Using the WHO Health Systems Framework to assess the health systems factors influencing hypertension control in Ghana

Background: Hypertension is a major public health problem affecting nearly 1 in 5 Ghanaians, increasing their risk for chronic diseases like stroke, coronary heart diseases and kidney diseases. It is clearly understood that hypertension poses a threat to the health of majority of the population in this developing country, yet information on the health system factors influencing optimal management and control of hypertension in Ghana is lacking.

Objective: This study uses the six building blocks of the World Health Organization’s (WHO) systems’ framework for action to examine the health systems factors influencing hypertension control in Ghana.

Methods: We systematically reviewed electronic databases such as PubMed and Google Scholar for published articles on health systems factors influencing hypertension in Ghana between 1990 and 2014. Studies were included if they identified any one of WHO six building blocks for Health Systems Strengthening: health workforce; health system financing; leadership and governance; health information; medical products, infrastructure and technologies.   

Results: We examined a total of 1191 studies of which 15 met the inclusion criteria. The studies revealed several health systems factors associated with hypertension control in Ghana and they included; shortage of qualified staff (n= 8); high medication costs and lack of insurance (n=6); lack of chronic disease policy (n = 5); inadequate information systems (n=1); poor access to existing interventions (n=3); limited availability of products and poor infrastructure (n= 4).

Discussion: Considering the increasing public health burden of hypertension in Ghana, perhaps it is time to fully understand the health systems factors influencing optimal control. Furthermore, findings from this review underscore the need to include hypertension control in all health systems policies in Ghana.