Background

Cardiovascular disease continues to be the leading cause of premature morbidity and mortality globally. According to the 2019 Global Burden of Disease Report, systolic blood pressure accounted for 10.8 million deaths in 2019 or 19.2% of total deaths. High systolic blood pressure was the leading attributable risk factor for disability-adjusted life years for people over 50.

Cardiovascular disease is also the leading cause of premature morbidity and mortality in the Americas. In 2016, there were 1.9 million deaths attributable to CVD.
Improvement in blood pressure control has occurred. However, part of the improvement seen in the last two decades has slowed significantly, and in some cases, even reversed. This has been shown clearly in the US, where NHANES data (JAMA. 2020;324(12):1190-1200), and in the WHO Region of the Americas, where 11 countries showed flattening and even an increase in mortality.

Significant improvement in hypertension control has been demonstrated in multiple settings. In both Southern and Northern California Kaiser Permanente regions, blood pressure control improved from approximately 50% to 90% for ten years. Similar improvements have been achieved in the Veterans’ Administration system in the US and nationally in Canada. In Kaiser Southern California, this improvement mirrored a significant decrease in CVD mortality, which outpaced the state of California and the US national rates.

WHO/PAHO RESPONSE
HEARTS IN THE AMERICAS

HEARTS is an initiative spearheaded by the World Health Organization involving various global actors, including the Centers for Disease Control and prevention of the United States (CDC) and the Resolve to Save Lives Initiative, among other global actors. The Department of Noncommunicable Diseases and Mental Health of the Pan American Health Organization (PAHO) leads the implementation of HEARTS in the Region of the Americas, ensuring that implementation actions are aligned with the strategic priorities of the region, particularly with the universal health coverage resolution, strengthening of health systems based on primary care and with the Sustainable Development Goals 2030, specifically those related to the prevention and control of noncommunicable diseases (NCD).

HEARTS in the Americas (https://www.paho.org/en/hearts-americas) is an initiative of the countries, led by the Ministries of Health with the participation of local stakeholders with the technical cooperation of PAHO, which seeks to integrate seamlessly and progressively to already existing health delivery services to promote the adoption of global best practices in the prevention and control of cardiovascular diseases (CVD) and improve the performance of the services through better control of high blood pressure and the promotion of secondary prevention with emphasis on the primary health care.

HEARTS is being implemented and expanded in 16 countries of the Region to include 478 health centers across the Region implementing HEARTS, covering approximately 7.8 million adults in the respective catchment areas.  HEARTS will be the institutionalized model of care for cardiovascular risk management, emphasizing the control of hypertension and secondary prevention in primary health care in the Americas by 2025.

Recognizing that the team-based care approach is not highly applied and that it is poorly implemented in many countries, there is a substantial gap to be filled.  The drivers of hypertension control are solidly embedded within a team-based approach and take advantage of the progress of this Region in implementing the Chronic Care Model. HEARTS in the Americas is focusing on substantially enhancing the team-based care component. This enhancement includes the design of innovative, simple, and functional workflow pathways, led by physicians, nurses or non-physician health workers (NPHW), to increase control of hypertension in PHC centers. HEARTS is enhancing its technical package with an emphasis on its team care approach and aligned with the foundations of the Kaiser care pyramid and the Kaiser Permanente hypertension care model, among other models.

Intended audience

This course is intended for primary care teams, primary care physicians, nurses, nurse assistants, nurse practitioners, allied health professionals, primary care centers administrators, medical, nurses and allied health students. In addition, teachers of health science programs, which include medicine and nursing, are recommended to embed the course, and make it available for their students or to incorporate it into their curriculum.

Course format

The course is placed on the platform of the Virtual Campus for Public Health of PAHO/WHO available 24 hours a day, 7 days a week, in a self-administered modality according to the own participant pace, individually or as part of professional programs and /or educational meetings in the workplace.

The course issues a certificate with 16 hours.

