Adapting the WHO Cardiovascular Disease Risk Management Package to the Ghanaian Community-Based Health Planning and Services (CHPS) Primary Care Model: An Implementation Pilot Study

项目概要和摘要 撒哈拉以南非洲的疾病负担正在迅速转向非传染性疾病， 其中心血管疾病（CVD）是主要原因，高血压是主要危险因素。经验证的 已经有了控制高血压和预防心血管疾病的一揽子干预措施， 在非洲一些地区进行试点。然而，该计划对疾病负担的潜在影响 人口仍然不清楚，因为在现有卫生系统内实施该计划的可持续性 仍然未知。 因此，我们建议制定一项试点高血压和心血管疾病预防计划， 世界卫生组织基本非传染性疾病一揽子计划的心血管疾病要素 疾病（PEN-NCD）方案[1，2]，成功筛查，诊断和控制高血压和其他 CVD危险因素作为社区健康计划和服务（CHPS）项目的一个要素， 加纳北方。我们将根据当地社区的健康信念， 以及当地可用的卫生系统构件，如社区卫生工作者、外展服务 志愿者和基本药物包 我们的研究计划包括三个阶段。首先，我们将使用多减量定量分析，图表 审查和审计，结构化的供应商观察，以及供应商书面考试，以评估 CHPS现有的高血压监测、筛查、转诊和治疗计划。 其次，我们将使用焦点小组和结构化访谈来确定这一基础设施的差距和障碍， 在乎我们的目标是在整个卫生系统的组成部分中确定高血压护理的障碍。 第三，我们将使用焦点小组和结构化访谈来确定解决已确定障碍的方法， 将通过对试点测试项目的结构化观察进行评估 这项分析旨在制定一项完整的试点干预措施，以解决高血压和心血管疾病问题。 疾病，根据世卫组织的指导方针，但加以调整（在使用卫生工作者培训;药物使用; 患者跟踪;以及卫生系统的所有方面）到前两个中描述的Navrongo上下文 以上阶段。 我们的工作将从三个方面提高撒哈拉以南非洲国家的非传染性疾病护理能力。首先，它将允许更多 准确的疾病监测，即使是疾病负担的程度（更不用说其根源了）， 和控制手段）仍然是一个有争议的问题。其次，它将产生一个试点方案，以确定 CHW领导的初级保健方案是否能有效地帮助控制可预防的大规模和不断增长的潮流， 加纳的CVD，这一进程可能导致其在全国范围内的实施。第三，它将建议 非传染性疾病计划（如WHO PEN）需要在整个卫生系统中进行修改， 如何在非洲和发展中国家的其他背景下在全国范围内实施这一计划。

Project Summary and Abstract The burden of disease in sub-Saharan Africa is shifting rapidly towards non-communicable disease (NCD), of which cardiovascular disease (CVD) is the leading cause and hypertension the leading risk factor. A validated package of interventions for hypertension control and cardiovascular disease prevention exists, and has been piloted in select regions of Africa. However, the potential impact of this program on disease burden across populations remains unclear, because the sustainability of its implementation within established health systems remains unknown. We therefore propose to develop a pilot hypertension and CVD prevention program, based on the cardiovascular disease elements of the World Health Organization's Package for Essential Noncommunicable Disease (PEN-NCD) protocol [1,2], to successfully screen, diagnose, and control hypertension and other CVD risk factors as an element of the Community-Based Health Planning and Service (CHPS) program in Northern Ghana. We will develop and refine this approach based on the health beliefs of local communities, and the locally available health system building blocks, such as community health workers, outreach volunteers, and basic medication kits. Our research plan involves three phases. First, we will use multiple-decrement quantitative analyses, chart review and audits, structured provider observations, and provider written exams, to evaluate the capacity of CHPS' existing hypertension surveillance, screening, referral, and treatment programs. Second, we will use focus groups and structured interviews to identify gaps in this infrastructure and barriers to care. We will aim to identify barriers to hypertension care across health system building blocks. Third, we will use focus groups and structured interviews to identify solutions to identified barriers, which we will evaluate via structured observation of pilot test programs This analysis will aim to generate a complete pilot intervention to address hypertension and cardiovascular disease, based on WHO guidelines but adapted (in terms of use of health worker training; medication use; patient tracking; and all aspects of the health system) to the Navrongo context as delineated in the first two phases above. Our work will improve capacity for NCD care in sub-Saharan Africa in three ways. First, it will permit more accurate disease surveillance in a context in which even the extent of disease burden (let alone its root causes and means for control) remains a matter of debate. Second, it will generate a pilot regimen to determine whether a CHW-led primary care package can effectively help control the large and growing tide of preventable CVD in Ghana, a process that could lead to its implementation across the country. Thirdly, it will suggest the processes by which NCD programs such as WHO-PEN require modification across health systems, and hence how this program could be implemented nationwide across other contexts in Africa and developing countries.