Introduction

This month, we turn our attention to country-level efforts to understand and address cardiovascular disease (CVD) and its associated risk factors. In Ghana, GBCHealth member and human development organization FHI 360 is leading a broad pilot program to assess local risk factor prevalence, strengthen hospital capacity, educate and screen people from two pilot communities and engage policymakers in disease prevention efforts.

Initiatives like FHI 360’s are critical in a country like Ghana, where non-communicable diseases such as CVD and diabetes are estimated to account for 39 percent of all deaths. In 2008, the WHO estimated that 36.4 percent of Ghanaians were hypertensive, 8.8 percent were diabetic, 17.6 percent had high cholesterol, and 36.4 percent were either overweight or obese. Further compounding the problem is the fact that NCD prevention and care services are not widely available.

The picture in Ghana is not unlike other low- and middle-countries. While the global NCD burden is predicted to increase by 17 percent in the next 10 years, in Africa, this number is expected to jump by 27 percent. Younger people living in low-income countries are more likely to die from NCDs than their counterparts in wealthier nations. The WHO estimates that nearly 30 percent of NCD-related deaths in low-income countries occur under the age of 60, compared to 13 percent in high-income countries.

Addressing the growing NCD burden in Ghana and in other parts of the world necessitates a number of actions, including more accurately understanding disease and risk factor prevalence, improving the ability of healthcare institutions to respond to the emerging health conditions, piloting prevention activities and engaging leaders and policy makers for long-lasting change. We are sure you will find FHI 360’s experience informative and hope it will help you and your company in future NCD programming. And don’t miss the FHI 360 sponsored session Influencing for Change: Tackling South Africa’s Diabetes Epidemic at the GBCHealth Conference on May 14-15 in New York City.

Case Study | FHI 360’s Cardiovascular Disease Pilot Intervention

About the Program

The objectives of FHI 360’s cardiovascular disease (CVD) pilot intervention in Ghana are to determine the prevalence of CVD risk factors; strengthen the capacity of health facilities to identify and manage CVD; initiate facility and community-based primary and secondary prevention activities; and engage policy makers in the primary prevention of NCDs.

Risk factor and health facility assessment. In 2009 and 2010, FHI 360 conducted a Biological and Behavioral NCD Risk Factor Assessment (RFA) and a Baseline Health Facility Assessment (HFA) in two Ghanaian communities. The program targeted adults in the communities surrounding two hospitals: the Police Hospital, an urban tertiary hospital in Accra, and Atua Hospital, a district hospital serving a semi-rural community in Ghana. Results found that both hospitals had adequate physical structures and staff eager to support CVD services. However, most staff had not received adequate training. Basic equipment for the identification and management of CVD, such as electronic blood pressure apparatuses, electrocardiogram machines, and weight and height measuring devices were either not in proper working condition or missing. Standard operating procedures, guidelines, and job aids on managing CVD were also not available. FHI 360 addressed these gaps prior to initiating services for the pilot intervention. Basic equipment to support the screening for CVD was supplied to the hospitals and over 50 health care providers were trained in primary and secondary prevention of CVD.

Primary and secondary prevention activities. Starting in mid-August 2011, the pilot intervention has screened approximately 400 clients per week for CVD risk factors. The pilot intervention focuses on clients accessing one of the two hospitals out-patient services. Counseling and health education on healthy eating and lifestyles are provided alongside screening. The pilot also uses mHealth technology to provide information on healthy lifestyles and encourage self-management. Currently, about 300 clients are being reached with SMS messages on healthy living, reminders on their next appointment, and adherence to CVD-related treatment.

A community-based behavior change campaign targeting female heads of household is also being launched in the Police Hospital community. The campaign, “From Your Heart to Theirs,” targets women because of their influence on their families’ eating and health habits.

Key results. Between August 2011 and December 2011, the pilot intervention has screened 6,441 clients and found the following results:

• In Atua Hospital, 21.7 percent of those who were screened were pre-hypertensive and 32.8 percent were hypertensive
• In the Police Hospital, 41.7 percent of those who were screened were pre-hypertensive, and 32.3% were hypertensive
• In Atua Hospital 48.2 percent of those who were screened had a body-mass index (BMI scores) ≥ 25
• In the Police Hospital 59.1 percent of those who were screened had a body-mass index (BMI scores) ≥ 25

Critical Success Factors

Leveraging established partnerships and existing health programs. FHI 360 has previously worked with both Atua Hospital and the Police Hospital in implementing HIV programs. Building on an existing and strong collaboration helped guarantee program efficiency and effectiveness.

Strong local leadership. It is critical to have local leaders who support your program. Throughout the pilot, FHI 360 consulted with the Ministry of Health, hospital management, and other stakeholders. Their support has led to the willingness and cooperation of health care workers in the pilot sites, as well as supported smooth implementation.

Recommendations — What the Private Sector Can Do

The preliminary data from FHI 360’s pilot intervention confirm a high prevalence of hypertension and high BMI, both of which are key risk factors for CVD as well as NCDs more broadly. The intervention also highlighted a clear need for a robust health system capable of addressing the NCD epidemic in Ghana. FHI 360’s findings are broadly applicable to other low- and middle-income countries faced with rising rates of NCDs. Companies engaged in NCD programs can use the findings from FHI 360’s pilot programs to augment their own efforts in the following ways:

• Utilize risk factor prevalence data to build or expand workplace programs to include primary and secondary prevention activities for CVD and other NCDs
• Advocate for additional resources at the national level to reduce the high prevalence of NCD risk factors in Ghana
• Lend business assets to strengthen existing public health services to identify and manage NCDs across disease areas for a comprehensive approach to good health
• Identify ways to translate the lessons learned in Ghana to other countries with a growing NCD burden

Learn More

• FHI 360 NCD Quiz
• World Health Organization. Noncommunicable Diseases Country Profiles 2011. WHO, 2011.
• Institute of Medicine. Report Brief, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. IOM, 2010.
• Lamptey P, Merson M, Piot P, Reddy KS, Dirks R. Informing the 2011 UN Session on Non-Communicable Diseases: Applying Lessons from the AIDS Response. PLoS Medicine 2011; 8(9): e1001086.