Table 1
List of interview questions.
| DOMAIN | QUESTION |
|---|---|
| Service delivery |
|
| Medication procurement and availability |
|
| Task shifting |
|
| Miscellaneous |
|
Table 2
Findings of the thematic analysis from the key informant survey responses.
| DOMAIN | QUESTION THEME | RESPONSE THEME | RESPONSE CODES | ABUJA n = 5 | KANO n = 5 | OGUN n = 5 | TOTAL (N = 15) |
|---|---|---|---|---|---|---|---|
| Service delivery | Main differences between the HEARTS approach and usual care for hypertension/diabetes | Enhanced Hypertension Management | Improved capacity for hypertension management | 4/5 | 4/5 | 3/5 | 11/15 |
| Deliberate focus on hypertension patients | 4/5 | 4/15 | |||||
| Adherence to protocol | 2/5 | 2/5 | 1/5 | 5/15 | |||
| Task Shifting and Service Delivery | Task shifting and its impact on service delivery | 2/5 | 2/15 | ||||
| Improved health-seeking behavior | 1/5 | 1/15 | |||||
| Increased awareness of hypertension | 1/5 | 1/15 | |||||
| Improved capacity for detection and management | 4/5 | 4/15 | |||||
| Improved capacity for tracking loss to follow-up (LTFU) patients | 4/5 | 4/15 | |||||
| Access to Medications | Improved access to quality-assured, relatively cheap medicines | 4/5 | 2/5 | 2/5 | 8/15 | ||
| Main challenges with the HEARTS approach | Training and Implementation Challenges | Incomplete training of health workers | 1/5 | 1/15 | |||
| Data burden on health workers | 2/5 | 2/15 | |||||
| Financial and Medication Issues: | Introduction of user fees leading to dropouts and LTFU | 4/5 | 4/15 | ||||
| Side effects of medications | 1/5 | 1/15 | |||||
| No challenges reported | 5/5 | 3/5 | 8/15 | ||||
| Inefficiencies in service delivery with the HEARTS program | Resource Utilization and Training: | Underutilization of health workers | 1/5 | 1/15 | |||
| Need for periodic retraining | 1/5 | 1/15 | |||||
| Equipment and Maintenance Issues: | Delays in equipment maintenance | 1/5 | 1/15 | ||||
| Medication procurement and availability | Difficulty in securing an adequate supply of medications | Logistical Challenges: | Difficulty in staff making trips for refills | 1/5 | 1/15 | ||
| No difficulty reported | 3/5 | 4/5 | 3/5 | 10/15 | |||
| Procurement source for medications | Procurement Sources | Abuja University Teaching Hospital | 5/5 | 5/15 | |||
| Drug Management and Consumable Supply Agency (DMCSA) | 3/5 | 3/15 | |||||
| From the state | 4/5 | 4/15 | |||||
| Challenges with the medication supply chain | Supply Chain Issues | Cost of transportation | 1/5 | 1/15 | |||
| Stockouts | 1/5 | 1/15 | |||||
| No challenges reported | 3/5 | 5/5 | 4/5 | 12/15 | |||
| Satisfaction with HEARTS protocol | Provider Satisfaction | Satisfaction with the protocol | 5/5 | 2/5 | 5/5 | 12/15 | |
| Task shifting | Perception of task shifting | Improved Service Delivery | Reduced burden for senior cadre | 1/5 | 1/5 | 2/15 | |
| Improved service delivery | 4/5 | 4/5 | 5/5 | 13/15 | |||
| Confidence boost for lower cadres | 2/5 | 2/15 | |||||
| Inefficiencies/challenges with task shifting | Training Needs | Need for training all health workers | 1/5 | 1/15 | |||
| No inefficiencies identified | 3/5 | 5/5 | 4/5 | 12/15 | |||
| Activities delegated from doctors to nurses | Delegation of Tasks | All tasks can be delegated | 1/5 | 2/5 | 4/5 | 7/15 | |
| Enrollment counseling, screening, and treatment | 3/5 | 3/5 | 6/15 | ||||
| Miscellaneous | Other aspects of HEARTS program | Program Expansion and Integration | Integration of diabetes care | 3/5 | 3/15 | ||
| Decentralizing medicine sourcing | 1/5 | 1/15 | |||||
| Affordability and Training | Affordability of drugs | 1/5 | 2/5 | 2/5 | 5/15 | ||
| Need for more training | 1/5 | 1/15 | |||||
| Support and Maintenance | Excitement about DHIS 2 deployment | 1/5 | 1/15 | ||||
| Support for equipment maintenance | 1/5 | 1/15 | |||||
| Strengthening medicine supply/availability | 1/5 | 1/15 |
[i] Note: Counts indicate the number of key informants/facilities in each state whose individual response explicitly or substantively reflected the response code. Denominators are five per state. Counts are not mutually exclusive because a single response could contribute to more than one code. Blank/non-responsive cells indicate that the code was not reflected in any response from that state.