Course structure

• Introduction/Overview of the Course. Key Hypertension Control Drivers Overview
• Module 1: Overview of quality improvement
• Module 2: Accurate BP Measurement
• Module 3: Medication Titration
• Module 4: Follow-Up Blood Pressure Check
• Module 5: Utilization of Scorecards for Quality Improvement
• Module 6: Community Outreach
• Module 7: Home Blood Pressure Monitoring
• Special module: COVID-19, Hypertension Control and Cardiovascular Disease

About the course

The course on accurate automated blood pressure measurement is an initiative of the Pan American Health Organization joined by the World Hypertension League, the Lancet Commission on Hypertension Group and Hypertension Canada, and Resolve to Save Lives, academically developed by a group of highly qualified experts recognized worldwide.

It is structured in an interactive way with a narrated video that illustrates step by step how to properly measure blood pressure, as well as the factors that can alter the measurement and give misleading records.

It consists of an interactive module with an illustrated video, an illustrated guide, and a narrative evaluation. At the end of the modules, the student will be able to download the certificate issued by the Virtual Campus for Public Health (VCPH) of PAHO/WHO and validated by World Hypertension League, Resolve to Save Lives initiative, and The Lancet Commission on Hypertension Group and Hypertension Canada.

Course purpose

Training members of the health care team who are in charge of blood pressure measurement to do it correctly, step by step, so that they can make an appropriate diagnosis and start the indicated treatment according to the blood pressure record.

Objectives

To develop an efficient mechanism for patients and health care professionals to update knowledge on proper blood pressure assessment, pass a knowledge test and provide a certificate of recognition.

Audience

Primary health care teams including doctors, nurses, physicians and nurse assistants, technical personnel, pharmacists, and specialists such as internal medicine doctors and other specialists in charge of blood pressure measurement. Patients and non-health care professionals who are knowledgeable about hypertension may also find this course useful.

Duration / Workload

The course is open and available in the VCPH. As it is a self-learning course, participants can regulate their times and moments of dedication. When including the estimated time to review the course contents and the Final Test, the course is assigned a total of 1 hour.

This course provides a certificate valid for 6 months starting from the day that it is issued and with 1 academic hour of accreditation. Afterwards, participants are welcome to retake the course.

About the course
Home blood pressure monitoring is a proven intervention to enhance the accuracy and reproducibility of blood pressure measurement, and the development and implementation of a BP measurement training course can empower patients to self-control their BP and ultimately reduce patient-related clinical inertia and improve BP control.

The course on Home Blood Pressure Monitoring-Promoting patient self-measurement highlights (1) the significance of increased blood pressure, (2) the importance of proper blood pressure measurement technique, (3) the step-by-step process to properly measure blood pressure at home, (4) the factors that can lead to measurement error, (5) why to measure blood pressure at home and (6) how to interpret home blood pressure numbers, including when to follow-up and when to seek immediate action.

It consists of an interactive module with an illustrated video, an illustrated guide, a printable 7-day HBPM log, and a narrative evaluation. At the end of the modules, the student will be able to download the certificate issued by the Virtual Campus for Public Health (VCPH) of PAHO/WHO and validated by the World Hypertension League, International Society of Hypertension, Resolve to Save Lives initiative, Hypertension Canada, and the Québec Society of Vascular Sciences.

General objectives
Educating people in HBPM using a step-by-step approach, highlighting proper technique, person and environment preparation and the use of BPMDs clinically validated.

Audience
This course is intended for patients and the public with possible or confirmed hypertension diagnoses; PHC providers, with emphasis on nurses, medical and nurse assistants, pharmacists, and nutritionists, are encouraged to take the course and educate their patients on HBPM. In addition, community healthcare workers and social workers are recommended to embed the course and make it available for their patients.

Course structure
Overall, it consists of an interactive module with:
(1) an illustrated video
(2) a link to online listings of properly validated (accurate) automated blood pressure measuring devices
(3) an illustrated guide on how to perform home blood pressure measurement
(4) a printable 7-day HBPM log
(5) a final quiz to test knowledge

Course format
The course will be placed on the platform of the Virtual Campus for Public Health of PAHO/WHO, available 24 hours a day, seven days a week, in a self-administered modality according to the own participant pace, individually or as part of professional programs and educational meetings in the workplace. The course issues a certificate with 1 academic hour that can be downloaded automatically after passing the exam and filling the PAHO’s Virtual Campus survey.

