Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India.
Junior Resident, Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India.
Indian J Public Health. 2023 Jan 1;67(Suppl 1):S27-S34. doi: 10.4103/ijph.ijph_694_23. Epub 2024 Jan 31.
Hypertension (HTN) portends a significant public health burden in India and calls for multi-stakeholder action.
We aimed to analyze the role of key stakeholder constituencies implicated in managing HTN across different levels of care within the public health system in India, alongside the enablers and barriers for effective program implementation.
We reviewed 45 articles and policy documents, and 17 consenting stakeholder representatives scored the stakeholder constituencies for "power," "position" and "interest." They ranked enablers and barriers to noncommunicable disease programs in each of the six building blocks of the WHO Health System Strengthening Framework. Data were analyzed on Jamovi 2.2.2.
Policymakers/program managers emerged as the most critical stakeholder in influencing policy implementation (score for power: 23.3 ± 8.5, position: 25.4 ± 6.9, and interest: 22.1 ± 8.3). Beneficiaries ranked lowest (power: 10 ± 5.1, position: 12.3 ± 4.5, and interest: 19.4 ± 4.2). Effective "on-ground" implementation ("service delivery") was the most important enabler (17.9 ± 3.3) as well as a barrier (17.6 ± 9.2). The health workforce (19.2 ± 4.8) emerged as a top barrier.
To bring around impactful efficiency in the health system, provider-side interventions, especially those at the point of delivery, emerged as the need of the hour. Policymakers and program managers could lead using a top-down leadership and Governance Approach, focusing on deploying an adequately trained and motivated health workforce to deliver HTN services. For ensuring better performance of the health system for HTN care, the health workforce/seemed to be the "obligatory pivot." Health-care providers could serve as the "point of convergence" of efforts made by all the stakeholder constituencies.
高血压（HTN）在印度造成了重大的公共卫生负担，需要多利益攸关方采取行动。
我们旨在分析在印度公共卫生系统的不同护理级别中，与管理 HTN 相关的关键利益相关者群体的作用，以及有效实施计划的促进因素和障碍。
我们回顾了 45 篇文章和政策文件，并让 17 名同意的利益相关者代表对关键利益相关者群体在公共卫生系统不同层面上管理 HTN 的“权力”、“地位”和“利益”进行评分。他们对世卫组织卫生系统强化框架的六个组成部分中的每一个部分的非传染性疾病方案的促进因素和障碍进行了排名。数据在 Jamovi 2.2.2 上进行分析。
决策者/方案管理者作为影响政策实施的最关键利益相关者出现（权力评分：23.3 ± 8.5，地位：25.4 ± 6.9，利益：22.1 ± 8.3）。受益者排名最低（权力：10 ± 5.1，地位：12.3 ± 4.5，利益：19.4 ± 4.2）。有效的“实地”实施（“服务提供”）是最重要的促进因素（17.9 ± 3.3），也是最大的障碍（17.6 ± 9.2）。卫生人力（19.2 ± 4.8）成为最大的障碍。
为了使卫生系统更具影响力的效率，提供者方面的干预措施，特别是在提供服务方面，成为当务之急。决策者和方案管理者可以通过自上而下的领导和治理方法来引领，重点是部署一支经过充分培训和激励的卫生人力来提供 HTN 服务。为了确保卫生系统在 HTN 护理方面的更好表现，卫生人力似乎是“必要的枢轴”。卫生保健提供者可以作为所有利益相关者群体努力的“汇聚点”。
