Health systems interventions for hypertension management and associated outcomes in Sub-Saharan Africa: A systematic review

Abstract

Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores the health system interventions on hypertension management and associated outcomes in SSA. The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and October 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for the risk of bias using the tools from the Joanna Briggs Institute. Twelve studies clustered in 8 SSA countries met the inclusion criteria. Two thirds (8/12) of the included studies had low risk of bias. Most interventions focused on health workforce factors such as providers’ knowledge and task shifting of hypertension care to unconventional health professionals (n = 10). Other health systems interventions addressed the supply and availability of medical products and technology (n = 5) and health information systems (n = 5); while fewer interventions sought to improve financing (n = 3), service delivery (n = 1), and leadership and governance (n = 1) aspects of the health systems. Health systems interventions showed varied effects on blood pressure outcomes but interventions targeting multiple aspects of health systems were likely associated with improved blood pressure outcomes. The general limitations of the overall body of literature was that studies were likely small, with short duration, and underpowered. In conclusion, the literature on health systems internventions addressing hypertension care are limited in quantity and quality. Future studies that are adequately powered should test the effect of multi-faceted health system interventions on hypertension outcomes with a special focus on financing, leadership and governance, and service delivery interventions since these aspects were least explored.

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review protocol

“…We will define the health system interventions using the modification from the framework by Witter et al(18) and a descriptive approach employed by Byinringiro et al(19) Studies would be eligible if the interventions address the following health system inputs (i.e., Service delivery, health workforce, supply chain, health information systems, financing governance) in the following ways; Service delivery. WHO defines service delivery as the activities that directly provide safe, effective, and high-quality health services to patients in need.…”

“…This time frame is selected to encompass studies that would have likely benefited from recent development and improvement in RCTs, CCTs and quasi-experimental studies. We will define the search terms for primary health care of diabetes at the facility level by borrowing and modifying the search strategy published in a systematic review of health systems interventions for hypertension by Byiringiro et al(19) These search terms will likely encompass the primary health care practices for diabetes management in our setting of interest.…”

“…The framework by Witter et al, describes mechanisms of change within six health system blocks (governance, financing, infrastructure, workforce, supply chain and information), describes the implementation process goals and outlines the final desired outcomes. Interventions that promote any of these domains of the health system or across integration of the domains, have been proven to have significant impact on the outcome of a health condition (non-communicable disease) in the African setting(19).…”

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review

“…In this systematic review, we drew on the WHO six building blocks as an analytical framework to describe the health system, in six core functional components/areas of service delivery, health workforce, supply chain, health information systems, financing and governance (33). Evidence suggests these core components are useful for assessing the process of strengthening the health systems (40,41). Strategies that promote any of these components of the health system or across integration of the domains are described as health system intervention and have been proven to have significant impact on the outcome of a health condition in the African setting (40).…”

“…Evidence suggests these core components are useful for assessing the process of strengthening the health systems (40,41). Strategies that promote any of these components of the health system or across integration of the domains are described as health system intervention and have been proven to have significant impact on the outcome of a health condition in the African setting (40). In addition, we drew on post building block frameworks, applying the mechanisms of change in the Witter et al framework and a descriptive approach by Byiringiro et al (40) (38) Objectives 1.…”