One man, 441 people, and a community for healthier hearts

May 16, 2017 by Bui Thi Minh Chau

Bringing blood pressure monitoring services to the community is transforming access to chronic disease management in Vietnam.

An animated man leans forward on a chair.

“Most people [still don’t know] the risks and complications related to hypertension,” says Mr. Phu. Photo: PATH.

Meet Mr. Ta Van Phu, a retired health worker and former leader in the military. With pen and pencil in his left pocket, glasses squarely centered on his face, and a shoulder bag containing his blood pressure monitor and educational materials about heart disease, Mr. Phu is a welcome sight as he walks from house to house in his neighborhood.

Roughly one year ago, the Communities for Healthy Hearts project (CH2), developed by PATH, the Ho Chi Minh City Provincial Health Department, and the Novartis Foundation, was looking for individuals who could volunteer to help combat hypertension in their communities. That’s when Mr. Phu offered his expertise. Actually, he was nominated by his neighbors since he was already offering medical support and advice whenever they needed him.

By becoming a free blood pressure checker as part of the CH2 project, Mr. Phu thought he could continue to serve his community, many of whom are now affected by the increased prevalence of cardiovascular disease in urban areas in Vietnam.

“Some people might feel dizzy and have a headache. They come to me for a blood pressure check and are surprised when [they learn] they have high blood pressure levels. I then tell them to go to a health clinic to confirm the diagnosis.”
— Mr. Ta Van Phu, a retired health worker
A man wearing glasses walks down a street. Another man is in the background.

Mr. Phu heads out to visit clients in the community. Photo: PATH.

And he’s doing a remarkable job

To date, Mr. Phu has screened 441 people for high blood pressure and for hypertension risk factors, 75 of whom had high blood pressure. When individuals learn they have high blood pressure, Mr. Phu urges them to go to a hospital or local health center to confirm whether or not they have hypertension. This is not always easy, but the continued support of Mr. Phu helped them seek diagnosis (all were diagnosed as hypertensive) and access treatment.

A man adjusts a blood pressure cuff on the arm of another man.

The community-based blood pressure checks through the Communities for Healthy Hearts project (CH2) increase access to hypertension screening for local people. Photo: PATH.

According to a survey conducted by CH2 with Ho Chi Minh City residents in April 2016, most people who don’t check their blood pressure regularly think that this quick and easy test has to be part of a full health checkup, a lengthy and expensive task. Or they don’t know where they can get their blood pressure checked. That’s where local volunteers like Mr. Phu provide great value. By offering community-based blood pressure checks they increase access to hypertension screening for local people.

Community checkers like Mr. Phu also support people who have hypertension to make lifestyle changes and follow treatment plans that empower them to live healthier and longer lives.

A recent national study found that 1 in 4 adults in Vietnam have hypertension, but a third of these cases go untreated. Hear their stories in this video.

“Some people who had high blood pressure were reluctant to go to the hospital for confirmation, because,” explains Mr. Phu, “they were afraid and did not want to take medicine for the rest of their lives.” He pauses and adds, “I try so hard to convince them to go to the hospital. Eventually they follow my advice. After that, if it is confirmed that they have hypertension, I [help] them keep up with their treatment and live a healthy lifestyle to better control their blood pressure.”

An open doorway into a building shows a health worker taking a blood pressure reading from a woman while two other people sit nearby.

So far, CH2 has trained 128 volunteer blood pressure checkers and established 284 community checkpoints. 18,749 people have checked their blood pressure using these community services. “Free blood pressure measuring point.” Photo: PATH.

A growing community of blood pressure checkers

There is strong evidence that providing accessible health services that fit into people’s lives—such as making blood pressure checks available through community volunteers and at checkpoints in everyday locations like pharmacies, grocery stores, and hair salons—can greatly improve people’s ability to monitor and take care of their own health. This is a key factor in the successful management of chronic diseases like hypertension.

Mr. Phu thinks that community-based blood pressure checks, besides being convenient, contribute to his neighbors’ interest in and ability to control their own blood pressure levels.

“There are still many poor households who cannot afford to buy a blood pressure monitor for themselves. [Going to a community checkpoint] is very convenient—it only takes a few minutes. For those families who already have a blood pressure monitor at home, the free checkpoint is still very useful as many people don’t know how to use the monitor properly or understand the meaning of the different numbers which appear on the screen. They often visit me so that I can explain and provide free consultations for them.”

A bespeckled man sits at a desk.

Local people like Mr. Phu, work alongside primary health care centers, pharmacies, private clinics, and private sector partners to create an integrated diagnosis and treatment network that builds on the existing health care system. Photo: PATH.

A health care worker attends to an elderly man who is bedridden.

Mr. Phu provides a free consultation to a man with hypertension. Photo: PATH.

Community for healthy hearts: a new model of care

In low-resource settings, health systems are often geared to address acute illnesses and infectious diseases, rather than chronic, noncommunicable diseases (NCDs)—including hypertension and cardiovascular diseases, diabetes, some cancers, and chronic lung diseases. These NCDs can often seem like a less immediate threat to public health. However, they are now the leading cause of illness and death worldwide, placing an enormous health and economic burden on individuals, families, and communities. Many effective solutions already exist for preventing, diagnosing, and treating NCDs, but these must be adapted to work in low-resource settings, integrating them into established care platforms to provide people with effective support closer to their homes.

PATH has 20 years of experience developing and scaling NCD innovations for low-resource settings in Africa, Asia, and Latin America. We recognize that innovative partnerships are key to unlocking accessible and effective chronic disease management options.

For instance, in Kenya, PATH integrates hypertension services with long-standing HIV programs to increase access to hypertension screening and treatment without additional cost. And because there is less stigma associated with hypertension than with HIV, these programs can attract hard-to-reach people for screening who can then be offered HIV testing. This novel partnership involves the US government via the President’s Emergency Plan for AIDS Relief (PEPFAR), and biopharmaceutical company AstraZeneca.

In Vietnam, innovation involves working with local people like Mr. Phu alongside primary health care centers, pharmacies, private clinics, and private sector partners (such as telecommunications companies), to create an integrated diagnosis and treatment network that builds on the existing health care system and focuses on the needs of the individual and their family. This work is supported by the Novartis Foundation, who also works with global and local partners to strengthen health systems around the world, including innovating around the delivery of hypertension care.

Approaches like these are key for achieving the World Health Organization’s global NCD targets for 2025, which include reducing premature deaths by 25 percent.

“Because people trust me, I am happy to support them.”

Having support from a known and trusted community member makes it easier for the residents of Ho Chi Minh City to manage hypertension—and it’s clear that Mr. Phu has quickly become invaluable to his friends and neighbors.

One of Mr. Phu’s neighbors said, “My husband had a stroke a year ago and was paralyzed as a result—only then did we find out that he had hypertension. Sometimes, [my husband] feels very uncomfortable and needs an urgent blood pressure check. Even if we call at midnight, Mr. Phu comes to my house to check my husband’s blood pressure. My family is very grateful to him for the care and support he provides.”