Health System Determinants of Hypertension Care and Outcomes in Sub-Saharan Africa: A Systematic Review

BackgroundHypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores health system factors contributing to hypertension outcomes in SSA. MethodsThe World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and June 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for risk of bias using the tools from Joanna Briggs Institute. ResultsThirty-nine studies clustered in 10 SSA countries met inclusion criteria. Health system determinants included human resource factors such as providers knowledge and adherence to hypertension treatment guidelines (n=21) and task sharing and shifting strategies (n=10). The second health system factors explored in service delivery were the health facility type and capacity (n=7) and hypertension service accessibility by cost, place, and time of services (n=15). A quarter of the included studies explored supply chain management for access to essential equipment and medicines. An additional set of studies addressed quality improvement strategies involving cross-integration of services (n=7) and various strategies of gauging the systems for better hypertension outcomes (n=8). ConclusionA combination of multiple rather than solo system interventions may yield significant improvements in blood pressure outcomes. Health information management and leadership involvement were less explored. Additional research on health system determinants of hypertension is needed to drive global improvements in hypertension outcomes. Future research would benefit from more rigorous implementation type interventional studies comprehensively assessing health system factors that contribute to better hypertension outcomes.