Acknowledgements
This course has been partially funded by Resolve to Save Lives, an initiative of Vital Strategies, and by the Centers for Disease Control and Prevention (CDC) of the United States.

Sponsoring organizations
World Hypertension League
International Society of Hypertension
STRIDE BP
Hypertension Canada
Lancet Commission on Hypertension Group
Québec Society of Vascular Sciences
Resolve to Save Lives

OBJETIVO GENERAL:

Este curso tiene como objetivo mejorar la formación de los proveedores de salud en todos los aspectos relacionados con la prevención y el control del cáncer de cuello uterino, incluida su historia natural, prevención primaria a través de la vacunación contra el VPH, detección y tratamiento de lesiones precancerosas de cuello uterino, diagnóstico y tratamiento de cáncer de cuello uterino invasivo. y prestación de cuidados paliativos. El curso también cubrirá aspectos de la movilización comunitaria para el uso de servicios preventivos del cáncer. También se informará sobre la correcta organización de los servicios de vacunación y cribado. El curso también ofrece la posibilidad de completar un módulo que informa sobre la organización de los programas de control del cáncer de cuello uterino.

DESTINATARIOS / PERFIL DEL PARTICIPANTE

El curso está dirigido a trabajadores de la salud (especialmente a los del primer nivel de atención):

• médicos;
• Trabajadores no médicos (enfermeras, matronas, personal auxiliar, entre otros); y
• Gerentes de programa.

MÓDULOS:

El “Curso Virtual de Control Integral del Cáncer Cervicouterino”, ha sido diseñado para capacitar a los trabajadores de la salud en los elementos más relevantes en el conocimiento, prevención y control del cáncer cervicouterino.

El curso consta de 10 módulos, que se enumeran a continuación:

• Introducción
• Módulo 1. Conceptos clave sobre el cáncer de cuello uterino
• Módulo 2. Vacunación contra el VPH para la prevención del cáncer de cuello uterino
• Módulo 3. Aspectos programáticos de la vacunación contra el VPH
• Módulo 4. Detección de cáncer de cuello uterino
• Módulo 5. Diagnóstico y Tratamiento del Precáncer de Cuello Uterino
• Módulo 6. Prestación de servicios para la detección del cáncer de cuello uterino y el tratamiento de lesiones precancerosas
• Módulo 7. Diagnóstico y Tratamiento del Cáncer Invasivo
• Módulo 8. Cuidados Paliativos
• Módulo 9. Movilización Comunitaria, Educación y Consejería
• Módulo 10. Establecimiento de un programa de prevención y control del cáncer cervicouterino

The purpose of this course is to contribute to the reduction of morbidity and mortality in children and adolescents with cancer by strengthening the capacities of healthcare professionals on the early diagnosis of cancer with concepts and learning instruments that allow them to recognize the signs and symptoms of cancer in a timely and early manner.

The course will also cover the epidemiological, genetic, clinical and initial management aspects of children with suspected cancer. Information will also be provided on the interpretation of complementary tests for the timely diagnosis of cancer in childhood and adolescence.

Purpose

Provide a framework for healthcare workers aimed to strengthen their capacities on the early diagnosis of cancer in childhood and adolescence.

Objectives

At the end of the course, participants will be able to:

• Define what the key concepts of cancer in childhood and adolescence.
• Describe the risk factors and genetic syndromes associated with cancer in childhood and adolescence.
• Apply knowledge in clinical practice (especially primary care).
• Examine the process of initial diagnosis and management of various types of cancer in childhood and adolescence.
• Know the interpretation of complementary tests used in the initial diagnosis of cancer in childhood and adolescence.

Recipients

The Course is aimed at Healthcare Workers (especially those in the first level of care):

• Doctors
• Non-Medical Workers

Course duration

Ten hours

Course modality

Self-study course, free, open to the public and without deadlines to complete it.

