A deadly silent epidemic, high blood pressure (BP) or hypertension affects 1 in 4 Indian adults yet only about 12% of them have it under control. Although easy to diagnose and treat, there are multiple barriers to achieving BP control. A recent study has revealed that multi-pronged SMART (Specific, Measurable, Achievable, Relevant and Timely) strategies can work to overcome these challenges. Published in the prestigious Journal of Human Hypertension, this paper finds that India’s hypertension initiative is implementing a highly impactful program. In recognition of its game-changing strategies, IHCI was recently awarded the 2022 UN Interagency Task Force and the WHO Special Programme on Primary Health Care Award at a UN General Assembly side event in New York.
Every year more than 60 lakh people die due to non-communicable diseases (NCDs) in India. Tackling risk factors like uncontrolled hypertension is emerging as a top priority not only to save lives but to also prevent the huge economic burden that ensues from premature deaths and disabilities. To meet the national target of 25% reduction in hypertension prevalence by 2025, an additional 5 crore people will have to be treated. A lot would depend on fast-tracking and running at full capacity the India Hypertension Control Initiative (IHCI), a multi-partner initiative of the Government of India’s Ministry of Health & Family Welfare, Indian Council of Medical Research (ICMR), WHO Country Office for India with technical support from Resolve to Save Lives.
Describing IHCI as a new age high-impact intervention, Dr. Prabhdeep Kaur, co-author of the paper and Scientist and Head of the Division of Noncommunicable Diseases, National Institute of Epidemiology, Indian Council of Medical Research (ICMR) said, “IHCI demonstrated that people living with hypertension can be treated in primary care close to their home and BP control can be achieved. The cost of medications is only Rs 200 per year per person, which makes it easier for the governments to scale hypertension treatment quickly across all districts.” IHCI strategies address obstacles such as poor awareness of people regarding hypertension, low treatment adherence due to people missing their medicines and failing to return for follow-ups, and challenges of medicine availability in the vast network of India’s primary health care. The paper, evaluating early outcomes of IHCI in 26 districts across 5 states of India, has found that with simple treatment protocols and tools for estimating drug requirements, the intervention has managed to overcome one of the toughest challenges in primary health care – establishing a reliable drug supply. At the district level and in the health facilities, all protocol drugs for hypertension treatment were available for more than 30 days, ensuring the uninterrupted availability of monthly drug refills for each patient.
In a country where 50 crore Indians rely on the public health system for their treatment, making hypertension service accessible to all is an important success factor. Travelling long distances to the nearest health centre, incurring extra expense, loss of wages and inability to get a day off from work, are various reasons that lead to poor treatment compliance. In India where 1 in 4 adults are hypertensive, the treatment adherence rate is one of the poorest - about 7 percent of women and 6 percent of men who have been diagnosed with high blood pressure are on regular medication. Although easy to diagnose and treat, patients have to continue taking their blood pressure medicines for their entire lifetime. With decentralization of hypertension treatment under IHCI to the vast network of Ayushman-Bharat Health and Wellness Centres (AB-HWCs), people are finding it easier to access care and continue their treatment. According to the study, overall blood pressure control rates have improved, with several states reporting the highest control rates at HWCs, as compared to higher-level facilities.
Speaking from her experience of working with communities, Dr Kalpana Apte, Director General, Family Planning Association of India (FPAI) points out, “IHCI has succeeded in supporting the public sector clinics and played a noteworthy role in creating awareness and bringing hypertension care at the community level and improving the state of Hypertension control initiative in the public sector clinics which in turn, has helped strengthen the NCD programme in the public health system of India.”
Applauding the early successes demonstrated by IHCI, Dr Sudarsan Mandal, Deputy Director-NCD division, Ministry of Health and Family Welfare, Govt of India said, "IHCI was started in 2017 with the goal of bringing high BP to a normal level for as many hypertensive persons as possible through Ayushman Bharat of National Health Mission (NHM). Demonstrating remarkable outcomes at an early stage, India’s hypertension program won the UN award in September 2022. Having treated 34 lakhs hypertensives till date, IHCI is making a major contribution to NCD care."
In recent months, hypertension has been steadily gaining prominence as a public health priority. Soon after the global recognition for IHCI, the Hon’ble Prime Minister Narendra Modi in Mann Ki Baat, his address to the nation, highlighted IHCI’s achievements and called it a matter of encouragement that “out of those who have been treated, about half of them are having their blood pressure under control.” The paper is a timely analysis of IHCI’s strategies and tools that have shown such a significant impact.