Early impact of the PEN HEARTS package to manage noncommunicable diseases in Bhutan: a mixed-methods evaluation

Abstract

Introduction: Non-communicable diseases (NCDs) pose significant public health challenges in Bhutan. In 2019, Bhutan's Ministry of Health introduced a set of interventions associated with the World Health Organization's Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Income Settings called PEN HEARTS. This initiative in four main areas: human resources, medicine shortages, equipment failure, and record-keeping. They also described benefits from increased supervision and peer support. Patients described experiencing more patient-centered care and overall positive experiences with the program. Conclusion:The evaluation identified areas of PEN HEARTS implementation that should be strengthened and improved, particularly training, record-keeping, and the use of AUDIT and cardiovascular disease risk assessments. The evaluation also showed evidence of improved disease control across achievement of treatment goals, reduction of treatment gaps, and improved patient retention in care. PEN HEARTS has potential to make a difference for NCD patients, and focusing on improving future implementation may further yield benefits in Bhutan.

Are low-and-middle-income countries using scarce resources effectively to tackle noncommunicable diseases in the pandemic era?

“…Tools (36) and simplified protocols (37) available for implementing this intervention in primary health care also identify individuals with previous heart attacks and strokes to ensure the continuation of drug treatment (secondary prevention). The total risk approach is being implemented in many LMICs (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51) and already included in the basic benefit packages in some universal health coverage initiatives (3).…”