Determinants of Implementing a Community-Based Diagnosis and Monitoring System for Hypertension at Community Level in Malawi

Abstract

Introduction: Hypertension control and management remains a major public health challenge in low-and-middle-income countries including Malawi. In addition, health facility-based diagnosis and monitoring of hypertension in Malawi is hampered by lack of access to care, shortage of health professionals, fragmented services and extra cost especially for the poor. The purpose of this study was to explore the determinants of implementing a community-based system for hypertension at community level.
Materials and Methods: Semi-structured interviews were conducted among 28 purposively selected community volunteers across 35 community sites in Lilongwe, Malawi. The tool was used to collect information about determinants of implementing community-based diagnosis at individual, health system and patient level. Data was analysed using thematic approach through pre-identified evolving themes. Ethical approval was granted by both Malawi and Ethics committee of the Medical Faculty of Heidelberg University.
Results: A total of 28 community volunteers participated in the study, of which 24 (85.7%) were females and 4 (14.7%) were males. The determinants that affect diagnosis and monitoring at community level were categorized into three socio-ecological units of analysis: individual level (limited training on hypertension and other non-communicable diseases, lack of incentives, poor collaboration and communication difficulties); health systems level (drug shortage, inadequate infrastructure and equipment, lack of well-functioning referral system, and limited number of community volunteers) and patient-related determinants (adherence to medication, lack of appreciation and use of alternative remedies for hypertension).
Conclusion: A socio-ecological perspective provided a useful framework to explore the interplay among multilevel and interactive factors that impact diagnosis and monitoring of hypertension at individual, health system and patient level. Planners and resource allocators could consider these factors during planning, implementation, and evaluation of community programs. Additionally, a holistic public health approach which builds upon community volunteer’s capacities and harnesses the community’s needs is paramount to improve hypertension control and monitoring at community level.