Salud Juntos (SJ) has been working in the Department of Yoro, Honduras for the past four years to develop sustainable public health services that prevent, manage, and treat chronic conditions including hypertension and diabetes. SJis made up of collaborators from the United States and Honduras – including health professionals, community leaders, community health workers (CHWs), educators, and students. SJ creates sustainable public health and clinical programs, using the Chronic Care Model (4) and demonstrated best practices. Programs are targeted to chronic disease prevention and/or management. They are planned and implemented to optimize the allocation and integration of resources (volunteer, consultative, monetary and in-kind) needed to meet each of their own the goals and objectives, while recognizing SJ’s constraints (scope, time, and budget.) Currently, SJ has community programming that is premised around a CHW model that addresses hypertension, diabetes, dental health, and asthma. SJ makes every attempt to disseminate their findings so that others might benefit.
In Honduras, though the national Secretary of Health System (Secretaria de Salud- SdS) provides medications to rural health outposts for NCDs, it is only in sporadic supply and without clear protocols for its use clinically. Upon request of the rural community of Punta Ocote, Yoro, Salud Juntos helped to design and implement a community-administered and fiscally sustainable hypertension management group to run in conjunction with the local SdS clinic. The HTN-G, which began in March 2010, provides medications, clinical care, education, and treatment-by-protocol to 75 members for a monthly cost of $2.60 USD per member. At monthly meetings, community health workers record blood pressures (BPs), adherence (prescribed medications taken on HTN-G meeting day), current medications, and demographic and behavioral measures using a modified World Health Organization STEPwise Approach to Surveillance Survey (5).
Evaluation of the group data from March 2010 to August 2011 found significant improvements in mean blood pressure, HTN control, and self-reported adherence. It was found that mean blood pressure decreased from the initial (156.7/87.6) to the final (127.8/79.6) meeting. Also, member self-reported medication adherence increased 17%, while the portion of members with controlled HTN increased from 18% (10/57) to 76% (19/25). While attendance dropped from 75 to 42 participants over the 18 month period, the improvements in medication adherence and BP levels display the promise of the HTN-G model. The fact that the HTN-G has been in existence for more than 2 years now, and spread to 2 other communities is a testament itself to its structure and potential. Ongoing evaluation of the HTN-G as it expands will enable further investigation of scalability and proper role in health systems in Honduras and other low resource settings.