Enhancing primary health care in Ukraine: WHO pilots a hypertension project in Chernivtsi

To improve the quality of primary health-care (PHC) services at local level in Ukraine, WHO has implemented a pilot project in Chernivtsi. This city in western Ukraine was selected by WHO as a pilot hromada to introduce a systematic approach to improve access and quality of PHC, with a focus on hypertension care. Consisting of 3 components, the project aimed at implementing PHC monitoring, improving patient engagement through a сommunication campaign to raise awareness among the local population about the risk factors and prevention measures of arterial hypertension, and building the capacity of local PHC doctors and nurses.

"Cardiovascular diseases, particularly hypertension, are the leading cause of noncommunicable disease (NCD) deaths and one of the main global and national concerns. The ongoing full-scale war in Ukraine has significantly increased the burden of NCDs, especially cardiovascular diseases, among the population. A strong PHC system could help to reduce the burden of arterial hypertension and improve overall health outcomes for the Ukrainian people," said Dr Jarno Habicht, WHO Representative in Ukraine.

Raising awareness of arterial hypertension

A communication campaign titled "Improving the health of the community through patient engagement" used various methods to reach more than 160 000 Chernivtsi residents over the age of 40, the group most at risk of arterial hypertension. In addition to outdoor advertising and social media messaging, printed materials were distributed in hospitals and citizens had the opportunity to have their blood pressure measured for free in tents across the city. Over 10 000 people participated directly, with 4000 filling out questionnaires and entering a draw for blood pressure monitors.

"During the campaign, many people learned about hypertension and the importance of monitoring their blood pressure. As a result, there has been an increase in the number of visits to the health facility, including for blood pressure checks," said Olena Nazariuk, a family doctor working in the city.

Another local doctor, Iryna Fliundra, observed that many patients learned how to correctly measure their own blood pressure. Dr Olena Lavrova at the Rosha PHC Centre in Chernivtsi added that the campaign increased patients' motivation levels, pointing out that, "prevention has, unfortunately, not been a priority for many of our patients".

PHC monitoring and strengthening the capacity of PHC workers

WHO, in collaboration with the Health Department of the Chernivtsi City Council, adapted and implemented a framework of indicators aimed at evaluating the provision of PHC services. Health management specialists gathered and analysed indicators from PHC providers and discussed the results with them, including the next steps for improvement.

To ensure long-term success, the project invested in capacity building for health-care providers. Twelve training sessions for doctors and nurses were conducted, covering 75% of all PHC staff in Chernivtsi. These training sessions were based on the WHO package of essential NCD interventions and the HEARTS technical package. They focused on integrated, patient-centred care for NCDs, equipping health-care professionals with cutting-edge skills and knowledge.

To assess the outcomes of the pilot project, WHO convened a site visit to Chernivtsi, meeting with representatives of the Chernivtsi City Council, the Health Department of the Chernivtsi City Council, and heads of PHC facilities to discuss the results of the project and further actions.

As a significant step towards improving PHC, this initiative is planned to be replicated across other regions in Ukraine.

The pilot project was implemented by WHO Ukraine with financial support from the Government of Canada.