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
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/212450

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oai_identifier_str oai:ri.conicet.gov.ar:11336/212450
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling 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
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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/
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application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
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