Strengthening access to antihypertensive medicines through HEARTS in the Americas: the Grenada experience

To describe how Grenada leveraged the HEARTS in the Americas standardized clinical pathway to strengthen procurement of a single-pill fixed-dose antihypertensive and align prescribing and procurement across public and private sectors.

Grenada adopted a national hypertension clinical pathway specifying a single-pill fixed-dose combination of telmisartan/amlodipine with chlorthalidone as preferred therapy. Implementation strategies included integration of pathway medicines into the essential medicines list and procurement systems; engagement of clinical and procurement leadership; dissemination to private providers; and engagement with private pharmacies. A descriptive analysis was conducted using predefined indicators aligned with adoption, feasibility, acceptability, and public-private alignment using survey data, program documents, procurement records, and routine reports.

Integration of the standardized regimen into procurement processes supported availability of telmisartan/amlodipine and chlorthalidone in public primary care facilities, although supply gaps persisted. Adoption of a single national pathway supported standardized prescribing, forecasting, and centralized procurement. Dissemination to private clinicians and pharmacies contributed to uptake in the private sector, with pharmacies independently procuring pathway medicines, supporting continuity of care across sectors, although alignment remained incomplete. Facilitators included early stakeholder engagement, alignment between clinical and procurement leadership, and regimen simplification. Limitations included data system gaps and supply chain constraints.

A standardized clinical pathway can strengthen procurement and promote public-private alignment in hypertension care. Addressing supply chain constraints remains essential for sustained access and continuity of treatment, with lessons applicable to other small island developing states implementing HEARTS.