Evaluation of interventions to improve clinical practices for hypertension in health facilities in rural Zambia: A cross-sectional study.

Responding to high disease burden of Hypertension (HTN), the Ministry of Health in Zambia considers improving services related to HTN a national priority. Therefore, this study evaluated the interventions for HTN pharmaceutical treatment by training of health staffs and procurement of necessary medical devices. We investigated service provision in the outpatient department (OPD) visits among patients aged 40 years and above in randomly selected health facilities in Chongwe district, between May and December 2017, before and after the interventions. The proportion of OPD visits that included standard clinical practices for HTN services significantly increased post-intervention: 45.8% to 71.9% for blood pressure screening, 26.8% to 31.8% for HTN diagnosis, and 14.2% to 20.9% for HTN medication. The proportion of OPD visits at which HTN medication was prescribed increased significantly post-intervention among patients with Grade 2 HTN or above, from 68.3% to 86.0%. The estimated district-wide monthly cost for HTN services in USD was $1,905 at baseline and increased to $2,643 post-intervention. These results suggest that improving HTN service provision is feasible and affordable at the district level. However, because a large number of individuals in need of HTN medication did not access a health facility, further investigation is required to estimate the expected effects and costs under improved access in the future.