India India Hypertension Control Initiative – a patient-centred approach to control hypertension at the Primary care level
Non-Communicable Diseases (NCDs), particularly cardiovascular diseases (CVDs), are a major contributor to premature mortality worldwide, with hypertension being especially prevalent in India where an estimated one in four adults suffer from the disease, of which only 10 percent have their blood pressure under control. To help India reach its target of a 25 percent reduction in the prevalence of raised blood pressure, the India Hypertension Control Initiative (IHCI) [1] was launched in November 2017, with the Government of India and state governments providing leadership, and the World Health Organization (WHO) India providing technical assistance. The IHCI was implemented in 141 districts across 25 states, covering 303 million people, resulting in 21 579 health facilities providing support for those suffering from hypertension. Over the past four years, 12.5% of India's estimated hypertensive adult population have been enrolled in the IHCI, with a 72% patient retention rate. This has led to the number of patients with controlled blood pressure increasing from 65 240 in the first quarter of 2019 to 777 243 in the first quarter of 2022.
The IHCI was implemented under the strong leadership of the Government of India and state governments, with technical assistance provided by WHO India and funding support from Resolve to Save Lives. The IHCI was guided by WHO HEARTS, a technical package aiming to promote comprehensive cardiovascular health strategies, and focuses on healthy lifestyle habits, evidence-based treatment protocols, access to essential medicines and technology, patient centred care, team care and task-sharing, and systems for monitoring. WHO India, as a member of the national Technical Advisory Group (TAG), directed the steps for efficient IHCI field implementation. WHO India held national and regional workshops to gain support from participating states and placed dedicated IHCI teams in states and districts to provide implementation support.
WHO leads the monthly review and reorientation meeting in a secondary level health facility in Pune Maharashtra, November 2022.
Photo credit : WHO.
The IHCI team conducted a comprehensive baseline assessment of hypertension services at both the state and district levels to develop state-specific protocols for hypertension treatment. IHCI provided technical support to 30 states to develop such treatment protocols and drug management tools, such as forecasting and ready reckoner [1] tools. WHO India developed a training package based on HEARTS for local settings. IHCI dedicated staff (Cardiovascular Health Officers) placed by WHO India were responsible for training nearly 60 000 healthcare professionals, including 7 600 Medical Officers, 8 200 Staff Nurses, 10 500 Paramedics, and 32 000 community workers. This training focused on the diagnosis, treatment, and monitoring of hypertension, as well as drug forecasting, patient tracking, and reporting of facility-based cohorts.
In 2018, the IHCI program was launched in 25 districts across 5 states, deploying 36 Cardiovascular Health Officers and 100 Senior Treatment Supervisors to primary healthcare facilities. This successful implementation resulted in a rapid program expansion to 141 districts across 25 states, providing IHCI services to 303 million people. The programme enabled 21 579 health facilities, 15 270 of which were either peripheral Sub-centres or Health and Wellness Centres, to provide IHCI services. Furthermore, first- and second-line hypertension protocol drugs were streamlined in 19 out of the 25 states, resulting in two months of stock availability at all health facilities, reducing travel times for patients and allowing for patient-centred care.
“The India Hypertension Control Initiative (IHCI) is a highly impactful programme that has the potential to reach those who may otherwise go unserved. Its unique strategies make it key to meeting the country's goal of enrolling 75 million patients by 2025. WHO India will continue to work closely with the Ministry of Health and Family Welfare to ensure the success of IHCI.”
- Dr Roderico H Ofrin, WHO Representative to India
Over the past four years, India's IHCI program has enrolled an impressive 4 million hypertensive patients, representing 12.5 percent of the estimated hypertensive adult population. Moreover, the program has achieved a retention rate of 72% or higher, leading to an increase in the number of patients with their blood pressure under control from 65 240 in the first quarter of 2019 to 777 243 in the first quarter of 2022. This improvement can be attributed to the programme's efficient strategies, such as its simple Treatment Protocol that facilitates easy understanding and implementation by health staff, Decentralized Patient-Centred Care, the use of forecasting and other tools that ensure uninterrupted drug supply, opportunistic screening for early patient detection, rational drug utilization, and a real-time robust information system.
"The strengthening of hypertension and diabetes services at the primary health care level through the India Hypertension Control Initiative has had a positive impact on the national public Health Insurance programme, Ayushman Bharat Yojana. It ensures that high-quality healthcare is available to patients close to their homes. India is committed to reducing the number of people suffering from high blood pressure by 25 percent by the year 2025. In light of the growing burden of Non-Communicable Diseases (NCD) in India, we must mainstream IHCI interventions across the country through our National NCD program"
- Shri Vishal Chauhan, Joint Secretary (NCDs and Policy) Ministry of Health and Family Welfare, Government of India
Despite challenges such as inadequate community awareness, an absence of validated digital Blood Pressure monitors at health facilities, and difficulties in sustaining uninterrupted drug and logistic supply and engaging the private sector, the IHCI has made a substantial impact in reducing the burden of NCDs and improving the health and wellbeing of Indian citizens. As a result, the programme has been incorporated into the National NCD Program and is now being implemented in all districts of the country.
