Proxy healthcare measures put Global South patients at risk

People in low and middle-income countries (LMICs) are missing out on effective treatments for cardiovascular diseases because measures used to gauge the quality of their healthcare are inadequate, a study shows.

Proxy measures used by national and international organisations to assess progress in LMICs on treating patients with hypertension and diabetes – for example, whether relevant policies, guidelines, funding, institutions or expertise are in place – did not reflect whether patients had their condition treated well, an international team of researchers has found.

People across the Global South living with cardiovascular diseases and their risk factors such as diabetes and hypertension, which are major causes of death and disability, may be missing potentially life-saving treatments as a result.

Assessing outcomes

Treatment for such conditions is simple and cheap, but without it, patients are vulnerable to heart attacks and strokes.

Proxy indicators are often used by institutions such as the World Health Organization (WHO) to prioritise health funding and policies, urging countries that are performing badly to improve and considering those that are doing well as successful outcomes. 

The study, published in PLoS Medicine, was led by researchers at the University of Birmingham, Harvard University in the US, and the University of Göttingen in Germany in collaboration with colleagues from more than 40 institutions around the world including several ministries of health.

The team measured whether 187,552 people with high blood pressure living in 43 LMICs and 40,795 people with diabetes living in 28 LMICs had their high blood pressure or diabetes diagnosed, treated, or controlled.

Researchers are calling for more support to directly assess whether people with these diseases are getting the treatment that they need, and to interpret current proxy indicators with caution.

Researchers found that individuals with hypertension living in countries with a higher GDP per capita were significantly more likely to be diagnosed, treated, and achieve control of their condition. Countries that had measures showing their health system functioned well were also likely to perform better on these measures. However, for diabetes, there were very few associations between these indicators and patients having good quality outcomes.  

Non-communicable diseases (NCDs) are a leading killer around the globe, and those with NCDs like diabetes are at increased risk of Covid-19. This is a wake-up call to get serious about understanding national capacity to tackle these chronic diseases. Having an NCD branch in the Ministry of Health or NCD guidelines or NCD funding does not necessarily translate into high numbers of patients with hypertension and diabetes getting diagnosed, treated, and under control.

Dr Lindsay Jaacks

We need to move towards assessing the numbers of people with a condition that have that condition diagnosed, treated, and controlled to target. This has worked well for HIV, where progress is assessed against whether 90 per cent of people with HIV have their condition diagnosed, 90 per cent of these have the condition treated, and 90 per cent of these have it under control. Similar targets must be used for diabetes and hypertension if countries are to meet international targets to reduce the burden of heart attacks and strokes.

Professor Justine Davies

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