Trinidad and Tobago HEARTS Initiative (TTHI)

Objectives

The Trinidad and Tobago HEARTS Initiative seeks to strengthen cardiovascular disease management, treatment and control in primary care through the Global HEARTS Initiative, while expanding non-communicable disease self-management and patient support.[1][2]Its intended model combines healthy-lifestyle promotion, evidence-based clinical protocols, cardiovascular risk assessment, team-based chronic care, reliable medicines and technologies, patient education, and monitoring systems for hypertension and diabetes.[3][4][5][2]

• Secure commitment from stakeholders and regional health authorities, establish governance arrangements and focal points, select demonstration sites, and complete a national implementation work plan.[1][3]
• Adapt HEARTS technical packages, treatment guidance and healthy-lifestyle materials to the national setting, including treatment algorithms for hypertension and diabetes and cardiovascular risk-management guidance.[3][5][2]
• Strengthen diabetes and hypertension registers, standardised data collection, surveillance and chronic-care delivery in primary healthcare settings.[4][5]
• Improve access to essential medicines, point-of-care technologies and other core medical supplies through formulary revision, needs assessment, procurement improvement, distribution and facility-level stock management.[4][5][2]
• Build workforce capacity through training and support for primary care staff, master trainers, surveillance personnel and lay people involved in non-communicable disease care.[3][4][5][2]
• Empower patients to manage chronic conditions through education, support groups, patient-guided care, self-monitoring, communication and documentation of effective practice.[2]
• Develop multi-sectoral partnerships with non-governmental organisations, civil society, academic institutions and policymakers to extend patient support, share innovation and promote whole-of-government and whole-of-society communication.[2]
• Apply cardiovascular disease risk tools across programme sites and strengthen access to core medicines and risk-management guidance by the end of 2020.[2]

Implementation

Implementation is structured around national oversight, a HEARTS subcommittee of the Non-Communicable Disease Oversight Committee, regional and local HEARTS teams, designated focal points and demonstration sites within regional health authorities.[1][3][5]Delivery brings together the Ministry of Health, Pan American Health Organization country and regional teams, the Global HEARTS team, regional health authorities, primary care workers, clinicians, surveillance and medical-records staff, universities, community organisations and non-governmental organisations.[1][3][4][5]

• Conduct site and needs assessments to identify implementation requirements, medicines and technology gaps, and procurement or stock-out problems at participating facilities.[1][3][4][2]
• Select and customise HEARTS packages, review patient documentation, revise the health passport, and develop or disseminate national clinical guidance and practical management tools.[1][5][2]
• Establish hypertension and diabetes registers at demonstration sites, use approved minimum data sets and data-capture forms, and initially support paper-based recording with potential transition to an information-technology platform.[4]
• Train master trainers, site personnel and relevant health workers, while providing training materials, forms, computers, medicines, point-of-care equipment and site-specific implementation support.[4][5]
• Strengthen patient-centred delivery by establishing support groups, improving patient education, promoting self-management, creating forums to share good practice, and documenting education and support approaches.[2]
• Engage civil society, non-governmental organisations, lay people, policymakers and academic institutions in training, communications, support-group development, innovation sharing, research dissemination and public engagement.[2][6]
• Monitor implementation through selected core and optional indicators, prevalence-based baselines, targets, a monitoring and evaluation plan, and a reporting framework.[6]Demonstration sites are expected to submit minimum diabetes and hypertension data to the Ministry of Health each month.[4]
• Track the completion of costing and budget work, medicine and technology provision, staff training, availability of core supplies, procurement-gap correction, and numbers of people treated whose hypertension and diabetes are controlled.[5]
• Produce and circulate a bi-monthly HEARTS non-communicable disease surveillance report, supported by surveillance teams, clinicians, clerks, district health visitors, medical-records staff and participating institutions.[5]
• Identify an evaluation team, undertake monitoring and evaluation, assess the programme one year after implementation, share findings with policymakers and academic institutions, seek publication of at least one peer-reviewed article, and hold a public results forum after one year.[6]
• Complete several early activities, including demonstration-site implementation, capacity building and surveillance reporting, by the end of 2019; continue actions on medicine and technology availability through the end of 2020.[5]

Monitoring & Evaluation

The Trinidad and Tobago HEARTS Initiative (TTHI) proposes a monitoring and accountability system centred on standardised clinical data, facility registers, routine reporting, surveillance outputs and a formal monitoring and evaluation framework. It combines early implementation monitoring at demonstration sites with a planned programme assessment one year after implementation.[4][5][6]

• Establish standardised minimum data sets for diabetes and hypertension, initially through paper-based forms, with possible transition to an information-technology platform; approve data-capture forms and train relevant staff in their use.[4]
• Create hypertension and diabetes registers at demonstration sites and require monthly submission of minimum data sets to the Ministry of Health.[4]
• Select core and optional indicators, establish baselines using prevalence data, set targets, and develop a monitoring and evaluation plan and reporting framework.[6]
• Measure implementation progress through indicators covering completion of costing and budgeting, provision of medicines and technologies, availability of core medicines and technologies, identification and correction of procurement gaps, and numbers of staff trained by category.[5]
• Track health-service outcomes, including the number of people receiving treatment whose hypertension and diabetes are controlled, and the number of clients achieving target blood-pressure and blood-sugar control.[5][2]
• Produce and circulate a bi-monthly HEARTS non-communicable disease surveillance report, involving surveillance teams, clinicians, clerks, district health visitors, medical-records staff and other participating institutions.[5]
• Identify an evaluation team, conduct monitoring and evaluation activities, and assess the programme one year after implementation.[6]
• Share findings with policymakers and academic institutions, publish research outputs including at least one peer-reviewed article, and hold a public forum on results after one year.[6]

Accountability is distributed across Ministry of Health oversight, the HEARTS subcommittee of the Non-Communicable Disease Oversight Committee, regional and local HEARTS teams, demonstration-site personnel and Pan American Health Organization partners.[1][4][5]The available material does not specify a detailed evaluation methodology, indicator definitions, reporting template, data-quality assurance process, public reporting schedule beyond the surveillance report, or sanctions for non-performance.[1][4][5]

Costing & Financing

Costing is envisaged as an implementation-planning activity rather than as a fully quantified financial plan. The initiative proposes using the World Health Organization HEARTS costing tool to calculate programme costs and develop an implementation budget, but no monetary totals, allocations or economic assumptions are provided.[5]

• Calculate the cost of the TTHI using the World Health Organization HEARTS costing tool and develop a budget for implementation.[5]
• Mobilise seed funding and other support from the Pan American Health Organization and the World Health Organization Global HEARTS Initiative.[1][3][4][5]
• Draw on the Health Systems Strengthening Project as an identified financing source.[1][3][4][5]
• Resource implementation with trained personnel, data-collection forms, computers, point-of-care testing equipment, essential medicines, medical technologies, training materials and site-specific support.[4][5]
• Support medicine and technology availability through needs assessments, procurement improvement, distribution measures and facility-level supply management.[2]

The source does not specify budget amounts, unit costs, expenditure categories, allocations by region or activity, financing commitments, funding gaps, domestic-government contributions, procurement budgets, cost-effectiveness assumptions, or resource-mobilisation targets.[1][3][4][5][2][6]