Bridging Hypertension Care Shortfalls Between Provider Capacity and Patient Needs: A Pooled Analysis of Data From 199 Countries and Territories

Abstract

BACKGROUND: This study estimates the overall gaps between health system capacity of physician and nonphysician providers (nurses, pharmacists, and community health workers) and patients' needs for hypertension management across country income groups. METHODS: We extracted data on population, physician, and nonphysician density (nurses, pharmacists, community health workers) per 10 000 people from the World Bank Databases for 199 countries in 2021. Data on hypertension prevalence were obtained from the Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) in 2021. We estimated patient need for clinic visits under 4 scenarios: 12 visits per patient per year (high demand [base scenario, reflecting common practice in many low- and middle-income countries, where physicians conduct monthly visits for medication refills]), 6 visits (intermediate scenario), 3 (low scenario), 1 (minimal scenario) and 2 scenarios based on health worker capacity to provide clinic services: 20 patients per day (base capacity) and 10 patients per day (low capacity) per provider. RESULTS: The overall prevalence of hypertension was 37.5 (SD, 6.6%): 36.2 (7.0%) in high-income countries, 40.3 (6.7) in upper middle-income countries, 36.1 (5.7%) in lower middle-income countries, and 36.7(4.8%) in low-income countries. Physicians (mean±SD, 19.2±17.4), nurses (47.3±54.1), pharmacists (3.9±4.7) per 10 000 were higher in high-income countries, whereas community health workers (3.4±7.3) were higher in low- and middle-income countries. All countries showed workforce deficits in the high-demand scenario, which eased under intermediate and minimal scenarios. Incorporating team-based care further reduced these deficits, yielding net surpluses in 36 countries. CONCLUSIONS: Our analysis highlights significant global health service capacity gaps if hypertension management continues to rely solely on physicians. Addressing these gaps requires expanding team-based care, improving training, and enhancing healthcare infrastructure.