Course structure

The "Virtual Course in Early Cancer Diagnosis in childhood and adolescence” has been designed to train the health worker on the most relevant elements in the knowledge of the timely diagnosis of cancer in the pediatric population. The course consists of 10 modules.

The Course modules are listed below:

• Introduction
• Module 1. Key Concepts of Cancer in childhood and adolescence.
• Module 2. Risk factors and genetic syndromes associated with cancer and childhood and adolescence.
• Module 3. Importance of early detection of cancer in children and adolescents.
• Module 4. Hematological neoplasms
• Module 5. Solid abdominal neoplasms
• Module 6. Neoplasms of bone and soft tissue
• Module 7. Central nervous system tumors, retinoblastoma
• Module 8. Neoplasms of germinal origin
• Module 9. Interpretation of complementary exams
• Module 10. Initial management of the child with suspected cancer

INTRODUCTION:

The Global HEARTS initiative of the World Health Organization (WHO) aims to improve practices in the control of cardiovascular diseases in the primary care level through the use of five technical packages: MPOWER for tobacco control, SHAKE for the reduction of salt consumption, REPLACE for the elimination of trans fat, ACTIVE for increasing physical activity, and HEARTS for the clinical management of hypertension, diabetes, and dyslipidemia (https://www.paho.org/en/hearts-americas/hearts-americas-technical-package). HEARTS prioritize the systematic and comprehensive management of hypertension through effective diagnostic and therapeutic interventions.

The course consists of 11 modules, from module III to XI each one is composed of 5 parts: 1) Module introduction and main concepts based on a presentation by an expert with experience in the implementation of HEARTS initiative, 2) Learning capsules consisting of short learning videos called "capsules" and other didactic material 3) Clinical exercise, 4) Recommended reading: include a set of reading to complement the learning, and 5) Evaluation, composed of 5 to 10 multiple choice questions that cover everything related to theoretical, practical, and reading material.

INTENDED AUDIENCE

This course is intended for primary care physicians, nurses, and others health workers, such as physician and nurse assistants, nutritionists, social workers, psychologists and other members of primary care team and health care managers.

Additionally, faculty at health sciences programs, including medicine, nursing, public health, are encouraged to make the course available to their students or to embed it in appropriate courses.

COURSE FORMAT

The course is available on the platform of the Virtual Campus for Public Health of PAHO/WHO, (VCPH) accessible 24/7, on a self-administered modality to be taken at the participant’s own pace, independently or as part of on-the-job professional development programs.

COURSE MODULES

• MODULE 0 Welcome remarks
• MODULE I Course structure and content
• MODULE II Framework of the HEARTS Global Initiative
• MODULE III Healthy-lifestyle counseling
• MODULE IV Evidence-based treatment protocols
• MODULE V Access to essential medicines and technology
• MODULE VI Risk based CVD management
• MODULE VII Team-based care
• MODULE VIII Systems for monitoring
• MODULO IX Implementation
• MODULE X Implementation and research
• MODULE XI Cost

Course purpose

The purpose of the course is to provide a basic introduction to the fundamentals of palliative care practice for clinical and non-clinical healthcare leaders and staff. By completing this virtual course, participants will have acquired knowledge about the modern definition of palliative care, and the basic principles that guide the evaluation and management of multidimensional suffering in patients with serious illness.

Learning objectives:

Main objective
Improve access to basic palliative care services in region via dissemination of the fundamentals of up-to-date, evidence-based palliative care practice to clinical and non-clinical healthcare staff.

