Implementing essential interventions for cardiovascular disease risk management in primary healthcare: lessons from Eastern Europe and Central Asia

Abstract

Globally, non-communicable diseases (NCDs) are the leading cause of morbidity and mortality, including in the WHO European region. Within this region, the Member States with the greatest cardiovascular disease (CVD) burden are also some of the lowest resourced. As the need for technical support for the implementation of essential CVD/NCD interventions in primary healthcare (PHC) in these regions grew urgent, the WHO Regional Office for Europe has been directly supporting national governments in the development, assessment, scale-up and quality improvement of large scale PHC interventions for CVD. Herein, we synthesise the key learnings from providing technical support to national governments under the auspices of the WHO across the European region and share these learnings as a resource for public health professionals to consider when increasing coverage of quality essential health services. Based on our experience providing technical support to a diversity of Member States in the European Region (eg, Tajikistan, Republic of Moldova, Ukraine and Uzbekistan), we have identified six key lessons: prioritising NCDs for public health intervention, identifying and mapping existing resources, engaging key stakeholders, tailoring interventions to the local health system, generating local evidence and ensuring quality improvement while mainstreaming. Common challenges across all phases of implementation include multiple and inconsistent international toolkits and guidance, lack of national capacity for evidence-based healthcare, limited access to essential medicines and technologies, inconsistent national guidelines and limited experience in evaluation methodology, clinical epidemiology and guideline implementation. We map the lessons to the Consolidated Framework for Implementation Research and highlight key learnings and challenges specific to the region. Member States in the region are at various stages of implementation; however, several are currently conducting pragmatic clinical trials to generate local evidence for health policy. As this work expands, greater engagement with peer-to-peer sharing of contextual wisdom, sharing of resources, publishing methodology and results and development of region-specific resources is planned.

Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan

“…Tajikistan) evidence base, and ensuring quality improvement while mainstreaming. [16] Improvements in blood pressure control were also observed in the Republic of Moldova after the implementation of adapted WHO PEN guidelines and structured training for health workers. Compared to baseline, significant improvements were seen in intervention clinics at one year follow-up for patients with blood pressure at normal range, hypertensive patients with blood pressure at normal range, and patients with elevated blood pressure.…”

“…These include: using evidence-based, simplified, protocols designed for primary health care, conducting integrated training of doctors and nurses with task sharing and quality of care as part of the curriculum, the provision of decision support tools, an emphasis on grass roots quality improvement, and monitoring and feedback for quality improvement. [16] Without a comprehensive approach, however, taking into account organization processes, capacity to implement simplified clinical guidelines, the provision of essential equipment, medicines, and diagnostic tests further improvements may be limited. [17] Focus should be the continued prioritization of NCDs for public health intervention, optimizing clinical guidance for primary health care, engagement of key stakeholders, generating a local (i.e.…”

Potential gains in health-adjusted life expectancy by reducing burden of non-communicable diseases: a population-based study

“…The Nordic welfare states have a long-standing commitment to egalitarian welfare policies that have helped to achieve significant improvements in the health of covered all social groups [44,45] . The WHO European Region has mapped the lessons to the Consolidated Framework for Implementation Research to support increasing coverage of quality essential health services in member states with the lowest resources [46] . In lower-middle- and low-income countries, priorities for the prevention and control of NCDs compete with other important agendas such as poverty eradication and environmental protection.…”

“…Research to support increasing coverage of quality essential health services in member states with the lowest resources [46] . In lower-middle-and low-income countries, priorities for the prevention and control of NCDs compete with other important agendas such as poverty eradication and environmental protection.…”

Non-communicable disease policy implementation in Libya: A mixed methods assessment

“…Additionally, many LMICs report competing needs from multiple disease burdens [122,123]. Human resource capacity influences implementation: countries must train primary health care professionals and provide them with supportive materials and tools throughout the implementation period [124]. Availability of medicines and diagnostics is another major concern; this is due to limitations in procurement systems and budget allocations for medicines and blood pressure devices in some programs [50,125].…”