- Report -

Ukraine

Making every school a health-promoting school: global standards and indicators

Credits

author

Outcome

Supportive and empowering societies through addressing health risk factors

[COUNTRY STORY]

Improving cardiovascular health from the local community to the national level with a participative approach

Ecuador

Photo: Ministry of Public Health of Ecuador Members of the PAHO/WHO team in Ecuador participate in a health fair, in which the HEARTS initiative is promoted.

Improving cardiovascular health in Ecuador

The STEPS survey, undertaken in 2018, showed that cardiovascular disease (CVD) represents the main cause of mortality in Ecuador. This survey was planned and carried out by the Ministry of Public Health (MoPH) and the National Institute of Statistics and Census (INEC) with the technical cooperation of PAHO/WHO Ecuador, in order to contribute to the surveillance of noncommunicable diseases (NCDs) and risk factors. The STEPS survey showed that 19.8% of the population had hypertension. Of these, at least 17% had uncontrolled hypertension and 56.3% did not take any medication for high blood pressure. With this alarming reality, and following advocacy from PAHO/WHO Ecuador, the MoPH assumed the implementation of the HEARTS initiative as a priority in 2019, tackling the prevention and control of arterial hypertension to reduce CVD. PAHO/WHO Ecuador cooperated with the MoPH and led the trainings with health care workers and procured appropriate equipment. By 2022, according to data from the MoPH, 130,591 patients were recruited trough the HEARTS program. Of those, the 75% are controlled.

Key WHO Contributions

Provision of technical expertise leveraging PAHO/WHO global goods
More than 45,000 health workers trained in HEARTS implementation through PAHO Virtual Campus
Donation of equipment for blood pressure measurement
Provision of technical expertise on education and communication plan on cardiovascular health
Coordination, technical support and evaluation of the national strategy through the management working group.

How did Ecuador, with the support of the PAHO/WHO Secretariat, achieve this?

The STEPS survey conducted in 2018 was a real turning point. The outcomes showed that 50.1% of people between the ages of 18 and 69 had never had their blood glucose measured. It also determined that 37.9% were overweight while 25.7% suffered from obesity. Within the blood pressure data obtained, it was found that 45.2% registered elevated blood pressure not diagnosed previously; 12.6% registered high blood pressure diagnosed but without treatment; the 16.2% registered elevated blood pressure diagnosed, under treatment and uncontrolled; and 26.0% registered high blood pressure diagnosed, under treatment and controlled.

Observing the alarming results of the STEPS survey, the MoPH formed a management group which was committed to the implementation of HEARTS in October 2019. The Country Office of PAHO/WHO advised the MoPH during this process of pre-implementation and implementation of the HEARTS initiative. The pre-implementation phase included support in the development of an action plan based on a situational analysis and the constitution of management groups.

^{Members of the PAHO/WHO team in Ecuador participate in a health fair, in which the HEARTS initiative is promoted.}Photo credit: Ministry of Public Health of Ecuador.

Once the members of the management group in charge of implementation and evaluation were identified, PAHO/WHO Ecuador facilitated the workshops with advisers from the regional office and Chile, as well as from the University of Calgary, to train the members of the committee on the components of the HEARTS initiative and its technical package. This comprises of six modules including healthy-lifestyle counseling, evidence-based protocols, and access to essential medicines and technology along with covering risk-based CVD management, team-based care and monitoring systems. The trainings also included standardization of pharmacological and non-pharmacological interventions. PAHO/WHO Ecuador advised the MoPH on the development of the communication materials used alongside the trainings. Following this, with the support from PAHO/WHO Ecuador and financial support from Resolve to Save Lives, the MoPH rolled out the trainings across 184 first-level health care facilities nationwide, out of 1,940 in total. These facilities were located in districts and zones with the highest prevalence of high blood pressure.

Following the trainings, a dedicated station was erected across the 184 health care facilities to measure the blood pressure of all patients and visitors aged 18 and above. Clear clinical criteria, presented and agreed during the trainings, were used to make referrals to specialists at higher level health care facilities. PAHO/WHO Ecuador supported these screening activities by procuring the blood pressure measuring equipment for all health care facilities and arranging supportive supervision to monitor data collection and the number of referrals. The implementation of the supportive supervision approach was in collaboration with the local health committees which also encouraged people not to miss their referral appointments. If high blood pressure or CVD was diagnosed, healthcare workers followed the defined pharmacological and non-pharmacological protocols, these included periodic visits to patients every three months, medicine delivery, counseling on healthy eating and physical activity.

“I suffered from grade 2 obesity and was about to have diabetes. My blood pressure was altered. They helped me with consultations and nutritional diets to improve my health and even change lifestyle habits. Now I keep a healthy lifestyle, which I share with my family. I have lost weight, am no longer obese and my blood pressure is stable. The monitoring by the health personnel, and medication and counseling provided have been important to improve my health.”

Sandra Bautista, beneficiary of HEARTS programme

As a result of these actions and positive feedback from the communities, the HEARTS initiative was included within the Ten-Year Health Plan 2022-2031, thus promoting the initiative as a health policy. The cooperation and technical advice from PAHO/WHO Ecuador were critical to the development of this plan, which sets the course of transformation of the vision of health in the country.

With the training of more than 45,000 Ecuadorian health care workers on the implementation of HEARTS through the PAHO Virtual Campus, the initiative has been successfully expanded and implemented in 483 health facilities nationwide. It is for this reason why in 2022, the World League of Hypertension distinguished Ecuador with the "Award for the Organizational Excellence in Prevention and Control of Arterial Hypertension” among all the countries implementing the HEARTS initiative.

An expansion plan for the HEARTS initiative continues with the support of PAHO/WHO Ecuador through training of health teams, donation of medical supplies and education and communication materials for health care professionals. Ecuador's goal remains that by 2025, 100% of first-level establishments in the country will be implementing this strategy.

“The approach of public health workers teams to the community has made it possible to identify, diagnose and offer the appropriate treatment to patients. PAHO/WHO, as the country's main ally in the field of public health, supports Ecuador in the implementation and expansion of HEARTS and commits its technical assistance to all programs that face the challenge of cardiovascular diseases, which continue to be the main cause of death in the region.”

Óscar M. Barreneche, PAHO/WHO Representative in Ecuador