Prioritizing Accessible Healthcare for Hypertension Management to Achieve Universal Health Coverage in Bermuda – a recognized PAHO NCD Good Practice

Kingston, Jamaica, 01 September 2025 (PAHO/WHO) - The Government of Bermuda's work to advance Universal Health Coverage (UHC) has been formally recognized as a PAHO/WHO Non-Communicable Diseases (NCD) Good Practice. Bermuda was invited to present this initiative alongside Bolivia, Brazil, and Costa Rica for innovative approaches to strengthen integrated NCD management and expand access to healthcare.

During the PAHO/WHO webinar "Best Practices for NCDs: Integrated Management, Advances in Diagnosis, Treatment & Primary Care," held on August 27, 2025, Ms. Brittany Darko presented Bermuda's experience with HEARTS Implementation under the theme "Prioritizing Accessible Healthcare for Hypertension Management to Achieve Universal Health Coverage."

Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality in Bermuda. A primarily private healthcare system, coupled with 12% of the population without health insurance and 23% uninsured or underinsured, creates inequities in access. Recognizing this, the Government of Bermuda initiated planning for Universal Health Coverage (UHC) in 2021 to expand access to affordable, high-quality healthcare while achieving long-term cost savings through prevention and early intervention. As part of these efforts, clinical services for patients with non-communicable diseases were offered and scaled up in the island's only public primary healthcare facility, Hamilton Health Centre.

In June 2023, Bermuda applied the PAHO/WHO "HEARTS in the Americas" framework to standardize management protocols, build healthcare provider capacity, and implement best practices.

Results Achieved (by December 2024)

1. Clinic Growth & Patient Engagement:
⦁ 110 clients enrolled (up from 20 in 2022).
⦁ Clinic initially designed for uninsured and underinsured patients but later attracted insured patients due to positive outcomes.

2. Blood Pressure Control:
⦁ 62% of patients achieved BP control (<140/90), up from 25% at the start of HEARTS implementation.

Interventions Driving Success

⦁ An equity-focused approach prioritized free services and free medications for uninsured/underinsured patients.
⦁ Standardized treatment protocols utilizing an algorithmic approach reduced medication waste, facilitated more aggressive titration when needed and ensured consistent, evidence-based care across all patients.
⦁ Nurses were empowered to dispense medications directly at the "point of care" under the Pharmacy and Poisons Act 1979. This team-based model increased efficiency, reduced waiting times, and allowed more clients to be seen at each session.
⦁ Regular program reviews, guided by the Plan-Do-Check-Act (PDCA) pathway, strengthened service design and supported sustainable improvements through implementation research.
⦁ Whole-of-team engagement of members, supported by strong leadership and multi-level alignment, ensured a shared vision of equitable access and improved outcomes.

The Hamilton Health Centre has grown into a model chronic disease clinic, showcasing measurable success in hypertension management. The program has expanded patient reach significantly, engaged a larger proportion of the hypertensive population and ultimately achieved more than double the blood pressure control rates.

Examples of PAHO Good Practices can be found at Good Practices in Public Health Portal | Experiences and Lessons Learned from the Americas