Improving cardiovascular disease prevention care in urban and rural Nigeria Evaluations of processes and outcomes

In sub-Sahara Africa, the burden of non-communicable diseases, in particular cardiovascular disease (CVD), is high. Hypertension is the leading risk factor for CVD and associated morbidity and mortality. In Nigeria, access to quality hypertension care is often poor, moreover, across the country there are large disparities in health status and access to affordable quality healthcare. In 2014, the Nigerian government has shown commitment to achieve universal health coverage, which implies that all citizens should have access to health services and protection from financial hardship. The aim of this thesis was to evaluate processes and outcomes of providing CVD prevention care through community pharmacies in urban Nigeria and in the context of a community-based health insurance program in rural Nigeria.
We found that remote monitoring of hypertensive patients in community pharmacies was feasible to implement and beneficial for patients’ health outcomes in urban Nigeria. In rural Nigeria, hypertensive individuals enrolled in a private subsidized health insurance program benefitted from CVD prevention care according to international guidelines and a cardiovascular health education program. To reduce the burden of CVD, additional strategies are needed to intensify treatment coverage and reduce costs. Inclusion of delivery of community-based hypertension care with remote monitoring in health insurance programs may an opportunity to further increase physical and financial accessibility of CVD prevention care. Further research is needed to investigate the costs and cost-effectiveness of offering this type of care for health financiers, healthcare providers and patients.