India Hypertension Control Initiative

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Background

  • Cardiovascular diseases (CVD) are a major cause of death among adults in India. 
  • Also, the leading cause of heart attacks and strokes is the negligence of high blood pressure or hypertension. Hypertension is a silent killer i.e. most of the time patients do not experience any symptoms.
  • India has reported over 20 crore people with hypertension, out of which only 14.5% of the patients are being treated. Hypertension is easy to diagnose and can be treated with low-cost generic drugs.

India Hypertension Control Initiative (IHCI)

  • India Hypertension Control Initiative was started in 2018.
  • It is a multi-partner initiative involving the Indian Council of Medical Research, WHO-India, Ministry of Health and Family Welfare, and State governments 
  • The main aim of the initiative is to improve blood pressure control for people with hypertension. 
  • It also aims to reduce disability and death related to cardiovascular disease (CVD).

Five scalable strategies of the Initiative

  • It has a simple treatment protocol with three drugs that were selected in consultation with the experts 
  • Strengthening of the supply chain to ensure the availability of adequate antihypertensive drugs.
  • Patient-centric approaches were followed which include refills for a minimum of 30 days and assigning the patients to the closest primary health centres to make follow-up easier.
  • Capacity building approach was followed with the health staff and all the tasks such as BP measurement, documentation, and follow-up were shared among them.
  • Minimal documentation methods were adopted using either paper-based or digital tools to monitor follow-ups and BP control.

Achievements and success of the Initiative

  • The project was started in 26 districts in 2018 and has now (2022) been expanded to over 100 districts.
  • Over 20 lakh individuals were started with the treatment and are monitored regularly.
  • The initiative has shown that hypertension can be treated and controlled with basic health care facilities in various health systems across India.
    • Before IHCI, many patients had to visit higher-level facilities like community district hospitals in the public sector for the treatment of blood pressure.
    • The BP control among patients treated was 48% at primary health centres and 55% at the health wellness centres.
    • The fact that BP control in the primary care facilities was better than compared to hospitals is an encouraging sign.
  • In three years all the strata of health staff at the primary health centres and health wellness centres are trained to provide treatment and follow-up services for hypertension.
  • About 47% of the patients achieved blood pressure control.
  • The availability of medications in the nearby facilities has facilitated the BP control treatment for the patient.

Data-driven approach

  • The data-driven approach is a major contribution to the project.
  • The approach involves the preparation of a list of patients who have not returned for treatment and these individuals were constantly reminded over the phone or through home visits. Also, the programme managers reviewed the data at the district and State levels and assessed the performance of facilities.
  • This approach encouraged a large number of individuals to continue treatment.
  • Considering India’s healthcare system, scaling hypertension treatment is very much feasible also the generic antihypertensive drugs cost only ₹200 per patient per year when scaled.
    • The initiative has utilised India’s network of primary health centres, doctors and staff very efficiently
    • Health and wellness centres set up under the Ayushman Bharat Yojana have been used to train healthcare staff about measuring blood pressure and providing refills for patients.
  • E-Sanjeevani which is a telemedicine platform was also used to provide teleconsultations.

Way forward

  • As the success of the initiative has encouraged many States to implement the strategies of the initiative beyond project districts, there is a need to address a few new challenges that have arisen such as reducing the treatment gaps in many states. 
  • Also since a large number of patients with hypertension are not aware of their high BP, all the healthcare institutions could be mandated to measure BP at the entry point of these centres for people who visit the doctor for any health problem. 
    • This strategy is called opportunistic screening and does not require additional resources.
  • The use of good quality blood pressure monitors is important for accurate BP measurement and these have to be procured and distributed to health facilities.
  • Extending the number of refills provided to 60 days from currently practised 30-day refills can help reduce visits to healthcare centres.
  • The lack of involvement of the private sector has been a cause of concern when such a large number of people are seeking treatment, hence there is a need to extend the facilities and make sure that early detection and treatment of hypertension reduces deaths and disability due to heart attack, stroke, and chronic kidney disease.

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