Trinidad and Tobago HEARTS Initiative (TTHI)

Objectives

The Trinidad and Tobago HEARTS Initiative (TTHI) provides a primary-health-care framework to reduce premature mortality from non-communicable diseases before age 70 by 25% by 2025, with particular emphasis on improving prevention, detection, treatment and long-term control of hypertension, diabetes and cardiovascular disease.[1]It seeks to introduce a chronic care model at selected facilities, aligning national clinical guidance, service delivery, medicines, technology, self-management support, surveillance and quality improvement with the HEARTS technical package.[2][3]

• Position TTHI among national stakeholders, secure its formal launch and establish national guidelines tailored to Trinidad and Tobago.[1][2]
• Implement HEARTS packages covering healthy lifestyles, evidence-based treatment protocols, access to essential medicines and technologies, cardiovascular risk-based management, team-based care and monitoring systems.[2]
• Strengthen management of hypertension and diabetes in primary care, including national protocols, clinical tools, treatment algorithms and improved cardiovascular risk management.[1][2][4]
• Establish and strengthen hypertension and diabetes registers, minimum data sets and non-communicable disease surveillance arrangements.[1][5]
• Improve availability of essential medicines, point-of-care testing, basic health technology and procurement mechanisms that address stock-outs and service-delivery gaps.[3][4]
• Build patient self-management and support through a customised Healthy Lifestyle Module, Health Passport integration, self-monitoring tools, patient groups and community engagement.[4]
• Measure programme impact using agreed indicators, prevalence baselines, targets, monitoring and evaluation, research and public dissemination of findings.[6]

Implementation

TTHI is designed for phased implementation through national governance, Regional Health Authorities and selected demonstration sites, combining Ministry of Health leadership with technical support from the Pan American Health Organization and World Health Organization HEARTS teams.[1][2]Delivery relies on regional and local HEARTS Teams, trained primary-care staff and local health teams, supported by clinicians, surveillance personnel, medical-records staff, universities, civil-society organisations, community groups, clients and patient support groups.[5][3][4]

• Establish a national governance mechanism, national team and HEARTS committees; obtain Ministry of Health approval, Pan American Health Organization acceptance and Regional Health Authority commitment.[1]
• Identify demonstration sites, conduct site assessments, approve a work plan and form or sensitise HEARTS Local Teams within each Regional Health Authority.[1][3]
• Adopt and adapt technical guidance, customise packages for individual sites and commission development of national hypertension and diabetes protocols.[2][3]
• Launch the initiative through a national symposium, circulation of national guidelines and master-trainer preparation.[2][5]
• Assess training needs, develop training plans and materials, and train demonstration-site staff and local teams.[5][3]
• Review the formulary against national treatment guidelines, identify procurement gaps, provide core medicines and technology, and address stock-out problems across participating facilities.[3][4]
• Engage non-governmental organisations, civil society, lay persons and whole-of-government and whole-of-society partners through communication, advocacy and the sharing of self-management innovations.[4]
• Collect standardised hypertension and diabetes data through approved forms, initially paper-based with planned migration to an information-technology platform, and require monthly reporting from demonstration sites to the Ministry of Health.[5]
• Monitor implementation through milestones including governance establishment, site selection and assessment, guideline adoption, package customisation, symposium delivery and staff training.[1][2]
• Track service and outcome measures, including numbers treated with controlled hypertension or diabetes, blood-pressure and blood-sugar control, availability of core medicines and technology, staff trained by category, communication planning and Health Passport integration.[3][4]
• Produce bi-monthly HEARTS non-communicable disease surveillance reports and use surveillance data from HEARTS sites to inform programme oversight.[3][5]
• Agree core and optional indicators, establish prevalence baselines and targets, create a monitoring and evaluation framework, appoint an evaluation team and conduct an evaluation one year after implementation.[6]
• Disseminate findings through research papers, at least one peer-reviewed journal article and a public forum after one year; impact-measurement activities are scheduled for completion by the end of 2021.[6]
• Cost the initiative with the World Health Organization HEARTS costing tool and develop a budget through that exercise.[3]
• Mobilise proposed seed and implementation support from the Pan American Health Organization, the World Health Organization Global HEARTS Initiative and the Health Systems Strengthening Programme for training, materials, computers, forms and point-of-care equipment.[1][2][5][3]

Monitoring & Evaluation

The Trinidad and Tobago HEARTS Initiative uses phased implementation milestones, routine service data and formal impact evaluation to monitor delivery and outcomes for hypertension, diabetes and cardiovascular disease in primary care. Accountability is centred on the Ministry of Health, Regional Health Authorities, HEARTS governance structures, demonstration-site teams and surveillance personnel.[1][2][5][3][6]

• Track approval of the initiative, governance arrangements, Regional Health Authority commitment, demonstration-site identification and assessments, work-plan completion, guideline adoption, HEARTS package customisation, national launch activities and master-trainer preparation as implementation milestones through 2019.[1][2]
• Establish a standardised minimum data set for hypertension and diabetes, initially through paper forms and subsequently through an information-technology platform.[5]
• Approve data-capture forms, train staff at demonstration sites, conduct at least five workshops and create master trainers to support consistent data collection and service delivery.[5]
• Require demonstration sites to submit monthly hypertension and diabetes minimum data sets to the Ministry of Health.[5]
• Begin non-communicable disease surveillance using data from HEARTS sites, involving clinicians, nurses, clerks, medical-records personnel, university partners, surveillance teams and Regional Health Authority surveillance teams.[5]
• Produce and circulate bi-monthly HEARTS non-communicable disease surveillance reports and monitor the availability of core medicines and technologies at participating sites.[3]
• Measure the number of people receiving treatment whose hypertension and diabetes are controlled, including blood-pressure and blood-sugar control outcomes.[3][4]
• Track training plans, training materials and staff trained by professional category, alongside communication planning, integration of the Health Passport, and documented self-management best practices.[3][4]
• Select core and optional indicators, establish prevalence baselines, set targets, develop and apply a monitoring and evaluation framework, and appoint an evaluation team.[6]
• Conduct an evaluation one year after implementation, publish findings through research papers including at least one peer-reviewed article, and hold a public forum to disseminate results; impact-measurement activities were scheduled for completion by the end of 2021.[6]

The available material identifies reporting frequencies, service and outcome measures, and evaluation dissemination mechanisms, but does not specify indicator definitions, numerical targets, data-quality procedures, reporting templates, sanctions for non-reporting or an independent audit process.[5][3][6]

Costing & Financing

Financing combines seed and programme support from international and health-system-strengthening sources with operational inputs such as trained personnel, local health teams, forms, computers, equipment, medicines, technology and training. The initiative also plans a formal costing exercise to produce a budget.[1][2][5][3]

• Mobilise seed funding from the Pan American Health Organization and the World Health Organization Global HEARTS Initiative for implementation activities.[1]
• Seek support from the Pan American Health Organization, the World Health Organization HEARTS Initiative and the Health Systems Strengthening Project or Programme for implementation, including site materials, point-of-care testing equipment, computers and training.[2][5][3]
• Provide operational resources including trained staff, local health teams, data-collection forms, computers and related equipment.[1][2][5]
• Calculate the cost of the Trinidad and Tobago HEARTS Initiative using the World Health Organization HEARTS costing tool and develop a budget from that costing exercise.[3]

No numerical budget, allocation, expenditure estimate, unit cost, funding gap, financing timetable or economic assumption is specified in the plan excerpts.[1][2][5][3]