Specific objectives

• Understand the history and current state of palliative care around the world
• Articulate a modern definition of the scope and mission of palliative care practice
• Understanding the basic principles of evaluation and management of pain
• Understand the basic principles of evaluation and management of other common physical symptoms (dyspnea, nausea, poor appetite and mood disorders)
• Recognize the role of psychosocial and spiritual support within palliative care practice
• Understand the ethical principles that guide palliative care practice
• Recognize basic principles of effective patient-provider communication within the context of palliative care
• Apply the multidimensional skills of high-quality palliative care practice to the specific scenario of caring for dying patient and their family
• Recognize the unique risk of burnout within palliative care providers, and highlight best practices to maximize resiliency

Audience

This course is aimed to:

• Primary care doctors and other general practitioners
• Non-palliative care specialists (oncologist, cardiologists, intensivist, etc.)
• Nurses
• Public health officials and ministry of health leaders
• Other allied professionals who regularly care for patients with patients with serious illness

Educational approach

The course is divided into 10 separate modules, with each including a short introductory video, core content delivered through informational slides, and reference list to support further learning. Finally, each section will end with an objective assessment to help highlight key teaching points.

Duration / Workload

The course is open and available in the VCPH. As it is a self-learning course, participants can regulate their times and moments of dedication. When including the estimated time to complete the modules and the Final Evaluation, the Course is assigned a total of 20 hours.

Course Structure

• Introduction to Palliative Care
• Pain Part 1
• Pain Part 2
• Non-Pain Symptoms Part 1
• Non-Pain Symptoms Part 2
• Psychosocial and Spiritual Support
• Ethics in Palliative Care
• Communication Skills
• End-of-Life Care
• Resiliency and Self-Care

Background

Cardiovascular disease continues to be the leading cause of premature morbidity and mortality globally. According to the 2022 Global Burden of Disease Report, high systolic blood pressure remains the leading modifiable risk factor globally for attributable premature cardiovascular deaths, accounting for 10.8 million deaths and 11.3 million deaths overall in 2021 and has been particularly linked to ischemic heart disease and stroke-related deaths. Cardiovascular disease is also the leading cause of premature morbidity and mortality in the Americas Region.

Improvement in blood pressure control has occurred. However, part of the improvement seen in the last two decades has slowed significantly and, in some cases, even reversed. 

The Pan American Health Organization through HEARTS in the Americas Initiative supports countries to develop their hypertension treatment protocols based on the latest 2021 WHO Guideline for the pharmacological treatment of hypertension in adults. Likewise, the initiative emphasizes the team care approach and supports the training and education of all members of the primary healthcare team, including physicians, nurses, or non-physician health workers (NPHW), to increase control of hypertension in PHC centers and to use antihypertension medication properly and effectively.

This virtual course aims to support clinicians using properly blood pressure medications, highlighting the newest WHO recommendations and the possible side effects of the main group of antihypertensive drugs.

Intended audience

This course is intended for primary healthcare teams members responsible for prescribing, titrating, and following up hypertensive patients. Primary care physicians, nurses, nurse assistants, nurse practitioners, allied health professionals, and medical, nurses and allied health science students will benefit from taking this course. In addition, teachers of health science programs, which include medicine and nursing, are recommended to embed the course, and make it available for their students or to incorporate it into their curriculum.

Course format

The course is placed on the platform of the Virtual Campus for Public Health of PAHO/WHO available 24 hours a day, 7 days a week, in a self-administered modality according to the participant’s own pace, individually or as part of professional programs and/or educational meetings in the workplace. 

The course issues a certificate with 16 academic hours that can be downloaded automatically once the students have met the course completion requirements, including passing the evaluation with 70% or more and completing the VCPH Quality Survey.

General objectives

1. To understand which common side effects of BP medications are dose-related and can be minimized with dose adjustment.
2. To understand which common side effects of BP medications, require medication discontinuation.
3. To understand how to deal with basic lab abnormalities including hyponatremia, hyperkalemia, hyperuricemia, and renal insufficiency.
4. To increase comfort level with use of spironolactone.

General skills

At the end of this course, health care providers who titrate BP medications (physicians, pharmacists, and nurses) should be able to more comfortably prescribe and titrate thiazide-type diuretics, ACEIs, ARBs, and CCBs, and deal with common side effects and lab abnormalities.  This will facilitate optimal use of preferred BP medication protocols.

