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. 2021 Apr;23(4):755-765.
doi: 10.1111/jch.14157. Epub 2021 Mar 18.

Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries: A qualitative study

Gloria P Giraldo  1 , Kristy T Joseph  2 , Sonia Y Angell  3 , Norm R C Campbell  4 , Kenneth Connell  5 , Donald J DiPette  6 , Maria C Escobar  7 , Yamile Valdés-Gonzalez  8 , Marc G Jaffe  9 , Taraleen Malcolm  10 , Javier Maldonado  11 , Patricio Lopez-Jaramillo  12   13 , Michaels Hecht Olsen  12   14   15 , Pedro Ordunez  1
Affiliations

Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries: A qualitative study

Gloria P Giraldo et al. J Clin Hypertens (Greenwich). 2021 Apr.

Abstract

The World Health Organization (WHO) Global Hearts Initiative offers technical packages to reduce the burden of cardiovascular diseases through population-wide and targeted health services interventions. The Pan American Health Organization (PAHO) has led implementation of the HEARTS in the Americas Initiative since 2016. The authors mapped the developmental stages, barriers, and facilitators to implementation among the 371 primary health care centers in the participating 12 countries. The authors used the qualitative method of document review to examine cumulative country reports, technical meeting notes, and reports to regional stakeholders. Common implementation barriers include segmentation of health systems, overcoming health care professionals' scope of practice legal restrictions, and lack of health information systems limiting operational evaluation and quality improvement mechanisms. Main implementation facilitators include political support from ministries of health and leading scientific societies, PAHO's role as a regional catalyst to implementation, stakeholder endorsement demonstrated by incorporating HEARTS into official documents, and having a health system oriented to primary health care. Key lessons include the need for political commitment and cultivating on-the-ground leadership to initiate a shift in hypertension care delivery, accompanied by specific progress in the development of standardized treatment protocols and a set of high-quality medicines. By systematizing an implementation strategy to ease integration of interventions into delivery processes, the program strengthened technical leadership and ensured sustainability. These study findings will aid the regional approach by providing a staged planning model that incorporates lessons learned. A systematic approach to implementation will enhance equity, efficiency, scale-up, and sustainability, and ultimately improve population hypertension control.

Keywords: Latin America and the Caribbean; cardiovascular disease; hypertension; implementation science; non-communicable diseases.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
HEARTS in the Americas vision, technical pillars, and cross‐cutting implementation strategies
FIGURE 2
FIGURE 2
Nested multi‐level nature of HEARTS in the Americas
FIGURE 3
FIGURE 3
The modified stages model shown in cyclic format; adapted from innovation to full scale, leading to sustainable impact at scale from the USAID, Supporting Country‐Led Efforts to Systematically Scale‐Up and Sustain Reproductive, Maternal, Newborn, Child
FIGURE 4
FIGURE 4
A cyclical, reiterative depiction of staged model of implementation occurring at every country implementing the HEARTS in the Americas Initiative
See this image and copyright information in PMC

References

    1. Pan‐American‐Health‐Organization . NCDs at a glance: NCD mortality and risk factor prevalence in the Americas: Pan‐American‐Health‐Organization; 2019.
    1. Pan‐American‐Health‐Organization & World‐Health‐Organization . Evidence and intelligence for action in Health Department/Health analysis, metrics and evidence unit. PLISA Database. Core Indicators 2019: Health Trends in the Americas: World‐Health‐Organization ; 2019.
    1. Martinez R, Soliz P, Mujica OJ, et al. The slowdown in the reduction rate of premature mortality from cardiovascular diseases puts the Americas at risk of achieving SDG 3.4: a population trend analysis of 37 countries from 1990 to 2017. J Clin Hypertens. 2020;22(8):1296‐1309. - PMC - PubMed
    1. World‐Health‐Organization . Global Hearts Initiative, working together to promote cardiovascular health. https://www.who.int/cardiovascular_diseases/global‐hearts/en/. Published 2020. Accessed.
    1. World‐Health‐Organization . Hearts: technical package for cardiovascular disease management in primary health care: World‐Health‐Organization; 2016.

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