PROGRAM LEAD: Dr. Shifu Ismail Ngwayi, MD, MBA©
Authors: Shifu Ismail Ngwayi, Sangwe Clovis N., Njedock Nelson S., Budzi Michael, Ghangha Jamin G., Ngalame Abigail
Introduction
The number of people living with hypertension (high blood pressure), continues to be on the rise in both urban and rural settings of Cameroon. The burden is disturbing in remote, hard-to-reach communities with fragile healthcare service delivery and limited access to healthcare. According to statistics from the Cameroon’s Ministry of Health, in 2023, about 35% of the population was suffering from high blood pressure, and more than 17,000 people die each year from this condition (CDBPS-H, 2023). These statistics are projected to be worse as time goes by. A study carried out in Moliwe Health Area, a rural area in Cameroon’s South West region revealed a prevalence of 31.1% (Walters, 2016). This shows that high blood pressure is not just a problem of the urban areas and cities or affluent societies. The rural population are more vulnerable to dying of hypertensive complications than the urban population due to misconceptions and poor knowledge about the disease, poor access to health facilities and poverty. In rural communities, complications of hypertension like stroke and ischemic heart diseases are often poorly managed especially with substandard care leading to poor outcomes.
In 2022, Rural Doctors, a non-profit organization working to bridge health iniquity gaps in rural and enclaved communities saw a need to create Non-Communicable Diseases Check and Care points in partnership with primary health care facilities to fight against this growing public health concern.
The NCD Check & Care Point (CCP) Approach
In rural communities, the little available health resources are geared towards combating communicable or infectious diseases like malaria, typhoid, diarrhoeal diseases, etc. Non-Communicable Diseases (NCDs) like hypertension, diabetes, cardiovascular diseases, cancer, etc are given little attention. Moreover, most of these NCDs like hypertension rarely presents with signs and symptoms in initial phase of the disease making most cases to go unnoticed and undiagnosed. A Study in Punjab, rural India, showed that about 50% of patients do not return to their health care providers for blood pressure control appointments. This means non-adherence to blood pressure control and care (Das, 2021).
Rural Doctors after working in these rural settings realized that creating a comprehensive integrated approach to tackle these NCDs through early awareness and detection together with the infectious diseases will go a long way to reduce morbidity and mortality. The NCD Check and Care Point Approach involves the following steps:
- Rapid Community Survey and diagnosis
- Co-designing the project with community stakeholders
- Signing of MoU with a primary health care structure to serve as CCP
- Training of CHWs
- Capacity building of healthcare workers
- Organization of routine screenings
- Monthly follow up of hypertensive cases
- Ongoing monitoring and evaluation
STEP ONE
Rapid Community Appraisal and diagnosis
To get insights about the burden of hypertension in each rural or vulnerable community, Rural Doctors field volunteers are dispatched into the community to conduct rapid community surveys. Information is also gathered from the community members’ observations and available statistics from the health districts.
With this piece of information, it helps to assess each community’s resources and health needs and how to tailor the interventions to meet each community’s specific needs in reducing the hypertension burden amongst other disease burdens.
STEP TWO
Co-designing the project with community stakeholders
Results from the rapid community appraisal paves the way to co-designing a tailored project with the community leaders, women leaders, youth leaders, and head of primary health facility within the area.
This community-oriented approach leverages on the inputs and experiences of these local stakeholders to better plan on culturally acceptable and community inclusive interventions. This is always a critical step during formation of CCPs as the success of the project lies here.
STEP THREE
Signing of MOU with a primary health care structure to serve as CCP
To get insights about the burden of hypertension in each rural or vulnerable community, Rural Doctors field volunteers are dispatched into the community to conduct rapid community surveys. Information is also gathered from the community members’ observations and available statistics from the health districts.
STEP FOUR
Training of Community Health Workers (CHWs)
After signing the MoU, together with the health area focal person, CHWs are recruited and given hands-on training on NCDs. They are trained on diagnosis and prevention of these diseases at the level of the community. Emphasis is being laid on early identification and referral to the CCPs during their home visits within the community.
They also receive training on how to properly measure and document blood pressure values to avoid wrong values. Proper health communication especially on preventive measures are also handled.
STEP FIVE
Capacity building of healthcare workers
To get insights about the burden of hypertension in each rural or vulnerable community, Rural Doctors field volunteers are dispatched into the community to conduct rapid community surveys. Information is also gathered from the community members’ observations and available statistics from the health districts.
STEP SIX
Organization of routine NCD screenings
After signing the MoU, together with the health area focal person, CHWs are recruited and given hands-on training on NCDs. They are trained on diagnosis and prevention of these diseases at the level of the community. Emphasis is being laid on early identification and referral to the CCPs during their home visits within the community.
STEP SEVEN
Monthly follow up of hypertensive cases
The NCD registers are well designed to capture important information and patients’ NCD values to help assess progress on control every month. These details are important to better counsel and orientate the patients to adopt healthier lifestyles and do necessary adjustments for better outcomes.
Patients contacts are also kept and they are called in case they absent their follow up visits. CHWs also get to the community during their home visits to remind them of their monthly follow ups. By putting all these in place, it helps us minimize lost to follow ups and consequently non-adherence to blood pressure control care.
STEP EIGHT
Ongoing monitoring and evaluation
Using a well-designed tool, Rural Doctors continuously monitors all her NCD CCPs with data from the field. This helps to identify gaps in intervention and ameliorate loopholes.
Conclusion
The burden of NCDs especially hypertension is coming to add to the already existing infectious disease burden in rural areas in Cameroon. This means a serious public health burden to a context with fragile health system still battling with common infections like malaria, typhoid, etc. The implementation of this practical comprehensive approach (NCD CCP Approach) by Rural Doctors has proven to be beneficial in curbing the burden of hypertension in these remote, hard-to-reach and vulnerable communities with larger health equity gaps. We are in the process of engaging more communities and health facilities based on the burden of the problem and availability of resources.
References:
Centre for Development of Best Practices in Health, CDBPS-H , 2023
Walters T A, Christain A D, Julius A,et al. Hypertension, an emerging problem in rural Cameroon: Prevalence, Risk factors, and control.
Das B, Neupane D, Singh Gill S, BirSingh G. Factors affecting non-adherence to medical appointments among patients with hypertension at public health facilities in Punjab, India. J Clin Hypertens.2021;23:713–719. https://doi.org/10.1111/jch.14142