India Hypertension Control Initiative (IHCI)
Cardiovascular diseases(CVD) are the leading cause of death among adults in India. One of the major drivers of heart attack and stroke is untreated high blood pressure or hypertension.
India registers success with high blood pressure (BP) treatment.
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KEY POINTS-
- IHCI is a multi-partner initiative, which was started in 26 districts in 2018, and by 2022 it is expanded to more than 100 districts.
- India has more than 200 million people with hypertension but only 14.5% of individuals are on treatment.
- Since 2018, more than two million patients have been started on treatment and tracked for BP control.
- The project has demonstrated that blood pressure treatment and control are feasible in PHC settings in the diverse health system.
- Over three years, health staff at PHCs health wellness centres have been trained to provide treatment and follow-up services.
- Nearly half(47%) of the patients under care have achieved control over blood pressure.
- Availability of medications in the peripheral facilities made it easier for the patient to continue treatment and achieve BP control.
- Based on the positive experience, several states have begun expanding the reach of the initiative beyond project districts.
FIVE SCALABLE STRATEGIES-
- A simple treatment protocol with three drugs was selected in consultation with the experts and non-communicable disease programme managers.
- The supply chain was strengthened to ensure the availability of adequate antihypertensive drugs.
- Patient-centric approaches were followed, like refills for at least 30 days and assigning the patients to the closest primary health centre to make follow-up easier.
- The focus was on building the capacity of all health staff and sharing tasks like BP measurement, documentation and follow-up.
- Finally there was minimal documentation using either paper-based or digital tools to track follow-up and BP control.
DATA-DRIVEN APPROACH-
The list of people who did not return for treatment was generated through a digital system by health workers. Patients were reminded either over the phone or by home visit(if feasible). This strategy motivated a large number of patients to continue treatment.
Health wellness centres under Ayushman Bharat Yojna have specially trained nurses to check blood pressure and provide refills for patients initiated on treatment by doctors at the higher health facility.
MAKING PROGRESS
- IHCI has worked for hand in hand with the state health department to strengthen the hypertension component, to control non-communicable diseases
- Several states have started implementing the strategies beyond project districts.
- Many people with hypertension are not aware of their high BP. All health facilities can measure BP at the entry point for people who visit the doctor for any health problem.
- This strategy also known as opportunistic screening, does not require additional resources.
- Extended refills up to 60 days can reduce visits to health facilities.
We must overcome the challenges to ensure early detection and treatment of hypertension to reduce preventable deaths and disability due to heart attack, stroke and chronic kidney disease.
