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Integrating a Non-Communicable Disease Care Cascade within Ghana's Community-Based Health Planning and Services
David J Heller1, Yehia Elkersh2, Engelbert A Nonterah3
1Associate Professor, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, USA.
Medrxiv : the Preprint Server for Health Sciences
|June 15, 2026
Summary
Ghana
Area of Science:
- Global Health
- Non-communicable Diseases
- Primary Care
Background:
- Hypertension and depression are leading global causes of death and disability.
- Control rates for these NCDs are low in LMICs, with limited evidence for adapting infectious disease programs.
- Rural access to care is a significant barrier in LMICs.
Purpose of the Study:
- To develop and test a non-communicable disease program within Ghana's CHPS initiative.
- To evaluate the effectiveness of a nurse-led intervention for hypertension and depression in remote areas.
- To assess the feasibility of integrating NCD treatment into existing primary care.
Main Methods:
- Trained 8 CHPS nurses for door-to-door diagnosis and treatment of hypertension and depression.
- Utilized telehealth supervision by physician assistants and volunteer counseling for adherence and behavior change.
- Implemented a 90-day intervention called COMBINE (CHPS Opportunity for Mentally and Behaviorally Integrated NCD Engagement).
Main Results:
- 60 adults were recruited, with 95% completing the 90-day intervention.
- 86% achieved blood pressure control and 95% achieved depression control after 90 days.
- At 12 months, 85% were retained, with 100% achieving disease control.
Conclusions:
- The COMBINE model demonstrated high diagnosis, retention, and disease control rates in a remote setting.
- This novel approach can improve NCD care cascades through existing non-physician models in LMICs.
- Further controlled trials are warranted to test this model at scale.
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