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Identifying the Gaps in Hypertension Management in Samoa


Gaps along the continuum of NCD care: the most significant are in the “screening” and “screening-to-diagnosis” stages

As in many Pacific Island Countries, non-communicable diseases (NCDs) are the major threat to the health of the Samoa population. To support Samoa’s national NCD action plan, the Samoan Ministry of Health and the World Bank jointly conducted an implementation cascade study in 2019 to systematically identify the gaps and bottlenecks in the continuum of NCD care. This work, funded through the MDTF to Advance UHC, used hypertension as a tracer condition and examined ways to address them. The study looked at hypertension screening, diagnosis, treatment, patient monitoring, and blood pressure (BP) control as indicators for treatment success.

The first key finding of the study raised concerns, as it showed that the rates of hypertension in Samoa albeit already significant, are still increasing. The study found 38% of Samoan adults are hypertensive, a 9% increase from the STEPS 2013 study (28.9%). The risk factors are also increasing; with 90% surveyed classified as overweight or obese.

“The study found that at each stage individuals were falling through the gaps, so in the end only one in twenty hypertensive adults reach the BP target,” says Team Lead Shuo Zhang. “The reasons for this are numerous, and the research team spent much of their time talking with residents, patients, health professionals and other community members to understand what the barriers at each stage might be.”

"The study found that at each stage individuals were falling through the gaps, so in the end only one in twenty hypertensive adults reach the BP (blood pressure) target."
Shuo Zhang
Team Lead

The barriers to successful hypertension care differed at each stage and ranged from psychological and cultural barriers, to human resource constraints within health facilities, limited access to drugs and equipment and sub-optimal clinical hypertension management in the rural health facilities. While the barriers differed by individual and community, the result is the same—a lack of universal access to health services for all people.

Addressing these gaps and the barriers along the NCD care continuum is vital to ensure appropriate access for all Samoans to effective and people-centered care. Interventions to address barriers to access, identified at each stage on the care continuum, were proposed. They include:

·       Stepping up public awareness campaigns on NCD risk factors including obesity, healthy diet, physical activities, alcohol, and psychological and cultural factors

·       Scaling up and broadening the scope of the PEN Fa’a Samoa (Package of Essential NCD interventions) program to more villages and individuals

·       Reforming the primary health care facilities in the communities to improve NCD care provision

·       Addressing hypertension treatment systematically and adhering to a people-centered approach.

The World Bank will continue to work with the Samoan government in their ongoing efforts to address NCDs, including to support the government in evaluating the impacts of health tax on NCD risk behaviors.

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