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Table 2 Challenges and opportunities for hypertension services captured by stakeholder level and health system building block

From: Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework

Health system building block Level of actor
Central level (Guatemala City) Providers
(Department & district levels)
Community level (patients, family members and community leaders)
Service delivery - Insufficient coverage and limited service unit infrastructure
- Lack of laboratory capacity
- Different models of service delivery implemented at the primary care level
- Copies of treatment guidelines often not available
Patients are uncertain about how to manage their disease and when they need to seek care
Human resources - Need for enhanced teams at the primary care level
- High staff turnover
- Limited opportunities for professional growth; short-term contracts
- Limited training on hypertension and in-service “cascade” trainings miss frontline providers
Limited consultation with community members (leaders, traditional healers) in some settings
Information systems - Lack of a standardized clinical encounter form
- Undercounting of people with hypertension in clinical encounters
Some but not all sites have lists of patients with hypertension & other chronic conditions Patients do not keep track of their blood pressure
Medications and technologies Hypertension medications are not consistently available (if available, primarily Enalapril) - Often lacking medications for hypertension (if available, primarily Enalapril)
- Lack of blood pressure monitors in some settings
Patients use traditional medicine in addition to pharmaceutical medications
Financing Public health system is underfunded Health Areas manage the budgets (not the local, district level) Patients are unable to afford medications (when there are stock-outs)
Governance & leadership Need for increased capacity for intersectoral collaboration to address chronic diseases Opportunity for increased coordination between community members and providers Patients with hypertension at times participate in diabetes clubs; eagerness to become more actively involved in their care