Assessing Service Availability and Readiness for Cardiovascular Disease Care in Selected Health Facilities in the Upper East Region

Abstract

Background: In 2019, an estimated 17.9 million people lost their lives to cardiovascular diseases (CVDs), accounting for 32% of global deaths. In Ghana, CVD-related fatalities remain a leading cause of mortality, particularly among individuals over 45 years. However, research indicates that the preparedness of health facilities to provide CVD services is generally inadequate in rural areas, including the Bolgatanga East, Talensi, and Nabdam Districts. Objective: The objective of the study is to evaluate the service availability, readiness, and utilization of CVD services in selected health facilities in Bolgatanga East, Talensi and Nabdam Districts. Methods: The study adopted a cross-sectional study design using quantitative methods to gather data from all the district hospitals and health centers in the three districts. A structured questionnaire, review of facility records and in-person observations were all employed to collect the relevant data. Collected data was analyzed using STATA I/C 18 (Stata Corp LLC, Texas, USA). Descriptive statistics was presented in tables and graphs. Relevant data was analyzed using the WHO-SARA manual to assess the readiness of health facilities to provide CVD services. Human resources, diagnostic capacity, basic equipment, essential medicines and commodities, infrastructure and guidelines were assessed based on the availability of each tracer item in the respective domains. The mean score for each domain was calculated based on the availability of tracer items within each domain. The overall readiness index was calculated by summing the scores for all domains and dividing by the total number of domains. The readiness score ranges from 0 to 100, with higher scores indicating a greater level of preparedness for providing CVD healthcare services. The readiness score was compared to a predetermined cut-off of 70, and the facilities with a score above the cut-off deemed ―ready‖. Results: The health facilities provide services like health promotion, disease prevention, diagnosis and treatment for CVD related diseases including hypertension, CHD, stroke, heart failure, dyslipidemia and diabetes mellitus. Basic treatments are undertaken by most of the health facilities; however, only 13% of the facilities provide long term care for some diseases with no facility providing long term care for stroke and dyslipidemia. The readiness score of health facilities to deliver CVD health care ranged from 30.8 to 70.7. The Talensi district hospital scored the highest of 70.7 whilst Biung health center scored the lowest of 30.8%. Apart from the hospital, the rest of the facilities had a score below the cut-off score of 70 implying sub- optimal readiness to provide CVD care services. The most obvious reasons resulting in the low readiness score were inadequate diagnostic capacity and a lack of essential medicines. Cardiovascular disease service utilization remained low across all districts, indicating potential gaps in detection and management. Conclusion: The study reveals the low level of readiness of the health facilities to provide CVD services. The WHO-SARA index for service readiness is met by the only the Talensi District Hospital, but all other facilities are below it, showing deficiencies in staffing levels, diagnostic capabilities, and medication supply. With scores as low as 20%, many health centers including the Biung, Datuko, and Duusi health centers are ill-prepared to handle cardiovascular problems. A mismatch between disease burden and healthcare availability may result in under diagnosis and poor management, as indicated by the underutilization of CVD services. Reducing the disease burden and enhancing Ghana's overall healthcare delivery need strengthening health centres that provide vital cardiovascular care services.