Best buys for Africa: Community Health Workers for hypertension control
Hypertension ranks among the main causes of mortality in sub-Saharan Africa (SSA). A principal contributor to cardiovascular disease, a costly and debilitating occurrence, in which many African households find themselves undertaking significant expenditures, in some cases considered catastrophic vis a vis their disposable income. The Pan-African Society of Cardiology (PASCAR) has identified the screening and treatment of hypertension as the first priority to reduce the burden of cardiovascular diseases in sub-Saharan Africa (SSA). Hypertension detection in Africa currently relies on opportunistic screening at health facilities. With the non-existence of health facilities in remote/rural areas and the shortage of staff willing to go to those areas, task-shifting or task-delegation has been positioned as a practical solution for improving hypertension control. Thus, the benefits and costs associated with the scaling-up of the screening and treatment of hypertension using community health workers as active case-finders have been analyzed. Screening everyone, that is potentially hypertensive, reveals itself to be an expensive proposition, as prevalence rates in SSA average 46%. The model analyzed is active case detection by professional community health workers, which results in modest benefit-cost ratios of 4.3, 2.1, 2.3 in South Africa, Nigeria, and Kenya.