Task‐Shifting to Nurses for Hypertension Control in Rural Sub‐Saharan Africa: A Narrative Review of Effectiveness and Implementation Challenges

Abstract

BACKGROUND: Rising cardiovascular morbidity and mortality in rural sub-Saharan Africa are largely attributable to insufficient awareness, treatment and control of hypertension. The delivery of care is further constrained by health system limitations, including shortages of physicians, inadequate infrastructure, challenges in medication supply chains and geographical barriers to access. As a tactic to increase access, adherence and continuity of care, task-shifting hypertension management to nurses-often with the assistance of community health workers-has become popular. The evidence on the efficacy and implementation difficulties of nurse-led hypertension therapies in rural Sub-Saharan African settings is compiled in this narrative review. METHODS: To investigate task-shifted and nurse-led hypertension care in rural SSA, a narrative evaluation was carried out. Terms associated with task-shifting, nurse-led care, hypertension and rural SSA were used to search PubMed, Scopus, Web of Science and Embase. Studies that met the eligibility requirements reported implementation results or patient outcomes. The effectiveness of the intervention, implementation difficulties and enabling variables were highlighted in the narrative synthesis of the data. RESULTS: In rural Sub-Saharan Africa, nurse-led and task-shifted treatments enhanced medication adherence, blood pressure control and continuity of care. Protocol-driven nurse management, patient education, follow-up monitoring and assistance from mobile health tools or community health professionals were common elements. Drug stockouts, scope-of-practice limitations, inadequate training, supervision and partial integration into primary care were among the implementation obstacles. Alignment with current health systems, community involvement and structured mentoring were among the facilitators. CONCLUSION: Evidence from rural Sub-Saharan Africa indicates that task-shifting hypertension care to nurses is feasible and, when adequately supported, can improve key care processes and outcomes. To optimize the potential benefit of nurse-led hypertension management in rural settings, it is imperative to address health system bottlenecks, improve training and supervision and align regulatory frameworks with task-shifting strategies.