Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework
Abstract Background Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportuniti...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-021-06889-0 |
| _version_ | 1819101975192535040 |
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| author | Meredith P. Fort William Mundo Alejandra Paniagua-Avila Sayra Cardona Juan Carlos Figueroa Diego Hernández-Galdamez Kristyne Mansilla Ana Peralta-García Dina Roche Eduardo Alberto Palacios Russell E. Glasgow Pablo Gulayin Vilma Irazola Jiang He Manuel Ramirez-Zea |
| author_facet | Meredith P. Fort William Mundo Alejandra Paniagua-Avila Sayra Cardona Juan Carlos Figueroa Diego Hernández-Galdamez Kristyne Mansilla Ana Peralta-García Dina Roche Eduardo Alberto Palacios Russell E. Glasgow Pablo Gulayin Vilma Irazola Jiang He Manuel Ramirez-Zea |
| author_sort | Meredith P. Fort |
| collection | DOAJ |
| description | Abstract Background Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach. |
| first_indexed | 2024-12-22T01:27:12Z |
| format | Article |
| id | doaj.art-a752a16a0f5a4967baf8b1cc852e2eb8 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-22T01:27:12Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-a752a16a0f5a4967baf8b1cc852e2eb82022-12-21T18:43:35ZengBMCBMC Health Services Research1472-69632021-09-0121111410.1186/s12913-021-06889-0Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks FrameworkMeredith P. Fort0William Mundo1Alejandra Paniagua-Avila2Sayra Cardona3Juan Carlos Figueroa4Diego Hernández-Galdamez5Kristyne Mansilla6Ana Peralta-García7Dina Roche8Eduardo Alberto Palacios9Russell E. Glasgow10Pablo Gulayin11Vilma Irazola12Jiang He13Manuel Ramirez-Zea14Department of Health Systems, Management and Policy, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical CampusUniversity of Colorado School of Medicine, Anschutz Medical CampusINCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)Ministry of Health and Social WelfareAdult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical CampusSouth American Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS)South American Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS)Tulane University School of Public Health and Tropical MedicineINCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)Abstract Background Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach.https://doi.org/10.1186/s12913-021-06889-0Cardiovascular diseaseGuatemalaHealth system building blocksHypertensionImplementation scienceLow- and middle-income countries |
| spellingShingle | Meredith P. Fort William Mundo Alejandra Paniagua-Avila Sayra Cardona Juan Carlos Figueroa Diego Hernández-Galdamez Kristyne Mansilla Ana Peralta-García Dina Roche Eduardo Alberto Palacios Russell E. Glasgow Pablo Gulayin Vilma Irazola Jiang He Manuel Ramirez-Zea Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework BMC Health Services Research Cardiovascular disease Guatemala Health system building blocks Hypertension Implementation science Low- and middle-income countries |
| title | Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
| title_full | Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
| title_fullStr | Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
| title_full_unstemmed | Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
| title_short | Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
| title_sort | hypertension in guatemala s public primary care system a needs assessment using the health system building blocks framework |
| topic | Cardiovascular disease Guatemala Health system building blocks Hypertension Implementation science Low- and middle-income countries |
| url | https://doi.org/10.1186/s12913-021-06889-0 |
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