Philippines embraces efforts to step up cardiovascular disease care

September 2017

Suffering a stroke when she was just 44 sent alarm bells ringing for Manila City Hall engineering assistant Marissa Receo.

A woman getting her waist measured in the Philippines
Marissa Receo getting her waist measured to assess her progress with physical activity in order to address hypertension and blood sugar issues running in her family
M. Receo

“My brother died from a stroke when he was 50, my mother suffered from hypertension, and I had a stroke and was overweight,” says Marissa, now 54. “I had to become healthier – not just for me but for my children and grandchildren.”

Seeking out medical help, particularly to improve her diet and physical activity levels, has made a huge difference. In just over two years, Marissa has shed 30 kilograms, thanks to regular Zumba classes, eating more fruits and vegetables and cutting out junk food. She no longer suffers from hypertension or high blood sugar.

Key to this turnaround has been the hands-on care and counselling provided by health authorities in the Philippines capital. This effort recently received a boost through the new WHO-backed HEARTS technical package for cardiovascular disease management in primary health care, which helps countries deliver targeted services for people at risk of heart attacks, strokes, hypertension and other cardiovascular conditions.

Starting in one area of the capital, Manila District VI, the HEARTS pilot project aims to step up prevention, detection and treatment of cardiovascular diseases, the world’s number one killer, responsible for one-third of all deaths in the Phillipines.

“It’s clear if the people of Manila District VI were more physically active, ate healthier foods and avoided tobacco, they would soon see the rewards in terms of healthier hearts,” says Dr Dolores Manese, coordinator for noncommunicable diseases (NCDs) at the Manila Health Department. “We cannot expect people to suddenly change long-standing habits, so it is up to us to ensure people have access to the information they need to make wise decisions and can consume products that ensure good health.”

Through the HEARTS project in Manila, WHO and partners like the US Centres for Disease Control and Prevention (US CDC), are supporting the training, planning and other essentials needed to beat the epidemic of cardiovascular diseases. Similar pilot projects are ongoing in Barbados, Nepal, Tajikistan and elsewhere and have the potential to generate dramatic results.

In Manila, HEARTS is focused on helping health providers implement the Philippine Package of Essential NCD Interventions for Primary Health Care (Philippine PEN). Adapted from WHO guidelines, Philippine PEN standardizes and strengthens care for NCDs, including cardiovascular diseases.

In July this year, guided by HEARTS technical package, Manila health authorities developed a plan identifying problems, including irregular availability of NCD medicines and supplies, such as cholesterol strips, as well as the limited capacity of health workers to counsel patients and families on healthy life choices and recovering from a heart attack.

The project will expand to other districts of Manila and help health authorities in 10 health centres improve access to care by systematically addressing barriers, including access to medicines, and avoiding unnecessary treatment costs.

NCDs, primarily cardiovascular diseases, cancers, chronic lung diseases and diabetes, impact all age groups in the Philippines, especially the nation’s young.

“All over the world, including in Manila, cardiovascular diseases pose the biggest threat to people’s health,” says Dr Gundo Weiler, WHO’s representative to the Philippines. “But when health services improve care and counselling for people and their families affected by heart disease, they go a long way to improving their patients’ health and preventing avoidable suffering.”

The HEARTS project is part of the Global HEARTS initiative, which also includes the MPOWER tobacco control package, and the SHAKE salt reduction plan. Supported by WHO, the WHO Regional Office for the Americas, US CDC, the World Heart Federation and others, Global Hearts strives to reduce the global burden of cardiovascular disease and save lives.

Dr Carmela Granada, who heads work on cardiovascular diseases and diabetes at the Philippines Department of Health’s Disease Prevention and Control Bureau, says strong collaboration across all levels of health system is essential for providing the best possible care to all.

“At least informally, there are networks in place which allow better resourced health centres to share personnel, medicines and supplies with other health centres in need,” Dr Granada says. “While this works in the short-term, we need a sustainable solution to the NCD challenge if we are to decrease the number of deaths and the disability they cause.”