Strengthening health systems for cardiovascular disease control in Africa Empirical evidence from the Ghana Heart Initiative

Background. Cardiovascular disease (CVD) is increasing yet inadequately managed burden in sub-Saharan Africa (SSA), where health systems remain oriented towards communicable disease and evidence to guide national policy is scarce. The Ghana Heart Imitative (GHI) is system wide intervention to improve CVD care.
Aim. To presents the magnitude and determinants of CVD in Ghana, identifies community- and system-level barriers to hypertension management, and evaluates the GHI as a national health-system strengthening response.
Methods. A multilevel, mixed-methods research combined with population and facility-based epidemiological surveys, qualitative studies in Greater Accra
Findings. CVD prevalence of 10% in the general population but higher in hospital settings; male sex, older age, unemployment, diabetes and hypertension were key determinants. Age-standardized hypertension prevalence was 26.0%, varying across subdistricts and inversely with monthly income. Community members demonstrated sound understanding and drew on family and faith-based support, yet financial constraints, distance to care and stigma remained key barriers. Baseline blood pressure control fell below 10%, compounded by limited provider knowledge, absent protocols and diagnostic equipment, and few CVD indicators. GHI implementation improved provider knowledge, with outcomes influenced by cadre, facility level and experience; resuscitation competence rose following GHI-supported AHA-standard training; and blood pressure control improved significantly relative to standard care. Digital health interventions, importantly SMS-based eHealth interventions, produced significant reductions in blood pressure and improvements in lifestyle and adherence.
Conclusion. Integrated, empirically grounded model of CVD control, demonstrating that coordinated health system strengthening and digital support can sustainably improve outcomes in low- and middle-income settings like SSA.