessons include the need for political commitment and cultivating on-the-ground leadership to initiate a shift in hypertension care delivery, accompanied by specific progress in the development of standardized treatment protocols and a set of high-quality medicines. By systematizing an implementation strategy to ease integration of interventions into delivery processes, the program strengthened technical leadership and ensured sustainability. These study findings will aid the regional approach by providing a staged planning model that incorporates lessons learned. A systematic approach to implementation will enhance equity, efficiency, scale-up, and sustainability, and ultimately improve population hypertension control.
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Affiliation(s)
- Gloria P Giraldo
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Kristy T Joseph
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sonia Y Angell
- College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AL, Canada
| | | | | | | | | | | | - Taraleen Malcolm
- Pan American Health Organization, Port of Spain, Trinidad and Tobago
| | | | - Patricio Lopez-Jaramillo
- Lancet Commission on Hypertension Group, London, UK.,University of Santander, Bucaramanga, Colombia
| | - Michaels Hecht Olsen
- Lancet Commission on Hypertension Group, London, UK.,Holbaek Hospital, Holbaek, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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