Identifying solutions to bottlenecks in hypertension service delivery: Insights for improving case detection in Tajikistan
Abstract Background Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of bottlenecks in service delivery for hypertension within primary health care in Tajikistan and define appropriate solutions.Methods Our study drew on the cascade of care framework to examine patient progression through the recommended stages of care. We triangulated data from household surveys and facility registries to describe the cascade. Focus group discussions with local stakeholders identified the determinants of discontinuities in care. Drawing on global empirical evidence on effective interventions and stakeholder judgments on the feasibility of implementation, we developed recommendations to improve hypertension service delivery.Results We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in either Oblast, about 10 percent have been diagnosed in Khatlon and only 5 percent in Sogd. Bottlenecks in case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, job aids for providers, and task-shifting to increase provider supply.Conclusions Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery bottlenecks.