September 2022

Trinidad and Tobago has become the first country to scale-up the HEARTS initiative to all public primary health care centers across the country.

“They told me that my blood pressure was too high, and that the situation had to be addressed and corrected” says Krishna Maharaj, a patient at the primary care center in Freeport, Trinidad and Tobago.

Mr. Maharaj is not alone: 30% of men and 23% of women in this island nation have high blood pressure (also known as hypertension). Hypertension dramatically increases the risk of heart attack and stroke, and often goes unnoticed by the patient. But it is preventable and easily treatable so long as health leadership prioritizes heart health. This is exactly what has happened in Trinidad and Tobago.

Patient Mr. Krishna Maharaj with his physician Dr. Michael Jaggernauth at Freemont Primary Care Center

Trinidad and Tobago is a twin-island state in the southern Caribbean. Its population of 1.35 million people come from diverse African, East Indian, and mixed ethnic backgrounds. Trinidad and Tobago joined the global HEARTS Initiative in July 2019, which is led in this country by the government in partnership with the Pan American Health Organization (PAHO). “The HEARTS Initiative is a new way to deliver health services, reforming the way we work”, explained Dr. Rohit Doon, Public Health Medical Advisor at the Ministry of Social Development and Family Services. The HEARTS Initiative includes key evidence-based interventions such as standardized treatment protocol, access to high-quality medication and blood pressure measuring devices, team-based care supported by training and a system for monitoring and evaluation to improve the quality of care provided.

Since 2019, the Ministry of Health in Trinidad and Tobago has been working to scale-up the implementation of this initiative. HEARTS was initially rolled out in five primary health care centers, one in each Regional Health Authority (RHA). Data provided by these health centers revealed that hypertension control improved significantly: In two of the health care centers, Sangre Grande blood pressure control increased from 20% to 36% and Arima from 30% to 51% (an increase of 16.0% and 21.0% respectively) within the first six months of implementation.[1] Today, HEARTS is being implemented in 102 primary care centers throughout the entire country, reaching around 100,000 persons with hypertension treatment, and transforming Trinidad and Tobago into the first country to scale up HEARTS nationally within its primary care system.

[1] Doon R, Malcolm T, Lewis Y, Holder L, Gulston L, Hamid A, et al. Improving cardiovascular health with the patientcentered, integrated primary care HEARTS model in Trinidad and Tobago. Rev Panam Salud Publica. 2022;46:e169. https://doi.org/10.26633/RPSP.2022.169

Siparia Health Center — Patients at Sangre Grande Health Center

For Dr. Roxanne Mitchell, Acting General Manager of Primary Care Services in Regional Health Authority of Tobago, HEARTS makes it easier “to follow up with our clients and get faster results. Prior to this initiative, individual physicians would see clients and treat them in accordance with their knowledge and what had worked for them over the years. Now, there is a standardized treatment protocol that can be followed up by physicians, clients and even relatives.”

Primary care workers have also been able to improve their training in the management of Cardiovascular Disease (CVD) through PAHO’s Virtual Campus for Public Health. To date, around 300 primary care physicians, nursing professionals, nutritionists and health service managers have taken the virtual courses led by professors from the Caribbean and the rest of the Region.

“What’s interesting is that since starting to test my blood pressure, I have noticed a drop,” said Mr Maharaj. “When I began the HEARTS program, my blood pressure was 155/90 and it’s now at 123/75 and dropping.” The team that takes care of Mr. Maharaj recommended a change in his medication based on updated hypertension treatment protocols, as well as some lifestyle changes, all of which have had a positive impact on his blood pressure.

Patient Mr. Krishna Maharaj at Freemont Primary Care Center

HEARTS Initiative

The HEARTS in the Americas Initiative is part of a global drive to strengthen health systems and provide better care for noncommunicable diseases at the community and individual levels. Thanks to its success in Trinidad and Tobago, other countries beginning to implement HEARTS are actively taking the lessons learned, including Guyana, Suriname, and Belize, among others. Today, 2,117 primary care centers in 24 countries in the Americas are providing care to 1,343,218 million patients like Mr. Maharaj – all of whom are aiming to improve their blood pressure and lead healthier, happier, and longer lives.

Capacity building workshop for health care providers, Suriname (August 17, 2022)

*PAHO gratefully acknowledges the financial and technical support of the United States Centers for Disease Control and Prevention (CDC) and Resolve to Save Lives.

Video: HEARTS Initiative in Trinidad and Tobago

Reaching 100,000 hearts on two islands

HEARTS Initiative

Video: HEARTS Initiative in Trinidad and Tobago

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