Intervention package improves men’s health in Uzbekistan

Two regions of Uzbekistan, Kashkadarya and Ferghana, have implemented an innovative package of interventions to prevent and control noncommunicable diseases (NCDs), with particular benefits for men at risk of cardiovascular disease, high blood pressure and type 2 diabetes.

Men in Uzbekistan tend to seek health care less frequently than women. Many suffer from badly controlled blood pressure, facing higher risks because of salt, tobacco and alcohol consumption. This is in spite of the country’s implementation of health promotion and disease prevention programmes for many years. Making the change from treating disease to preventing it is a challenge for any country’s health system, and Uzbekistan is no exception.

A key issue has been the insufficient identification and management of high-risk patients. The risk of early death – at less than 69 years of age – is estimated to be 31% in Uzbekistan, mostly because of cardiovascular diseases. Almost one third of adults aged 40–64 years are at high risk of a heart attack or stroke within the next 10 years.

Nurses play key role

Part of the solution to this problem was in place already – Uzbekistan’s nurses. Thanks to a systematic approach that included changes to the regulatory framework, the pilot regions were able to expand the independent role of nurses. This led to better task-sharing between doctors and nurses, reducing the burden on general practitioners.

In local communities, teams of doctors and nurses now use patient registers to identify target groups and invite them for a cardiovascular risk assessment. When patients arrive, nurses ask them about risk factors and measure height, weight and blood pressure before they see the general practitioner. Nurses also visit patients at home and use questionnaires to detect risk factors. When people fail to attend their assessments, health-care workers conduct follow-ups.

The regions have also transformed clinics, making available cholesterol and other blood tests with rapidly accessible results. Specially designed software that makes it easier to track high-risk patients and evaluate results is being integrated into the information system for outpatient care services. Coordination teams visit the health clinics regularly to provide supportive supervision based on evaluations from both staff and patients.

Each nurse has a logbook of patients with chronic diseases and an individual patient management plan attached to the outpatient records. Whenever possible, they give these to the patients so they can be more involved in their own care.

These changes in public health care were supported by a community health promotion project called Healthy Life. Led by local government, this project draws support from a wide variety of stakeholders, from youth leaders to government agencies, religious representatives to women’s committees.

Impact where it is most needed

After 1 year, the 8 pilot facilities saw a nearly 80% uptake of cardiometabolic risk screening in people over 40 years of age. The data show that levels of participation among men are high – up to 86%, which is nearly the same as the rate among women. They also show an increase of approximately 50% in newly detected cases of arterial hypertension and type 2 diabetes.

Other results from the pilot project have included:

  • improved quality and effectiveness of patient counselling on NCD risk factors and healthy lifestyle;
  • increased completeness of clinical examinations by doctors;
  • increased use of public health-care services by the male population for cardiovascular risk assessment;
  • higher patient satisfaction attributed to the feeling that clinicians are showing more interest in patient health;
  • increased task-sharing between doctors and nurses and promotion of team decision-making; and
  • increased confidence and empowerment among nurses regarding their expanded role.

According to Jill Farrington, Coordinator for NCD Conditions at WHO/Europe, the lessons learned in Uzbekistan can inspire other countries. “Implementing this cocktail of measures in a coordinated way is what made this project so successful,” she explains. “No one intervention would have had the same impact, but when all these measures were deployed together the project became a powerful force, it has made a real difference. Other Member States of the WHO European Region should feel encouraged to follow the Uzbekistan example, as the positive impact was clearly evident.”