Developing a Health Facility Capacity Assessment Tool for Cardiovascular Disease Management in Lao People’s Democratic Republic Open Access

Tokieda, Natsuko (Spring 2019)

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Background: In Lao People’s Democratic Republic (PDR), cardiovascular diseases (CVDs) have become a huge burden, accounting for 22% of all deaths in 2014. According to the World Health Organization (WHO), the most cost-effective management of CVD in low- and middle-income countries (LMICs) is through prevention at the primary healthcare level. The WHO developed the Package of Essential Noncommunicable Disease Interventions (WHO PEN) for primary healthcare in low-resource settings with protocols for CVD management, which Lao PDR has recently adapted. Assessing the capacity of health facilities to implement CVD interventions is needed as the country prepares for scaling up these measures.

Purpose: The purpose of this study was to design, pilot, and evaluate an assessment tool for CVD management capacity in health facilities aimed at identifying the current status of CVD management and its barriers in Lao PDR.

Methods: The assessment tool included two components, a health facility questionnaire and a medical chart review tool. It covered CVD interventions of the WHO PEN protocol and WHO’s six building blocks of the health system. The pilot test was conducted at three facilities, and descriptive analyses were conducted on pilot data.

Results: The tool was useful for collecting information on human resources, essential medicines and equipment for CVD, and out-of-pocket medical costs. Data on utilization and quality of care could not be thoroughly collected due to the current status of facilities’ health information systems and limitations of the questionnaire. The medical chart review tool could not be used to its fullest potential due to the lack of individual medical records for outpatients at health facilities.

Discussion: This pilot study revealed several gaps related to the tool itself and the capacity of health facilities. At the tool level, questions related to clinical practice among healthcare providers needed improvement. At the health facility level, major gaps were identified in health information systems, which precluded a thorough assessment of health utilization.

Conclusion: While designed and piloted in the context of Lao PDR, this assessment tool has the potential for deployment in any other LMICs considering the expansion of CVD interventions. 

Table of Contents

Chapter 1 Introduction…3

1-1 Introduction and Rationale…3

1-2 Problem Statement…6

1-3 Purpose Statement…6

1-4 Objectives…6

1-5 Significance Statement…7

Chapter 2 Literature Review…8

2-1 Epidemiological transition in causes of death and CVD burden in global settings and in Lao PDR…8

2-2 Global action for the prevention and control of NCDs and technical guidelines for CVDs…10

2-3 Health System Strengthening and CVD management in LMICs…15

2-4 Current national action for CVD prevention and control in Lao PDR…16

2-5 Challenges in promoting CVDs management in Lao PDR…17

2-6 Comprehensive CVD Assessment Tool in LMICs…19

Chapter 3 Manuscript…22

3-1 Abstract…22

3-2 Introduction…23

3-3 Methods…26

3-4 Results…29

3-5 Discussion…46

Chapter 4 Conclusion and Recommendations…53

4-1 Conclusion…53

4-2 Recommendations…53


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