Rationale

Noncommunicable diseases (NCDs) are the world’s leading cause of death and disability. They include cancer, cardiovascular disease, diabetes, and chronic lung disease, many of which can be prevented by reducing risk factors such as tobacco and alcohol consumption, physical inactivity, and unhealthy eating.

NCDs are the leading cause of death in the Region of the Americas. In 2021, they were responsible for six million deaths, 38% of them premature, occurring in people between 30 and 70 years of age. Following the outbreak of COVID-19, there was a change in death distribution among the leading causes of mortality, with more deaths attributed to communicable diseases. It is not known how many COVID-19 deaths occurred in people with NCDs, but it is likely that many of these deaths were associated with underlying NCDs. In 2021, NCDs accounted for 65% of all deaths, down from 80% in 2019, but remained the leading cause of death in the Americas. Despite this shift in death distribution, NCD mortality rates increased by 1.8% between 2019 and 2021. 

An estimated one in four adults in the Americas lives with at least one NCD, highlighting the need to strengthen primary care services. In line with Sustainable Development Goal (SDG) 3—which aims to reduce premature mortality from NCDs by one-third—it is crucial to improve the prevention, treatment, and management of these diseases in primary care.

To address this challenge, in 2023 PAHO launched the Better Care for NCDs Initiative (2023-2030), with the aim of scaling up equitable access to integrated services in primary health care (PHC).

Countries in the Region must bolster the ongoing training of their health teams, adapting to different national and local contexts. The Virtual Campus for Public Health (VCPH) promotes permanent education in health as a work-based process aimed at improving care for the population.

This course is part of the Initiative’s training itinerary and supports its implementation. It provides decision-makers and health teams with a comprehensive view of the epidemiological context, gaps in service quality and availability, and challenges to achieving better care for NCDs in PHC.

Objective

To present and analyze the main dimensions and strategic areas of PAHO’s Better Care for NCDs Initiative so that decision-makers and health teams can identify challenges and define the actions needed to strengthen NCD care in PHC, based on a preliminary analysis of their local situation.

Learning objectives

By the end of the course, participants will be expected to: 

1. Understand the concept and epidemiological context of NCDs and their comorbidities from a life course approach.
2. Understand the impact of social determinants of health on the development of NCDs and their risk factors.
3. Recognize the Initiative’s potential based on its objectives, recommended essential services, and expected impact.
4. Understand the opportunities for integrating NCD care into PHC based on the Operational Framework for PHC.
5. Understand the Initiative’s strategic areas and actions.
6. Recognize how to use the rapid assessment instrument as a local planning tool.
7. Identify the importance of providing accessible and equitable health services for NCD care through territorial planning and management, strengthening health promotion and the SDH approach, community engagement, intersectoral action, and telemedicine solutions.
8. Understand approaches to promote quality and safety in recommended essential NCD services.
9. Identify the importance of having competent interprofessional teams for comprehensive and integrated NCD care.
10. Recognize the need for planning, forecasting, provision, and quality assurance of NCD medicines and diagnostic tools.
11. Identify the importance of monitoring and evaluating lines of care for people with NCDs and the strategy’s key indicators.

Competencies

By the end of the course, participants will be expected to: 

• Develop a critical view of their local context, enabling the identification of available and necessary resources and actions, as well as the main challenges for better NCD care in PHC.
• Identify the importance of providing accessible health services for NCD care through territorial planning and management, addressing social determinants, identifying access barriers associated with both supply and demand, intercultural community engagement, and identifying vulnerable populations and territories, and telemedicine solutions.
• Recognize the Initiative as an opportunity to guide the integration of NCD care into PHC. 

Target audience 

• Primary healthcare teams, including community workers.
• Health services and NCD program managers.

Workload and contact hours

Total number of hours: 15

Self-administered, asynchronous.

Teaching strategies

Course Modality and Technology Platforms: self-administered, using the PAHO/WHO Virtual Campus for Public Health virtual educational platform. 

Flexible Lessons and Teaching Resources: Lessons will be presented using a variety of teaching resources and tools on the virtual platform. 

Course structure

Module 1: Presenting the Better Care for NCDs Initiative and its integration into PHC.

