Cardiovascular disease prevention in a health insurance program in rural Nigeria

Cardiovascular diseases (CVD) are a leading cause of death and disability in sub-Saharan Africa. Treatment of cardiovascular risk factors, such as hypertension and diabetes, greatly reduces the risk of CVD. However, this treatment is often not available or not accessible for patients in sub-Saharan Africa. Health systems in sub-Saharan Africa are dysfunctional with poor infrastructure and a lack of qualified staff, essential equipment and supplies. The Hygeia Community Health Care program is a health insurance program for low-income groups in Kwara State, rural Nigeria. The program provides access to care for patients through subsidized insurance and improves the quality of healthcare clinics that participate in the program. The aim of this thesis was to evaluate the feasibility and effects of providing cardiovascular prevention care within this insurance program.
We found that offering access to care for patients combined with quality improvement of health facilities through the insurance program was associated with a significant decrease in blood pressure in a hypertensive population in rural Nigeria. In addition, implementation of CVD prevention guidelines with financial and organizational support from the insurance program in one of the program clinics resulted in high quality care. Therefore, insurance programs are a promising opportunity to scale-up CVD prevention care services in SSA. However, CVD prevention care was resource-intense with relatively high costs. Rapid scale-up of CVD prevention services in SSA does not seem feasible when using current guidelines. Simplified, low-cost treatment protocols are needed in order to combat the growing CVD burden in SSA.