Scaling up a landmark medical intervention across Samoa’s 413 villages is among the top recommendations made to improve care for hypertension and other chronic disease patients.

This is according to newly published research highlighting challenges in the sector.

The research, conducted by the World Bank and the Ministry of Health, has identified profound difficulties in diagnosing, treating and maintaining care for people with non-communicable diseases (NCDs) like hypertension. 

In hypertensive patients alone, the research found less than 20 per cent patients are on treatment and just five percent have control of their blood pressure after beginning treatment.

One way to beat this issue is to improve village implementation of a programme called P.E.N. Fa’aSamoa, the World Health Organisation’s Package of Essential Non-communicable disease interventions for Samoa.

So far, it has been active in just 17 villages out of 431, and in those villages is proving to catch more diagnoses earlier, and get more people into treatment programmes that are being maintained.

Among the 300 adults with hypertension surveyed, a whole ten per cent more people in P.E.N. villages had blood pressure screenings in the previous 12 months, and five per cent more P.E.N. village residents had begun hypertension treatment than those in ‘non-P.E.N. villages.’

The reports states that if the programme was scaled up and expanded to more villages, there would be more health screenings done and more cases detected earlier.

The programme, which used non-healthcare workers like the voluntary Women’s Committees to coordinate and deliver screening programmes and treatment follow-up, could help close gaps in the long life of care that hypertensive and other N.C.D. patients require. 

This year, after the pilot of P.E.N. Fa’aSamoa between 2015 and 2018, the World Bank will fund rolling it out further under a US$9.3 million (T$25.3 million) grant for the next five years.

The grant is a contribution to the Samoa Health System Strengthening Programme, which all up will cost US$40.5 million (T$110.2 million). Among the targeted outcomes are: “primary health care reform, investment in health workforce development, and community-based disease prevention and management to help ensure Samoan families, particularly those in rural areas, have access to trained physicians and quality services,” a press release on the funding states.

Reflections from survey participants on the pilot show women more than men were interested in the programme, and liked having care “closer to the home.” Because of the village women’s committees, women were more likely to have participated in and understood the programme.

But there were issues with the programme, that will likely be ironed out with the second roll-out.

“Many respondents felt P.E.N. had been under-resourced and hinged on unpaid community-based work. They also commented negatively about the M.O.H. not giving feedback about P.E.N. results,” the report states.

Women suggested that as well as screening, P.E.N. needs to address monitoring and retention in care, an issue that healthcare workers echoed.

“They (healthcare workers) questioned P.E.N.’s sustainability and attributed the failure to fully launch P.E.N. to insufficient investment in training, human resources, equipment and data recording systems, resulting in relatively small reach of P.E.N.

“Providers expressed enthusiasm for restarting or expanding the program, but highlighted the need for P.E.N. to better align and coordinate with health facilities,” the report states.

The programme showed to improve outcomes for regular screening, diagnoses and treatment, though barely improved blood pressure control showing there are more barriers at play.

Clinical Director of the National Kidney Foundation (N.K.F.), Leituala Dr. Ben Matalavea said the problem catching people with high blood pressure or other risk factors for more severe cardiovascular or renal diseases is immense, and starts with Samoa’s primary healthcare system.

He said while getting screening programmes and monitoring into villages will help, primary health care needs to utilise the private practice, and digitise records to get adequate quantity of care and follow up.

“We haven’t got a functional system to address the issues of N.C.D.s,” Leituala told the Samoa Observer. He said Samoa is able to screen and diagnose many, but actually managing chronic (lifelong) conditions is another matter.

“The trouble is the follow up of these people, and that is what I mean by not having a good primary health care to follow all these people up.

“You get different medication, different advice, no one is following up with you on your blood test results, and then next thing, you are told you have end stage kidney disease.”

If patient records were digitised, than they could be treated adequately no matter where they sought treatment, and if they missed a booked follow up appointment, a computerised alarm system would advise a nurse or doctor to call and remind them to attend. 

Leituala said this lack of continuous care is what leads to drastic disease like kidney failure, and ultimately death, because patients do not understand their condition is life-threatening.

He said it can be difficult to convince patients with no symptoms they need treatment, regular doctor’s visits and that without a change in lifestyle and diet their condition may worsen and become irreversible.

To help in overcoming that hurdle, be believes Government should work closer with the private sector to manage most cases of N.C.D.s, Leituala argued.

“The hospital is inappropriately used for these things, when they should be treating very sick people. 

“People with high blood pressure and diabetes are not sick, they are well people who need to be treated in the community, and be kept in the community in a state of wellbeing, because they are treatable.

“I think if Government can subsidise visits by patients with diabetes and high blood pressure it will relieve the hospital and I truly believe the care of those patients will be a lot better.”