Contextual and landscape analysis of team-based care practices for hypertension management in Ghana, West Africa

The World Health Organization recommends team-based care (TBC) for hypertension control, particularly in low-resourced settings. This study assessed current practices, task distribution, and perspectives on a team-based approach to hypertension management in Ghana. In this cross-sectional study, we used convenience sampling to disseminate the Resolve to Save Lives Survey (RTSL) online to healthcare workers (HCWs) involved in hypertension management. Hypertension task-complexity was conceptualized (administrative, basic, and advanced clinical tasks) based on the RTSL Team-Based Hypertension Care conceptual framework and stratified by HCWs and facility-level characteristics. Among 345 HCWs, the mean age was 34 (± 6.3), 58% were males, and 48% practiced in urban centers. Clinical task performance varies by setting, level of care, and education. Most administrative tasks were performed by non-clinicians (69%) and community health workers (14%). Basic clinical tasks were team-based, shared among nurses, pharmacists, and physician assistants. Most of the advanced tasks were handled by physicians (28%) and physician assistants (43%). Major barriers to TBC included limited scope-of-practice laws (79%), inadequate training of non-physician workers (74%), opposition by physicians (62%), resistance by patients (57%), and opposition by nurses (43%). Utilization of treatment algorithms (96%), m-health technology (93%), and adequate HCW compensation (79%) were notable facilitators. With dire shortages of physicians, strengthening the capacity of non-physician HCWs to perform advanced clinical tasks is essential for effective hypertension care in Ghana. Policies are needed to strengthen capacity building and training opportunities, expand scope of practice, and review regulatory reforms to advance TBC.