Background: The Alma Ata declaration (1978) and The Ottawa Charter (1986) identified community empowerment as being central to health promotion. In terms of chronic disease management, such as in hypertension, the roles of community health workers (CHW) are regarded to have had a positive impact on care, particularly in poorly resourced populations. However, studies show that hypertension, as an intermediate risk factor of cardiovascular disease, remains poorly controlled.
Aims: To evaluate how health outcomes relating to hypertension treatment have been evaluated in CHW-based programs.
Method: PART 1: searched literature search via multiple electronic databases was undertaken to identify studies evaluating the health outcomes of CHW-based programs for hypertension across the world. PART 2: 3 Health Officers in the Bantul District of Yogyakarta, Indonesia, were interviewed face to face regarding how they evaluated the effectiveness of the CHW programs conducted in 27 Primary Health Centres (PHCs).
Results: PART 1: 10 studies were identified, including 3 randomized controlled trials, with all focusing on poorly resourced populations in both developed and developing countries. Studies reported health outcomes in terms of blood pressure values, cardiovascular risk, and medication adherence, and also reported various process measures (follow-up rate, satisfaction, program utilization). Importantly, indicators of positive service impact were used, specifically the increasing proportion of patients with controlled hypertension. PART 2: interviewed Health Officers indicated that data for hypertensive patients were reported manually in individual patient medical records and the so-called Elderly Health Chart. However, no clear indicators of the impact of the service on health outcomes were identified or reported. Data pertaining to any improvements in the proportion of controlled hypertension cases was not monitored.
Conclusion: Essential health outcome indicators in CHW-based programs are needed to systematically identify treatment gaps and help translate evidence-based recommendations into practice.