India Hypertension Control Initiative: a patientcentred approach to control hypertension at the primary care level

Noncommunicable diseases (NCDs), particularly cardiovascular diseases (CVDs), are a major contributor to premature mortality worldwide, with hypertension being especially prevalent in India. An estimated one in four adult Indians suffers from the disease, only 10% of whom have their blood pressure under control 1. To help India reach its target of a 25% reduction in the prevalence of raised blood pressure, the India Hypertension Control Initiative (IHCI) 2 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, and resulted 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.

How did India, with the support of the WHO Secretariat, achieve this?

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 the global health initiative Resolve to Save Lives. It was guided by WHO HEARTS, a technical package aiming to promote comprehensive cardiovascular health strategies, which 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.

The IHCI team conducted a comprehensive baseline assessment of hypertension services at both the state and district levels to develop statespecific protocols for hypertension treatment. The team further provided technical support to 30 states to develop treatment protocols and drug management tools such as forecasting and ready reckoners 2. WHO India developed a training package based on HEARTS technical package for local settings and it was revised in 2022. IHCI dedicated staff (Cardiovascular Health Officers) placed by WHO India were responsible for training nearly 60 000 health care professionals, including 7600 medical officers, 8200 Staff Nurses, 10 500 Paramedics, and 32 000 community workers up until December 2022. 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 programme was launched in 25 districts across five states, deploying 36 cardiovascular health officers and 100 senior treatment supervisors to primary health care facilities. This successful implementation resulted in rapid programme expansion to 141 districts across 25 states, providing IHCI services to 303 million people. Six new states and 40 new districts started IHCI implementation in 2022, with more than 7 500 health facilities added under IHCI in 2022. The programme enabled 21 579 health facilities, 15 270 of which were either peripheral subcentres 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, thereby 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 in India

India’s IHCI programme has enrolled an impressive four million hypertensive patients representing 12.5% of the estimated hypertensive adult population. Out of these, in 2022, 1.8 million patients were enrolled under IHCI. Moreover, the programme 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 a simple treatment protocol that facilitates easy understanding and implementation by health staff, decentralized and patient-centred care, the use of forecasting and other tools to ensure an uninterrupted drug supply, opportunistic screening for early patient detection, rational drug use and a robust, realtime 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 health care 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 noncommunicable 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 supplies and engaging the private sector, the IHCI has made a substantial impact in reducing the burden of NCDs and improving the health and well-being of Indian citizens. As a result, the programme has been incorporated into the National NCD Programme and is now being implemented in all districts of the country.

Knowledge

WHO country stories: delivering for all

“This impact story was published as part of the WHO country stories: delivering for all report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2022-2023.”