India’s hypertension control programme is an example for the world

The article has been authored by Dr Tom Frieden, President and CEO of Resolve to Save Lives and senior fellow for global health at the Council on Foreign Relations. Resolve to Save Lives is international technical partner of the India Hypertension Control Initiative.

Hypertension, also known as high blood pressure, kills more than 15 lakh people in India every year, but now India has made a strong start improving care for the life-threatening condition.

India’s approach to hypertension treatment has been so successful that the programme received a 2022 UN Interagency Task Force and the WHO Special Programme on Primary Health Care Award at the UN General Assembly earlier this month.(Pixabay)

India’s approach to hypertension treatment has been so successful that the programme received a 2022 UN Interagency Task Force and the WHO Special Programme on Primary Health Care Award at the UN General Assembly earlier this month. The award recognises India’s “highly impactful, large-scale hypertension intervention within India’s existing primary health care system.” Prime Minister Modi recognised the hard work of frontline health workers resulting in this award in his maan ki baat address.

Hypertension, also known as high blood pressure, is the leading preventable risk factor for heart attacks and strokes. Improving hypertension control has the potential to save more lives than any other adult primary care intervention, is a pathfinder for Universal Health Coverage, and is crucial for achievement of one of the most important Sustainable Development Goal targets: Reduction of the leading cause of premature death by one third by 2030.

This progress is due to the India Hypertension Control Initiative (IHCI), a primary health care intervention launched in November 2017 to help India address hypertension with evidence-based strategies that are proven to work. The IHCI is greatly improving management of hypertension by adapting the World Health Organization’s systematic approach to treating high blood pressure to India’s context.

A crucial reason for success of India’s hypertension control programme has been the network of 150,000 Health and Wellness Centres, an integral part of the government’s Ayushman Bharat Programme, throughout the country. These centres have been shown to be more effective in controlling blood pressure than hospitals and community health centre facilities. The Health and Wellness Centre programme is the most promising development in the Indian health care field that I’ve seen in my nearly three decades of having the honour and privilege of working alongside health workers in India to protect and improve health.

IHCI is currently being implemented in 138 districts of 23 states, with more than 34 lakh people with hypertension receiving treatment at more than 15,000 government health facilities under the programme, with plans for further expansion. About half of those treated under IHCI have blood pressure under control, far higher than the baseline control rate before the programme started.

IHCI’s strategies are readily scalable to cover large populations, from entre states to the entire country. These strategies include: Use of a simple drug-dose-specific standard treatment protocol for all patients, ensuring adequate quantity of quality-assured protocol medications and blood pressure monitors, care that makes the patient the VIP with follow-up and medicine refills convenient in their communities, task-sharing that enables all health staff to provide care appropriate to their training under a doctor’s direction, and a real-time information system to track every patient for follow-up and blood pressure control.

India’s enormous pharmaceutical industry is the world’s leading supplier of generic medicines, including the ones in the IHCI protocols. My organisation, Resolve to Save Lives, partners with more than 30 countries which implement hypertension control programmes; India is one of the very few where medication costs are not a significant barrier for patients or the programme, and in this and other ways, India can be an example and resource for the world.

An important reason for the IHCI’s success has been adoption of the Simple mobile application, a free, open-source digital information system for large-scale hypertension control programmes. Designed entirely in India and also used in Bangladesh, Sri Lanka, and Ethiopia, Simple is fast and easy to use, and has been recognised as a Digital Public Good that streamlines clinical encounters and provides needed data for continuous programme improvement.

Simple takes health care workers an average of 14 seconds to enter follow-up information. A time-and-motion study documented that the Simple app saves nurses nearly 30 minutes every day. Detailed programme reports that took staff more than two hours to produce by hand can be generated with three taps on the screen. This has the potential to facilitate rapid and effective expansion of hypertension treatment programmes and save more lives.

As we mark World Heart Day on September 29, we recognise the progress India is making against this leading killer and the importance of protecting and expanding the programme to prevent disabling and deadly heart attacks and strokes. We congratulate India for serving as an example for the world, showing that it’s possible for any country to provide every person with hypertension with life-saving treatment, every clinician with accurate and timely information, and every programme manager with the information needed to monitor and continuously improve the programme.