Evaluating and Improving Cardiovascular Health System Management in Low- and Middle-Income Countries
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Cardiovascular diseases represent an urgent global health burden and priority. A 2017 report from the Global Burden of Disease Study estimates that there were 422.7 million prevalent cases of cardiovascular disease and 17.9 million cardiovascular disease–related mortalities in 2015.1 The World Health Organization (WHO) established ambitious, voluntary global health targets in 2013 to reduce premature mortality (30–69 years) from noncommunicable diseases by 25% by 2025 (25×25).2 These targets include reductions in the national prevalence of key population-level risk factors (tobacco use, sodium intake, blood pressure, diabetes mellitus, overweight and obesity, and physical inactivity), increasing availability of drug therapies and technologies, and strengthening health systems to improve medication delivery and counseling. Despite the efforts, these targets will not be met in most low- and middle-income countries if current trends continue.3
The 25×25 targets inadequately address many elements of health system management identified by the WHO health system framework. The framework consists of 6 building blocks: (1) service delivery, (2) health workforce, (3) health information systems, (4) access to essential medicines, (5) financing, and (6) leadership governance.4 Although the WHO’s health system framework is largely descriptive, it underscores the complexity and importance associated with healthcare management as systems decentralize from central government to local entities. Health system stewardship was highlighted in 2014 Ebola epidemic in West Africa during which the co-ordination of clinical and nonclinical processes was essential to resource allocation, disease control, and quality of care.5 In this Perspective, we discuss the importance of health system management and review emerging methods to evaluate and improve health systems for better, safer global cardiovascular care with emphasis on low- and middle-income country settings.
Health System Management
Health system management, which may be led by senior clinicians without formal management training in low- and middle-income country settings, includes a variety of activities: …