Non-Communicable Disease Care in Sierra Leone: Understanding the Drivers and Barriers to Retention in Chronic Care for Hypertension Patients in the Kono District

Abstract

Non-communicable diseases (NCDs) are the world’s leading cause of morbidity and mortality, with serious health and socioeconomic consequences, particularly in poor and vulnerable populations. Sierra Leone, one of the world’s poorest countries, with over seventy percent of the population living on less than a dollar a day, suffers greatly from the NCD burden. The nation’s history of colonial rule, civil war, and disease outbreaks has limited the government’s capacity to provide quality, accessible health care to its population. In part one of this thesis, we review the political economy of Sierra Leone’s current healthcare delivery system and identify opportunities for improving NCD care. In part two, we analyzed the facilitators and barriers to retention in chronic care for hypertensive patients in the Kono district of Sierra Leone. We conducted a convergent mixed-methods study at the NCD clinic at Koidu Government Hospital (KGH). We undertook a descriptive analysis of key variables for all of the 1628 hypertensive patients that sought care at the NCD clinic between February 2018 to August 2019. We interviewed 22 patients and 7 staff for the qualitative study to assess factors affecting patient’s retention to care at the NCD clinic. Qualitative findings highlighted facilitators for engagement in care - notably high-quality education sessions, free medications and good interpersonal interactions. Challenges to seeking care include long wait times, transport costs and misunderstanding the long-term requirement for hypertension care. Finally, we identified various mechanisms that explained why patients who had missed an appointment were reluctant to re-engage in care. We concluded that free medications, high-quality care services, and health education maybe effective ways of helping NCD patients stay engaged in care. However, key socioeconomic and clinical factors pose a challenge for long-term care retention for patients in our study.