Hypertension diagnosis and management in Bamako, Mali.

Problem: The capacity and site readiness for delivering hypertension management services in Mali were unknown, hindering the effective implementation of the World Health Organization (WHO) HEARTS technical package for cardiovascular disease management. Approach: We selected one tertiary and two secondary hospitals to be assessed. From December 2021 to January 2022, hospital cardiologists collected data on indicators of capacity and site readiness using an adapted version of the WHO service availability and readiness assessment questionnaire. The study team verified the collected data through site inspection and review of administrative documents. Local setting: Mali, a low-income country with a population of 22 395 489, had an estimated hypertension prevalence among adults of 35% in 2019. Most people with hypertension receive care from primary care clinicians, but there are no national hypertension treatment guidelines. Relevant changes: The tertiary hospital had a larger workforce (392 personnel) compared to the two other sites (124 and  182 personnel, respectively) and treated approximately three times more patients with high blood pressure (324 patients versus 106 and 132 patients, respectively). Diuretics and centrally acting agents were the only antihypertensive medications available at all three sites. While all three sites had the capacity to diagnose and confirm hypertension, only one site was fully equipped to provide comprehensive hypertension treatment. Lessons learnt: Political engagement is important for expanding service availability and readiness assessments across health-care facilities, and supporting the implementation and funding of the HEARTS package. Improving access to antihypertensive medications will be essential to ensuring better treatment options for patients.