TABLE 2. Barriers to adoption of national WHO-HEARTS hypertension control programs and potential solutions provided by health economic analysis.

Barrier	Solution
Countries are unlikely to invest budget sufficient to deliver life-long services for a highly prevalent condition like hypertension absent a convincing investment case	Health economic analysis can quantify value for money.
It is hard for countries to finance hypertension control without fundamental improvements to universal access, including health care financing overall. Countries need to explore financing schemes that support a broad package of essential services, including for NCDs but also incentivize highest priority conditions like hypertension.	Health economic modeling may reveal the balance between capitation and disease-specific incentives.
Cost of antihypertensive medications is among the biggest barriers to countries adopting national hypertension control programs, and lack of transparency re drug pricing and variable pricing across countries.	Quantifying cost-effectiveness and budget impact gives countries specific benchmark prices to work toward and may encourage regional or global pooled procurement.
Team-based care is known to be effective compared with usual care, but the economic case for team-based care must be better established. For example, shifting tasks to lower salary healthcare worker cadres should save money; but costing of team-based care complex.	Research is needed to determine what is more important, adding members to the team, or expanding the scope of practice for individual team members.
Presence of a large private sector presence in some countries complicates the design, execution, and health economic evaluation of national hypertension control programs.	Studies in country private sectors are needed, including studies of private sector financial incentives to monitor and retain chronic disease patients, like people living with hypertension.
National health insurance programs may not cover a full package of essential, high-value health care services that includes hypertension screening and treatment.	There is a need for comprehensive and inclusive health services evaluations, including costing and economic analysis of HEARTS hypertension control services in the context of integration with other primary care priority conditions.
A compelling investment case is needed before countries will adopt and scale up the HEARTS hypertension control package must address the needs, incentives, and competing priorites of multiple in-country stakeholders.	Need for regular, intensive engagement of local governments, medication and device manufacturers, health workers, patients and their families, and information system designers in the health economic evaluation process.

Source: This list of barriers and solutions was generated from informal discussion among the authors of this special report.