Care for Hypertension and Other Chronic Conditions in Samoa: Understanding the Bottlenecks and Closing the Implementation Gaps

The Samoan Ministry of Health and the World Bank jointly conducted a cascade analysis to systematically identify the gaps and bottlenecks in the delivery of hypertension care (as a tracer condition for NCDs) and look at ways to address them. The analysis looked at hypertension screening, diagnosis, treatment, and patient monitoring, and used blood pressure (BP) control as the indicator for treatment success. The study found that both the hypertension and obesity prevalence’s are still rising. There are large gaps in case finding as 39 percent of all hypertensive adults had not had a BP screen over 12 months. It also identified gaps in referral with 37 percent of hypertensive adults having been screened but not fully diagnosed. Among all the diagnosed hypertension patients in care, only one in 5 reached BP control, suggesting there are serious challenges with treatment. These gaps in care make Samoa’s hypertension cascade tumble: Overall, only 1 in 20 hypertensive adults benefits from effective treatment and reaches the BP target. Recommended actions fall into the areas of public awareness campaigns, service configuration at primary care facilities and in communities, recording and use of patient data, broadening of the scope of PEN Fa’a Samoa and scale-up, treatment adherence with a patient-centered care approach, and the continuous policy and program efforts required for addressing Samoa’s obesity and non-communicable disease epidemics.