By the year 2020, it is estimated that hypertension will contribute to 75% of deaths in sub-Saharan Africa. In Ghana, hypertension is the second leading cause of outpatient morbidity and mortality. One of the key barriers to optimal management of hypertension in Ghana is the severe shortage of physicians, exacerbated by the “brain drain,” or the movement of physicians out of lower-middle-income-countries to higher income countries. Task-shifting, defined as the rational movement of clinical duties from physician to non-physician health care workers is one potential mechanism of mitigating the consequences of the brain drain.
In Ghana, the TAsk-Shifting Strategy for Hypertension was a cluster-randomized trial in which community health clinics were randomized to a control group, or an intervention group in which community health nurses were trained in the WHO-PEN package to diagnose, treat, and manage hypertension. This dissertation sought to examine 1) how patients involved in TASSH perceived the program and their ability to manage hypertension; 2) the role of social determinants of health in influencing intervention outcomes; and 3) factors influencing the sustainability of the program.
This study provides information that can inform the development of future task-shifting strategies for hypertension by elucidating: positive aspects of the program that fostered behavior change; contextual factors that influence hypertension and can be the focus for tailoring interventions in the future; and factors that can influence the long term sustainability of task-shifting programs from the perspective of stakeholders involved in implementation
