Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework
- Autores
- Fort, Meredith P.; Mundo, William; Paniagua Avila, Alejandra; Cardona, Sayra; Figueroa, Juan Carlos; Hernández Galdamez, Diego; Mansilla, Kristyne; Peralta García, Ana; Roche, Dina; Palacios, Eduardo Alberto; Glasgow, Russell E.; Gulayin, Pablo Elías; Irazola, Vilma; He, Jiang; Ramirez Zea, Manuel
- Año de publicación
- 2021
- Idioma
- inglés
- Tipo de recurso
- artículo
- Estado
- versión publicada
- Descripción
- Background: Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods: We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results: Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions: This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach.
Fil: Fort, Meredith P.. University of Colorado; Estados Unidos
Fil: Mundo, William. University of Colorado; Estados Unidos
Fil: Paniagua Avila, Alejandra. No especifíca;
Fil: Cardona, Sayra. No especifíca;
Fil: Figueroa, Juan Carlos. No especifíca;
Fil: Hernández Galdamez, Diego. No especifíca;
Fil: Mansilla, Kristyne. No especifíca;
Fil: Peralta García, Ana. No especifíca;
Fil: Roche, Dina. No especifíca;
Fil: Palacios, Eduardo Alberto. No especifíca;
Fil: Glasgow, Russell E.. University of Colorado; Estados Unidos
Fil: Gulayin, Pablo Elías. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: He, Jiang. University of Tulane; Estados Unidos
Fil: Ramirez Zea, Manuel. No especifíca; - Materia
-
CARDIOVASCULAR DISEASE
GUATEMALA
HEALTH SYSTEM BUILDING BLOCKS
HYPERTENSION
IMPLEMENTATION SCIENCE
LOW- AND MIDDLE-INCOME COUNTRIES
MULTICOMPONENT PROGRAM
NON-COMMUNICABLE DISEASES
PRIMARY CARE - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by/2.5/ar/
- Repositorio
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/212450
Ver los metadatos del registro completo
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CONICET Digital (CONICET) |
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Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks FrameworkFort, Meredith P.Mundo, WilliamPaniagua Avila, AlejandraCardona, SayraFigueroa, Juan CarlosHernández Galdamez, DiegoMansilla, KristynePeralta García, AnaRoche, DinaPalacios, Eduardo AlbertoGlasgow, Russell E.Gulayin, Pablo ElíasIrazola, VilmaHe, JiangRamirez Zea, ManuelCARDIOVASCULAR DISEASEGUATEMALAHEALTH SYSTEM BUILDING BLOCKSHYPERTENSIONIMPLEMENTATION SCIENCELOW- AND MIDDLE-INCOME COUNTRIESMULTICOMPONENT PROGRAMNON-COMMUNICABLE DISEASESPRIMARY CAREhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods: We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results: Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions: This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach.Fil: Fort, Meredith P.. University of Colorado; Estados UnidosFil: Mundo, William. University of Colorado; Estados UnidosFil: Paniagua Avila, Alejandra. No especifíca;Fil: Cardona, Sayra. No especifíca;Fil: Figueroa, Juan Carlos. No especifíca;Fil: Hernández Galdamez, Diego. No especifíca;Fil: Mansilla, Kristyne. No especifíca;Fil: Peralta García, Ana. No especifíca;Fil: Roche, Dina. No especifíca;Fil: Palacios, Eduardo Alberto. No especifíca;Fil: Glasgow, Russell E.. University of Colorado; Estados UnidosFil: Gulayin, Pablo Elías. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: He, Jiang. University of Tulane; Estados UnidosFil: Ramirez Zea, Manuel. No especifíca;BioMed Central2021-12info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/212450Fort, Meredith P.; Mundo, William; Paniagua Avila, Alejandra; Cardona, Sayra; Figueroa, Juan Carlos; et al.; Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework; BioMed Central; Bmc Health Services Research; 21; 1; 12-2021; 1-141472-6963CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1186/s12913-021-06889-0info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T10:31:29Zoai:ri.conicet.gov.ar:11336/212450instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 10:31:29.606CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
dc.title.none.fl_str_mv |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
title |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
spellingShingle |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework Fort, Meredith P. CARDIOVASCULAR DISEASE GUATEMALA HEALTH SYSTEM BUILDING BLOCKS HYPERTENSION IMPLEMENTATION SCIENCE LOW- AND MIDDLE-INCOME COUNTRIES MULTICOMPONENT PROGRAM NON-COMMUNICABLE DISEASES PRIMARY CARE |
title_short |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
title_full |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
title_fullStr |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
title_full_unstemmed |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
title_sort |
Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework |
dc.creator.none.fl_str_mv |
Fort, Meredith P. Mundo, William Paniagua Avila, Alejandra Cardona, Sayra Figueroa, Juan Carlos Hernández Galdamez, Diego Mansilla, Kristyne Peralta García, Ana Roche, Dina Palacios, Eduardo Alberto Glasgow, Russell E. Gulayin, Pablo Elías Irazola, Vilma He, Jiang Ramirez Zea, Manuel |
author |
Fort, Meredith P. |
author_facet |
Fort, Meredith P. Mundo, William Paniagua Avila, Alejandra Cardona, Sayra Figueroa, Juan Carlos Hernández Galdamez, Diego Mansilla, Kristyne Peralta García, Ana Roche, Dina Palacios, Eduardo Alberto Glasgow, Russell E. Gulayin, Pablo Elías Irazola, Vilma He, Jiang Ramirez Zea, Manuel |
author_role |
author |
author2 |
Mundo, William Paniagua Avila, Alejandra Cardona, Sayra Figueroa, Juan Carlos Hernández Galdamez, Diego Mansilla, Kristyne Peralta García, Ana Roche, Dina Palacios, Eduardo Alberto Glasgow, Russell E. Gulayin, Pablo Elías Irazola, Vilma He, Jiang Ramirez Zea, Manuel |
author2_role |
author author author author author author author author author author author author author author |
dc.subject.none.fl_str_mv |
CARDIOVASCULAR DISEASE GUATEMALA HEALTH SYSTEM BUILDING BLOCKS HYPERTENSION IMPLEMENTATION SCIENCE LOW- AND MIDDLE-INCOME COUNTRIES MULTICOMPONENT PROGRAM NON-COMMUNICABLE DISEASES PRIMARY CARE |
topic |
CARDIOVASCULAR DISEASE GUATEMALA HEALTH SYSTEM BUILDING BLOCKS HYPERTENSION IMPLEMENTATION SCIENCE LOW- AND MIDDLE-INCOME COUNTRIES MULTICOMPONENT PROGRAM NON-COMMUNICABLE DISEASES PRIMARY CARE |
purl_subject.fl_str_mv |
https://purl.org/becyt/ford/3.3 https://purl.org/becyt/ford/3 |
dc.description.none.fl_txt_mv |
Background: Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods: We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results: Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions: This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach. Fil: Fort, Meredith P.. University of Colorado; Estados Unidos Fil: Mundo, William. University of Colorado; Estados Unidos Fil: Paniagua Avila, Alejandra. No especifíca; Fil: Cardona, Sayra. No especifíca; Fil: Figueroa, Juan Carlos. No especifíca; Fil: Hernández Galdamez, Diego. No especifíca; Fil: Mansilla, Kristyne. No especifíca; Fil: Peralta García, Ana. No especifíca; Fil: Roche, Dina. No especifíca; Fil: Palacios, Eduardo Alberto. No especifíca; Fil: Glasgow, Russell E.. University of Colorado; Estados Unidos Fil: Gulayin, Pablo Elías. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: He, Jiang. University of Tulane; Estados Unidos Fil: Ramirez Zea, Manuel. No especifíca; |
description |
Background: Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods: We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results: Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions: This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-12 |
dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://purl.org/coar/resource_type/c_6501 info:ar-repo/semantics/articulo |
format |
article |
status_str |
publishedVersion |
dc.identifier.none.fl_str_mv |
http://hdl.handle.net/11336/212450 Fort, Meredith P.; Mundo, William; Paniagua Avila, Alejandra; Cardona, Sayra; Figueroa, Juan Carlos; et al.; Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework; BioMed Central; Bmc Health Services Research; 21; 1; 12-2021; 1-14 1472-6963 CONICET Digital CONICET |
url |
http://hdl.handle.net/11336/212450 |
identifier_str_mv |
Fort, Meredith P.; Mundo, William; Paniagua Avila, Alejandra; Cardona, Sayra; Figueroa, Juan Carlos; et al.; Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework; BioMed Central; Bmc Health Services Research; 21; 1; 12-2021; 1-14 1472-6963 CONICET Digital CONICET |
dc.language.none.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
info:eu-repo/semantics/altIdentifier/doi/10.1186/s12913-021-06889-0 |
dc.rights.none.fl_str_mv |
info:eu-repo/semantics/openAccess https://creativecommons.org/licenses/by/2.5/ar/ |
eu_rights_str_mv |
openAccess |
rights_invalid_str_mv |
https://creativecommons.org/licenses/by/2.5/ar/ |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
BioMed Central |
publisher.none.fl_str_mv |
BioMed Central |
dc.source.none.fl_str_mv |
reponame:CONICET Digital (CONICET) instname:Consejo Nacional de Investigaciones Científicas y Técnicas |
reponame_str |
CONICET Digital (CONICET) |
collection |
CONICET Digital (CONICET) |
instname_str |
Consejo Nacional de Investigaciones Científicas y Técnicas |
repository.name.fl_str_mv |
CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas |
repository.mail.fl_str_mv |
dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar |
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13.070432 |