Topics:

• Definition and epidemiological context of NCDs.
• Life course, multimorbidity, and risk factors.
• Social determinants of health, their impact on NCDs, and their risk factors.
• Gaps and inequities in access to services.
• Presenting the Initiative: objectives, essential services, and challenges.
• Integrating NCD care into PHC: approach and benefits.

Module 2: Implementation – Strategic Areas 1, 2, and 3

Topics: Implementing the Initiative: strategic areas and actions (Part 1).

• Strategic Line 1: Needs assessment and operational planning. Telehealth and governance.
• Strategic Line 2: Community outreach and engagement in NCD services, with a focus on equity.
• Strategic Line 3: Normative guidance and improving quality of care. Evidence, clinical guidelines, and quality of care for risk factors, cardiovascular disease, hypertension, diabetes, asthma, COPD, and cancer.

Module 3: Implementation – Strategic Areas 4, 5, and 6

Topics: Implementing the Initiative: strategic areas and actions (Part 2).

• Strategic Line 4: Developing interprofessional health teams in PHC. Training itinerary.
• Strategic Line 5: Scaling up access to medicines and technologies. Pharmaceutical services and PAHO Strategic Fund.
• Strategic Line 6: NCD monitoring and follow-up based on key indicators.

Foundation: 

Cardiovascular disease (CVD), with about 2.2 million deaths annually, is the leading cause of death in all countries of the Americas. CVD is the leading cause of premature mortality and disability, reducing the life expectancy of the population, and increasing inequities. In addition, the reduction in cardiovascular mortality has slowed down in the last decade (2010-2019), putting at risk the regional goal of reducing premature mortality from noncommunicable diseases by 30% by 2030. 

Hypertension (≥ 140/90 mm Hg) affects more than one-third of adults in this region and is the main modifiable risk factor for CVD. However, despite the efforts made, approximately 30% of people with hypertension are unaware of their condition, and only half of those who receive treatment achieve adequate control of their blood pressure. As a result, only about 37% of people with hypertension in the region manage to keep their blood pressure under control. These figures show significant gaps in access, coverage, and quality of health services, particularly in timely diagnosis and effective treatment, highlighting the limitations of the current model of health care. 

What factors are limiting the effective control of hypertension in the health systems of the Region? How can primary care teams overcome current barriers and achieve better results? 

HEARTS in the Americas, the regional adaptation of the World Health Organization's (WHO) Global HEARTS initiative, seeks to transform hypertension care and cardiovascular risk management through a continuous quality improvement approach in primary health care (PHC). This multicomponent, evidence-based program uses the clinical management of hypertension as a starting point to integrate and strengthen prevention and treatment of cardiovascular, renal, and metabolic diseases, which represent the main causes of disease burden in the region. 

HEARTS is fully aligned with PAHO's strategy "Better Care for Noncommunicable Diseases: Accelerating Action in PHC" and acts as its spearhead to improve the quality of care for these conditions in the region's health systems. It is estimated that a 1% increase in population hypertension control in the region can reduce CVD mortality by about 3% per 100,000 people, especially due to ischemic heart disease and stroke. If Latin America and the Caribbean were to increase the level of population control of high blood pressure to 50%, around 500,000 premature deaths could be avoided in a period of five years. And if cardiovascular risk were addressed in an integrated way, as HEARTS proposes, the impact would be even greater, also reducing complications related to diabetes and chronic kidney disease. 

The HEARTS quality improvement methodology guides the systematic implementation of the Drivers for Hypertension Control and Cardiovascular Risk Management, reducing gaps in hypertension coverage and control and reducing associated mortality. Central to this process is the HEARTS Clinical Pathway, a standardized, evidence-based tool designed to guide the comprehensive management of hypertension and cardiovascular risk in primary care settings, simplifying decision-making and facilitating the delivery of quality care. 

