title: Health Systems Readiness to Manage the Hypertension Epidemic in Primary Health Care Facilities in the Western Cape, South Africa: A Study Protocol.
abstract: BACKGROUND
  Developing countries are undergoing a process of epidemiological transition from infectious to noncommunicable diseases, described by the United Nations Secretary General Ban Ki-Moon as ''a public health emergency in slow motion." One of the most prevalent in sub-Saharan Africa is hypertension, which is a complex chronic condition often referred to as a "silent killer" and key contributor to the development of cardiovascular and cerebrovascular diseases. Hypertensive patients in this setting are estimated to increase from 74.7 million in 2008 to 125.5 million in 2025, a 68% increase. However, there is an important gap between emerging high-level policies and recommendations, and the near-absence of practical guidance and experience delivering long-term medical care for noncommunicable diseases within resource-limited health systems.
  
  
  OBJECTIVE
  To address this gap, our study will consist of field investigations to determine the minimum health systems requirements to ensure successful delivery of antihypertensive medications when scaling-up interventions to control the hypertension epidemic.
  
  
  METHODS
  A cross-sectional analytic study will be conducted in the Western Cape using a mixed-method approach with two semistructured interview guides. The first will be for health professionals involved in the care of hypertensive patients within at least 6 community health centers (3 urban and 3 rural) to understand the challenges associated with their care. The second will be to map and assess the current supply chain management system of antihypertensive medications by interviewing key informants at different levels of the processes. Finally, modeling and simulation tools will be used to understand how to estimate minimum numbers of health workers required at each supply chain interval to ensure successful delivery of medications when scaling-up interventions.
  
  
  RESULTS
  Funding for the study was secured through a Doctoral Research Award in October 2014 from the International Development Research Centre (IDRC). The study is currently in the data analysis phase and results are expected during the first half of 2016.
  
  
  CONCLUSIONS
  This investigation will highlight the detailed processes in place for the care of hypertensive patients in primary health care facilities, and thus also identify the challenges. It will also describe the drug supply chain management systems in place and identify their strengths and weaknesses. The findings, along with the estimates from modeling and simulation, will inform the health system minimum requirements to scale-up interventions to manage and control the hypertension epidemic in the Western Cape province of South Africa.
authors.affiliation: Population Health Program, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. rdeub006@uottawa.ca.
authors.forename: Rodrigue Innocent
authors.identifier: http://orcid.org/0000-0003-0173-2898
authors.initials: RI
authors.lastname: Deuboué Tchialeu
authors.forename: Sanni
authors.identifier: http://orcid.org/0000-0002-4876-6043
authors.initials: S
authors.lastname: Yaya
authors.forename: Ronald
authors.identifier: http://orcid.org/0000-0002-0615-740X
authors.initials: R
authors.lastname: Labonté
keywords: Antihypertensive agents; Control; Delivery of Health Care; Epidemics; Health System; Hypertension; Manage; Requirements; Scaling-up Interventions; Supply Chain