Effectiveness of a Community Health Worker–Led Hypertension Screening and Referral Program in Rural Western Tanzania: A Pilot Implementation Study

Getera Isack Nyangi^1, , Olela Manuel Dennish² and Witness Erick Macha³

¹District Medical Officer, Kakonko District Council, Tanzania

²District Community Health Workers Coordinator, Kakonko District Council, Tanzania

³District Non-Communicable Disease Coordinator, Kakonko District Council, Tanzania

Cite this paper:
Getera Isack Nyangi, Olela Manuel Dennish and Witness Erick Macha. Effectiveness of a Community Health Worker–Led Hypertension Screening and Referral Program in Rural Western Tanzania: A Pilot Implementation Study. American Journal of Public Health Research. 2026; 14(4):71-79. doi: 10.12691/ajphr-14-4-1

Abstract

Hypertension remains a leading modifiable risk factor for cardiovascular diseases globally, yet early detection is still limited in many rural settings of low- and middle-income countries. This study evaluated the effectiveness of a Community Health Worker (CHW)–led hypertension screening program by assessing screening performance, referral completion, concordance between CHW and facility-based diagnosis, and changes in facility-level hypertension detection. A quasi-experimental study was conducted in Kakonko District, Tanzania, where CHWs carried out household-based blood pressure screening and referred individuals with elevated readings to nearby health facilities (dispensaries). Participants who completed referral underwent repeat blood pressure measurements at health facilities to assess diagnostic concordance. Routine DHIS2 data were analyzed using a Difference-in-Differences approach to evaluate changes in hypertension detection. A total of 981 adults were screened by CHWs, of whom 224 (22.8%) were identified with elevated blood pressure. Referral slips were available for 201 (89.7%) participants, while referral slips for the remaining 23 (10.3%) participants were not observed. Among those who received referral slips, 161 (80.1%) completed referral to health facilities. Of the participants reassessed at the health facilities, 130 (80.7%) were confirmed to have hypertension, indicating good agreement between community- and facility-based blood pressure measurements. Facility-level hypertension detection increased markedly in intervention facilities compared to control facilities. The Difference-in-Differences analysis showed an additional 6.6 percentage point increase in hypertension detection attributable to the intervention. In conclusion, CHW-led hypertension screening is a feasible, accurate, and effective strategy for improving early detection and linkage to care in rural Tanzania.

Keywords:
Hypertension Community Health Workers Screening Referral system Rural Tanzania

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