HEARTS conceives quality monitoring and evaluation as a continuous process of collective learning and strengthening of organizational commitment. This non-punitive process is aimed at identifying barriers in implementation and developing innovative, effective and sustainable local solutions that improve both processes and health outcomes. The evaluation for quality improvement in HEARTS focuses on a systematic and standardized assessment of four fundamental domains: fidelity, feasibility, acceptability, and effectiveness of the interventions promoted by the program.

General objective: 

Strengthen the competencies of primary care teams to systematically implement the HEARTS program in the Americas, applying its methodology of continuous quality improvement and integrating clinical and management tools, with the purpose of closing gaps in the care and control of hypertension and cardiovascular risk, and contributing to the reduction of premature mortality from noncommunicable diseases in line with the goal established for 2030. 

General Competencies: 

• To analyze the impact of cardiovascular diseases in the region of the Americas, understanding hypertension as the main modifiable risk factor and applying the concept of the "Treatment Cascade" to identify gaps in care and accelerate the implementation of the quality standards of the HEARTS program in primary health care.
• Introduce the HEARTS in the Americas initiative, understanding its vision, mission, and programmatic strategies to facilitate the transition to a model of continuous quality improvement in primary care centers and its effective integration into health systems.
• Recognize and apply the Drivers and essential clinical tools of the HEARTS program, operationalized in primary care through the Clinical Pathway, to optimize the management of hypertension and cardiovascular risk.
• Implement the HEARTS continuous quality improvement methodology, designing and implementing improvement cycles that include: the development of an implementation plan; the systematic integration of HEARTS drivers into clinical and management processes; the documentation of improvements; the conduct performance review meetings; continuous feedback to health teams; and the establishment of effective communication mechanisms.
• Use monitoring and evaluation tools for continuous improvement, analyzing the fidelity, feasibility, acceptability, and effectiveness of the interventions proposed by the HEARTS program, and developing improvement plans that contribute to optimizing the performance of primary care centers in the population control of hypertension and cardiovascular risk.

Admission profile: 

This course is aimed at professionals and workers in the health sector at any level of the system (macro, meso or micro) who wish to contribute from their role to the reduction of preventable mortality and the alleviation of individual and collective suffering caused by avoidable morbidity and mortality due to cardiovascular conditions. It is especially aimed at those who work in primary health care and seek to improve the quality of services in the control of hypertension and the management of cardiovascular risk. No previous experience in quality improvement methodologies is required.

Course Format: 

The course is available on the PAHO/WHO Virtual Campus for Public Health (VCPH) platform, 24 hours a day, 7 days a week. As it is a self-study course, participants can regulate their times and moments of dedication. 

The course issues a certificate with 8 hours that can be automatically downloaded once participants have met the course completion requirements, including passing the assessment of each module with 80% or more and completing the VCPH Quality Survey.

Modules:

• Module 1. The central role of hypertension control in advancing in the reduction of mortality from cardiovascular diseases in the region of the Americas.
• Module 2. HEARTS Continuous Quality Improvement Methodology for Primary Care Settings.
• Module 3. Essential clinical tools for quality improvement.
• Module 4. Implementation of the HEARTS quality improvement methodology in primary care facilities.
• Module 5. Monitoring and evaluation of the implementation of HEARTS in primary care facilities.

Expected results: 

At the end of the course, and using the technical and methodological knowledge, as well as the clinical and management tools that HEARTS in the Americas makes available to countries, participants will be able to implement and evaluate effective interventions to improve the quality of care in their health centers. In this way, they will be able to contribute to the reduction of mortality and morbidity associated with hypertension and cardiovascular diseases in the region of the Americas.

Assessment and certification: 

This course will provide participants with the tools needed to drive meaningful changes in cardiovascular health care in each country implementing the HEARTS program, ensuring comprehensive, equitable, and sustainable management of hypertension and cardiovascular risk in communities. 

Participants must pass the evaluation corresponding to each module (5 in total). These assessments are designed to offer participants multiple opportunities and consist of five multiple-choice questions.

Participants who meet the course requirements and obtain the minimum passing grade of 80% will be able to download their certificate, issued by the Pan American Health Organization/World Health Organization (PAHO/WHO).